Variations in the Severity of Rhinitis Symptoms: A Systematic Review and Meta-Analysis

ObjectiveKey rhinitis symptoms include nasal obstruction, rhinorrhea, sneezing, and nasal itching. Different subtypes of rhinitis can have varying presentations, making it difficult to diagnose and categorize. The objective of this review is to characterize the baseline presentation of rhinitis and highlight differences in the presentation of various subtypes. Data SourcesPubMed (National Library of Medicine), Scopus (Elsevier), and CINAHL (EBSCO). MethodsA literature search was conducted from database inception to August 2024 for articles reporting baseline symptoms for adult patients with rhinitis. Specific questionnaires of interest were the Total Nasal Symptom Score (TNSS) and Visual Analog Scale (VAS) equivalents of the four TNSS items. Rhinitis types included allergic (AR) and nonallergic rhinitis (NAR); allergic rhinitis was further subcategorized by intermittent (IAR) and persistent (PER) symptomatology. Primary outcome measures included proportions (%) and mean difference/proportion difference (Delta) with 95% confidence intervals. ResultsA total of 89 studies (N = 14,448 patients) were included for meta-analysis. Nasal congestion was the most severe symptom (2.03 [95% CI 1.91-2.15]) across all patients. Rhinorrhea was the symptom reported as moderate/severe (score of 2-3) at the highest frequency (93.2%). AR patients had higher total TNSS scores (7.31 vs. 5.22 [95% CI 1.84-1.91]), rhinorrhea and sneezing scores (p < 0.0001) than NAR patients. NAR patients, however, had more severe nasal congestion (2.04 vs. 1.99 [95% CI 0.04-0.05]). PER patients recorded higher total TNSS scores than IAR patients (7.20 vs. 6.85 [95% CI 0.25-0.45]), but IAR patients reported more severe individual symptoms scores for congestion, rhinorrhea, and nasal itching (all p < 0.0001). ConclusionNasal congestion is the most severe symptom at baseline presentation for all subtypes of rhinitis. Allergic status and symptom duration influence both overall disease severity and individual symptom scores.