Condition

Allergic Rhinitis

Hay fever - Allergic reaction causing nasal symptoms

400M
People Affected
60
Active Trials
40M
New Cases/Year
1,500
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Combination Intranasal Corticosteroid + Antihistamine
92% Effectiveness• 85% Confidence• 75% Safety• 4 trials• 15K participants
HIGH EvidenceGood ValueDose: 1 spray per nostril twice daily (e.g., Azelastine/Fluticasone)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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75
DangerousModerateSafe

Time to Effect

15-30 minutes for initial, few days for full effect

Duration

Seasonal or daily as needed

Response Rate

85%

Remission Rate

50%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

5

Common Side Effects:

Bitter taste/dysgeusia: 20%
Nasal irritation/epistaxis: 15%
Headache: 8%
Drowsiness: 3%

Annual Cost of Care

Drug Cost

$900

Monitoring

$25

Side Effects

$20

Total Annual

$945

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$75,000/QALY

Cost per Remission

$1,890

Cost per Responder

$1,111.76

Treatment Outcomes
Primary Outcomes
Total Nasal Symptom Score (TNSS)TNSS score: 9/12
-35% (-3.2 points)
Total Ocular Symptom Score (TOSS)TOSS score: 7/9
-30% (-2.1 points)
Nasal Congestion SeverityCongestion score: 2.5/3
-40% (-1.0 point)
Secondary Benefits
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)RQLQ score: 3.5/6
-25% (-0.9 points)
Patient Global Assessment of Disease SeveritySeverity score: 6/10
-30% (-1.8 points)
Sleep Disturbances (RQLQ domain)Sleep domain score: 3/6
-33% (-1.0 point)
Common Side Effects
Bitter taste/dysgeusia
+20%
Nasal irritation/epistaxis
+15%
Headache
+8%

Clinical Trial Phases:

Phase 4
2
Allergen Immunotherapy (AIT)
90% Effectiveness• 90% Confidence• 60% Safety• 19 trials• 50K participants
HIGH EvidenceGood ValueDose: Allergen-specific, gradually increasing doses
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

3-6 months for initial effect, 1-3 years for maximal benefit

Duration

3-5 years

Response Rate

78%

Remission Rate

40%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

30

Common Side Effects:

Local injection site reactions: 60%
Local oral reactions (SLIT): 40%
Systemic reactions (SCIT): 3%

Annual Cost of Care

Drug Cost

$1,500

Monitoring

$900

Side Effects

$100

Total Annual

$2,500

Cost-Effectiveness

GOOD

QALYs Gained

0.15

ICER

$60,000/QALY

Cost per Remission

$6,250

Cost per Responder

$3,205.13

Treatment Outcomes
Primary Outcomes
Total Nasal Symptom Score (TNSS)Average daily TNSS: 8.5/12
-30% (-2.55 points)
Total Ocular Symptom Score (TOSS)Average daily TOSS: 4.0/6
-28% (-1.12 points)
Medication Score (MS)Average daily MS: 5.0/10
-40% (-2.0 points)
Combined Symptom and Medication Score (CSMS)Average daily CSMS: 13.5/22
-35% (-4.7 points)
Secondary Benefits
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)RQLQ score: 3.5/6
-25% (-0.9 points)
Allergen-specific IgG4500 µg/mL
+400% (+2000 µg/mL)
Nasal Peak Inspiratory Flow (PNIF)90 L/min
+15% (+13.5 L/min)
Common Side Effects
Local injection site reactions
+60%
Local oral reactions (SLIT)
+40%
Systemic reactions (SCIT)
+3%

Clinical Trial Phases:

Phase 4
3
Intranasal Corticosteroids (INCS)
88% Effectiveness• 95% Confidence• 78% Safety• 6 trials• 300K participants
HIGH EvidenceExcellent ValueDose: 1-2 sprays per nostril once daily (e.g., Fluticasone propionate 50 mcg/spray)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
78
DangerousModerateSafe

Time to Effect

Several days to 2 weeks for maximal effect

Duration

Seasonal or perennial (long-term)

Response Rate

75%

Remission Rate

50%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

20

Common Side Effects:

Nasal irritation/dryness: 15%
Epistaxis (nosebleed): 10%
Sore throat: 7%
Headache: 8%

Annual Cost of Care

Drug Cost

$150

Monitoring

$50

Side Effects

$15

Total Annual

$215

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

Cost per Remission

$430

Cost per Responder

$286.67

Treatment Outcomes
Primary Outcomes
Total Nasal Symptom Score (TNSS)8.5/12 points (sum of 4 symptoms, 0-3 scale each)
-40% (-3.4 points)
Nasal Congestion Score2.5/3 points (0-3 scale)
-40% (-1.0 point)
Rhinorrhea (Runny Nose) Score2.2/3 points (0-3 scale)
-35% (-0.8 points)
Overall Allergic Rhinitis Severity (VAS)65 mm (0-100mm Visual Analog Scale)
-35% (-23 mm)
Secondary Benefits
Total Ocular Symptom Score (TOSS)5.0/9 points (sum of 3 symptoms, 0-3 scale each)
-25% (-1.3 points)
Rhinitis Quality of Life Questionnaire (RQLQ) Score3.5/6 points (average score, lower is better)
-30% (-1.1 points)
Sleep Disturbance Score2.0/3 points (0-3 scale for sleep-related issues)
-30% (-0.6 points)
Common Side Effects
Nasal irritation/dryness
+15%
Epistaxis (nosebleed)
+10%
Sore throat
+7%

Clinical Trial Phases:

Phase 4
4
Intranasal Antihistamines (e.g., Azelastine)
80% Effectiveness• 88% Confidence• 77% Safety• 100 trials• 10K participants
HIGH EvidenceGood ValueDose: 1-2 sprays per nostril twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Tylenol💊
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Water💧
77
DangerousModerateSafe

Time to Effect

15-30 minutes

Duration

Seasonal or daily as needed

Response Rate

72%

Remission Rate

30%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

8

Common Side Effects:

Bitter taste/dysgeusia: 15%
Nasal irritation/bleeding: 7%
Headache: 8%
Drowsiness: 3%

Annual Cost of Care

Drug Cost

$360

Monitoring

$25

Side Effects

$10

Total Annual

$395

Cost-Effectiveness

GOOD

QALYs Gained

0.07

Cost per Remission

$1,316.67

Cost per Responder

$548.61

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+72%
Remission Rate
+30%
Common Side Effects
Bitter taste/dysgeusia
+15%
Nasal irritation/bleeding
+7%
Headache
+8%

Clinical Trial Phases:

Phase 4
5
Oral H1 Antihistamines (2nd Generation)
75% Effectiveness• 90% Confidence• 82% Safety• 1 trials• 80K participants
HIGH EvidenceExcellent ValueDose: 10mg once daily (e.g., Cetirizine, Loratadine)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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82
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

Seasonal or daily as needed

Response Rate

68%

Remission Rate

15%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

15

Common Side Effects:

Drowsiness: 7%
Dry mouth: 3%
Headache: 7%

Annual Cost of Care

Drug Cost

$150

Monitoring

$600

Side Effects

$5

Total Annual

$755

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

Cost per Remission

$1,033.33

Cost per Responder

$227.94

Treatment Outcomes
Primary Outcomes
Total Nasal Symptom Score (TNSS)8/12 (sum of 4 nasal symptoms, each 0-3)
-40% (-3.2 points)
Total Ocular Symptom Score (TOSS)5/9 (sum of 3 ocular symptoms, each 0-3)
-45% (-2.25 points)
Reflective Total Symptom Score (rTSS)11/18 (sum of 6 nasal and ocular symptoms, each 0-3)
-38% (-4.18 points)
Patient Global Assessment of Disease Severity (PGADS)7/10 (0=no symptoms, 10=worst possible)
-30% (-2.1 points)
Secondary Benefits
Rhinitis Quality of Life Questionnaire (RQLQ) Mean Score3.5/7 (higher score = worse QoL)
-28% (-0.98 points)
Sleep Disturbance Score (from RQLQ)2.2/6 (higher score = worse sleep)
-35% (-0.77 points)
Daily Activity Impairment Score (from RQLQ)1.8/6 (higher score = more impairment)
-30% (-0.54 points)
Common Side Effects
Drowsiness
+7%
Dry mouth
+3%
Headache
+7%

Clinical Trial Phases:

Phase 4
6
Leukotriene Receptor Antagonists (LTRAs)
65% Effectiveness• 85% Confidence• 55% Safety• 200 trials• 30K participants
MODERATE EvidenceModerate ValueDose: 10mg once daily (e.g., Montelukast)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
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Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Seasonal or daily as needed

Response Rate

50%

Remission Rate

7%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

2000

Common Side Effects:

Headache: 12%
Gastrointestinal upset: 7%
Neuropsychiatric events: 0.5%

Annual Cost of Care

Drug Cost

$180

Monitoring

$25

Side Effects

$10

Total Annual

$215

Cost-Effectiveness

MODERATE

QALYs Gained

0.02

Cost per Remission

$3,071.43

Cost per Responder

$430

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+65%
Response Rate
+50%
Remission Rate
+7%
Common Side Effects
Headache
+12%
Gastrointestinal upset
+7%
Neuropsychiatric events
+0.5%

Clinical Trial Phases:

Phase 4