Pharmacist Education Eases Allergic Rhinitis Symptoms but Can’t Replace Care

A new study has shown that a pharmacist-led education intervention significantly improves symptoms of allergic rhinitis, but it cannot replace standard care.1

“…no significant differences were observed for coprimary outcomes, including knowledge levels, medication adherence, or QOL,” wrote the team, led by Chii-Chii Chew, MSc, from the Clinical Research Centre at the Hospital Raja Permaisuri Bainun, Institute for Clinical Research, National Institute of Health, in Malaysia.1

Allergic rhinitis, affecting approximately 10% to 30% of the adult global population, impacts quality of life, work productivity, and academic performance. This allergic disease generates high health costs due to frequent medical visits, whether that be for visits and procedures, endoscopy, immunotherapy, or allergy testing. A 2020 study reported that the annual mean cost per patient for allergic rhinitis clinic visits and procedures was $282.2

Research has shown the important role pharmacists play in allergic rhinitis management through patient education and pharmacological recommendations. Pharmacists can help improve symptom control and quality of life. Still, pharmacists are often underused in allergic rhinitis management.1

Community pharmacies in the private sector have established allergic rhinitis management protocols under Allergic Rhinitis and its Impact on Asthma (ARIAA) pharmacy guidelines. However, public, government-funded pharmacies lack standardized allergic rhinitis protocols.

Investigators aimed to see whether a pharmacist-led education intervention in a public health care institution was more effective than standard care for managing allergic rhinitis in adults. Chew and colleagues conducted a parallel-group, open-label randomized clinical trial in the otorhinolaryngology clinic of a government-funded tertiary referral hospital in northern Malaysia from June 1, 2023 (enrollment start) to August 6, 2024 (end of follow-up).

The primary outcomes were between-group differences in knowledge level at day 180, symptom control (Total Nasal Symptom Score) for the past 12 hours and past 2 weeks, medication adherence (number of days of intranasal corticosteroid use), and quality of life (European Quality of Life 5-Dimmension 5- Level Instrument and European Quality of Life Visual Analog Scale. Investigators assessed these measures at days 60, 120, and 180.

The sample included 154 Malaysian patients aged 18 – 80 years (mean age, 46.5 years; 63% women) who had an allergic rhinitis diagnosis. Ethnicities included Malay (52.6%), Chinese (28.6%), Indian (17.5%), and other (1.3%). Less than half (48.7%) had tertiary education, and 46.8% were unemployed, retired, or students. Most (73.2%) worked < 45 hours a week.1

Moreover, 51.9% and 72.7% of participants reported food allergies or an allergy to other allergens, respectively. A total of 44.8% had a family history of allergy predisposition, and 19.5% had comorbid asthma. Most took mometasone furoate (82.5%) for allergic rhinitis, followed by fluticasone furoate (15.6%) and budesonide (1.9%).1

Participants were randomized 1:1 to the pharmacist-led education intervention (AR-PRISE), consisting of an 8-minute educational video on allergic rhinitis and structured pharmacist counseling, and a placebo.

The intention-to-treat analysis showed that the intervention group brought statistically significant improvements in Total Nasal Symptom Score for the past 2 weeks compared with controls (estimate, 0.14; 95% credible interval [CrI], 0.03 to 0.25). Investigators also observed significant reductions in the Total Nasal Symptom Score at day 60 (estimate, 0.18; 95% Crl, 0.08 – 0.08), day 120 (estimate, 0.21; 95% Crl, 0.11 – 0.31), and day 180 (estimate, 0.11; 95% Crl, 0.01 – 0.21). The study found no significant group differences for knowledge level, Total Nasal Symptom Score for the past 12 hours, medication adherence, and quality of life.1

“…the lack of statistically significant differences in knowledge, despite symptom reduction, suggests additional strategies are needed for behavioral change,” investigators wrote. “One possible explanation is the narrow focus of the knowledge questionnaire, which assessed only INCS-related knowledge. Future studies could adopt broader measures to capture the full spectrum of knowledge gained from educational interventions.”1

References

1. Chew CC, Lim XJ, Letchumanan P, Rajan P, Chong CP. Pharmacist-Led Education Intervention for Adults With Allergic Rhinitis: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(7):e2517160. Published 2025 Jul 1. doi:10.1001/jamanetworkopen.2025.17160

2. Roland LT, Wise SK, Wang H, Zhang P, Mehta C, Levy JM. The cost of rhinitis in the United States: a national insurance claims analysis. Int Forum Allergy Rhinol. 2021 May;11(5):946-948. doi: 10.1002/alr.22748. Epub 2020 Dec 10. PMID: 33300670; PMCID: PMC8062294.