PROSPECTIVE symptom recording identified substantial recall bias in seasonal allergic rhinitis (SAR) classification and enabled distinct severity groups to be identified using electronic symptom diary (e-Diary) data. The findings suggest that prospective patient-reported symptoms could support more precise assessment and management of SAR.
The multicentre observational study included 815 children and adults with SAR across nine study centres in Mediterranean countries. Participants recorded daily organ-specific symptoms using the Rhinoconjunctivitis Total Symptom Score (RTSS), alongside overall symptoms using a visual analogue scale (VAS) and quality-of-life measures through an e-Diary app.
Retrospective clinical questionnaires were completed at the beginning and end of the pollen season. Researchers then compared prospective symptom recordings with retrospective classification based on the Allergic Rhinitis and its Impact on Asthma (ARIA) framework.
The comparison demonstrated substantial differences between retrospectively reported and prospectively recorded symptoms. Among patients with available data, 56/164 (34.1%) retrospectively overestimated symptom frequency, while 173/366 (47.3%) underestimated it.
A moderate correlation was observed between SAR severity reported at the end of the pollen season and severity recorded prospectively. These findings indicated that retrospective assessment did not consistently reflect the frequency or severity of symptoms experienced during the season.
The researchers subsequently used unsupervised clustering around medoids to classify patients according to their prospective patient-reported data.
The clustering analysis identified distinct mild, moderate, and severe SAR groups. Classification incorporated the prospective severity of organ-specific symptoms measured by RTSS, overall symptoms assessed using VAS, and quality-of-life measures.
The findings suggest that prospective e-Diary recording may provide a more consistent representation of symptom burden than retrospective recall alone. A prospective SAR classification inspired by the existing ARIA approach could therefore enable more precise evaluation of individual patients.
For clinical practice, the approach may support improved characterisation of disease severity and inform more tailored SAR management. Further application of prospective patient-reported data could help address the recall bias identified in conventional retrospective classification.
Reference
Dramburg S et al. Classification of seasonal allergic rhinitis patients by prospective patient-recorded symptoms: The @IT.2020 Project. Allergy.2026;DOI:10.1111/all.70447.
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