Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: Case-control study
Open accessAbstract
Background Seasonal allergic rhinitis is common globally, and symptoms have been shown to impair learning ability in children in laboratory conditions. Critical examinations in children are often held in the summer during the peak grass pollen season.Objective To investigate whether seasonal allergic rhinitis adversely impacts examination performance in United Kingdom teenagers.Methods Case-control analysis of 1,834 students (age 15-17 years; 50% girls) sitting for national examinations. Cases were those who dropped 1 or more grades in any of 3 core subjects (mathematics, English, and science) between practice (winter) and final (summer) examinations; controls were those whose grades were either unchanged or improved. Associations between allergic rhinitis symptoms, clinician-diagnosed allergic rhinitis, and allergic rhinitis-related medication use, recorded on examination days immediately before the examination, were assessed using multilevel regression models.Results Between 38% and 43% of students reported symptoms of seasonal allergic rhinitis on any 1 of the examination days. There were 662 cases (36% of students) and 1,172 controls. After adjustment, cases were significantly more likely than controls to have had allergic rhinitis symptoms during the examination period (odds ratio [OR], 1.4; 95% CI, 1.1-1.8; P = .002), to have taken any allergic rhinitis medication (OR, 1.4; 95% CI, 1.1-1.7; P = .01), or to have taken sedating antihistamines (OR, 1.7; 95% CI, 1.1-2.8; P = .03).Conclusion Current symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations.Clinical implications This is the first time the relationship between symptomatic allergic rhinitis and poor examination performance has been demonstrated, which has significant implications for clinical practice.
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The indirect costs of allergic rhinitis, such as absenteeism and presenteeism, are significant and make up the majority of the cost burden of allergic rhinitis.
“The indirect costs of AR, such as absenteeism and presenteeism, are also significant and actually make up the majority of the cost burden of AR.767,768”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [768]
The Discussion (page not available in our copy) mentions lost school days and increasing direct and indirect costs of allergic rhinitis, supporting the existence of indirect costs. It does not say that absenteeism and presenteeism account for a majority of the cost burden or provide a breakdown of those costs. (LLM, conf=0.87)
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References 20 · Cited by 431
Research works printed but not linked: 4
- Vuurman EPF, van Veggel LMA, Uiterwijk MMC, Leutner D, O'Han- lon JF. Seasonal allergic rhinitis and anti-histamine effects on childrens' learning. Ann Allergy 1993;71:121-6.
- European Parliament. Official journal L 121, 01/05/2001
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- Authors
- Walker, S., Khan-Wasti, S., Fletcher, M., Cullinan, P., Harris, J., & Sheikh, A.
- Affiliations
- University of Edinburgh (GB)
- Imperial College London (GB)
- Corresponding author
- Walker, Samantha
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 120
- Issue
- 2
- Pages
- 381-387
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2073254034
- Cited by
- 431
- References
- 20
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 24 · 2023: 13 · 2022: 12 · 2021: 21 · 2020: 23 · 2019: 17 · 2018: 23 · 2017: 27 · 2016: 28 · 2015: 28 · 2014: 24 · 2013: 22 · 2012: 35
- FWCI
- 19.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Schering-Plough
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Keywords
- allergic rhinitis, exam performance, academic performance, adolescents, sedating antihistamines, learning disabilities
- MeSH terms
- Adolescent, Educational Measurement, Female, United Kingdom, Rhinitis, Allergic, Seasonal, Histamine H1 Antagonists, Humans, Hypnotics and Sedatives, Male, Surveys and Questionnaires, Regression Analysis, Task Performance and Analysis, Case-Control Studies, Anti-Allergic Agents
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