Validation of an Allergic Rhinitis Instrument That Synergizes With the Sino‐Nasal Outcome Test

BACKGROUND: Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) frequently co-occur with shared symptomatology, such that evaluating both entities concurrently yet discretely is of help. Previously validated options, however, may require more than 45 questions and introduce redundant content at each administration. We thus assessed whether a novel AR-specific instrument, which has synergy with the Sino-Nasal Outcome Test (SNOT-22/26/29) used in CRS, is valid for research and clinical care. METHODS: Patients who prospectively completed the proposed AR-specific and SNOT instrument variations, the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), and a general health assessment were included. Factor analysis was performed on 3566 consecutive responses, and 598 patients had allergy testing. Discriminant validity was assessed among patients with positive and negative allergy test results. Convergent validity was assessed using the MiniRQLQ and general health scores. Intra-rater reliability and responsiveness to change were quantified. RESULTS: The AR-specific test supported concurrent yet discrete evaluation of AR and CRS with 26 questions (instead of 46 from SNOT-22+MiniRQLQ) and no repetition (SNOT22+RCAT/RQLQ repeat query content, e.g., patients asked about sneezing twice). The AR instrument discriminated between patients with positive or negative allergy tests (difference in means 1.22 [95% CI: 0.36-2.09]). Convergence with MiniRQLQ (Spearman's rho: 0.346-0.736) and PROMIS (Spearman's rho: -0.118 to -0.264) was observed. Intra-rater reliability (Cohen kappa: 0.802-0.829; Spearman's rho: 0.918-0.935) and responsiveness to change (difference in means -0.28 [95% CI: -0.52 to -0.05]) were demonstrated. CONCLUSIONS: This synergistic approach offers a novel, concise, efficient, and validated method to assess AR and CRS concurrently yet discretely. KEY POINTS: This allergic rhinitis instrument offers a novel, concise, efficient, and validated method to assess AR and chronic rhinosinusitis (CRS) discretely yet concurrently with the Sino-Nasal Outcome Test, while reducing redundancy and response burden. The allergic rhinitis-specific items demonstrate internal consistency, discriminant and convergent validity, strong intra-rater reliability, and responsiveness to clinical change. Five-, six-, and seven-item versions can function as AR-specific assessments that can be used independently or alongside other Sino-Nasal Outcome Test domains.