Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC)

Ludger Klimek, Karl-Christian Bergmann, Tilo Biedermann, Jean Bousquet, Peter Hellings, Kirsten Jung, Hans Merk, Heidi Olze, Wolfgang Schlenter, Philippe Stock, Johannes Ring, Martin Wagenmann, Wolfgang Wehrmann, Ralph Mösges, Oliver Pfaar, Ludger Klimek, Karl-Christian Bergmann, Tilo Biedermann, Jean Bousquet, Peter Hellings, Kirsten Jung, Hans Merk, Heidi Olze, Wolfgang Schlenter, Philippe Stock, Johannes Ring, Martin Wagenmann, Wolfgang Wehrmann, Ralph Mösges, Oliver Pfaar

Abstract

Backround: Visual analogue scales (VAS) are psychometric measuring instruments designed to document the characteristics of disease-related symptom severity in individual patients and use this to achieve a rapid (statistically measurable and reproducible) classification of symptom severity and disease control. VAS can also be used in routine patient history taking and to monitor the course of a chronic disease such as allergic rhinitis (AR). More specifically, the VAS has been used to assess effectiveness of AR therapy in real life, both in intermittent and persistent disease.

Methods: This position paper takes a detailed look at the historical development of VAS and its method-specific principles. Particular focus is put on aspects of practical application in daily routine and on a critical discussion of the advantages and disadvantages of the individual methods.

Results: VAS are well validated for the measurement of AR symptoms and correlate well with the ARIA (allergic rhinitis and its impact on asthma) severity classification and also correlated well with rTNSS and RQLQ. Moreover, several treatment studies on AR have used VAS as an evaluation parameter. Thanks to the use of new (real-life and real-time) communication technologies, such as smartphone apps, Discussion: VAS can be used relatively simply and highly effectively to assess disease control. The VAS lends itself very well to digitization and has now been incorporated into a smartphone app (called Allergy Diary) to assess AR control and direct treatment decisions as part of an AR clinical decision support system (CDSS). MASK Rhinitis has developed this app, which is currently available in 15 different languages.

Keywords: Allergic rhinitis; Treatment monitoring; Visual analogue scales.

Conflict of interest statement

L. Klimek has received research funds and/or given lectures on behalf of ALK-Abelló, Allergopharma, Bionorica, Biomay, Austria, Boehringer Ingelheim, Circassia, Stallergenes, HAL, Allergie-Therapeutika/Bencard, Hartington, Lofarma, MEDA, MSD, Novartis, Leti, ROXALL, GlaxoSmithKline (GSK), Cytos, Curalogisch. He also provides consultancy services to Allergy Therapeutics/Bencard, HAL (the Netherlands), MEDA, and Boehringer Ingelheim. K.-C. Bergmann has served as speaker for ALK-Abelló, Denmark; Stallergenes, France; HAL, the Netherlands; Allergy Therapeutics/Bencard, Great Britain/Germany; Novartis, Switzerland, Leti, Spain; ROXALL, Germany and as consultant for Mobile Chamber Experts GmbH, Germany. T. Biedermann gave advice to or got a honorarium for talks or research grant from the following companies: Alk-Abelló, Astellas, Bencard, Biogen, Janssen, Leo, Meda, MSD, Novartis, Phadia, Thermo Fisher. J. Bousquet has received honoraria for: Scientific and advisory boards—Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach. Lectures during meetings—Almirall, AstraZeneca, Chiesi, GSK, Meda, Menarini, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach. K. Jung has served on THW speakers bureau for ALKAbello, Denmark and MEDA, Germany. She is consultant for MEDA, Germany. H. Merk has received research grants from RIFM (USA). He is a consultant for Johnson & Johnson (Germany), IDEA (Europe), MEDA (Germany). P. Stock is a consultant for MEDA (Germany), ALK-Abello (Denmark), Stallergenes-Greer (Germany), Novartis (Germany). J. Ring has been consultant in advisory boards for ALK-Abello, Bencard Allergy Therapeutics, Astellas, Allmirall-Hermal, Galderma, Meda, Novartis, ThermoFisher. M. Wagenmann (MW) has received research grants and/or has served on the speaker’s bureau for these companies: ALK-Abelló, Germany; Allakos, USA; Allergopharma, Germany; Allergy Therapeutics/Bencard, Germany; HAL, Germany; MEDA, Germany. He served as a consultant for ALK-Abelló, Germany; Allergy Therapeutics/Bencard, Great Britain/Germany; Bionorica, Germany; HAL, Germany; MEDA, Germany, Stallergenes, Germany. W. Wehrmann is a consultant for Allergy Therapeutics/Bencard, Great Britain/Germany, MEDA (Germany). R. Mösges reports personal fees from ALK, grants from ASIT biotech, personal fees from allergopharma, personal fees from Allergy Therapeutics, grants and personal fees from Bencard, grants from Leti, grants, personal fees and non-financial support from Lofarma, non-financial support from Roxall, grants and personal fees from Stallergenes, grants from Optima, personal fees from Friulchem, personal fees from Hexal, personal fees from Servier, personal fees from Klosterfrau, non-financial support from Atmos, personal fees from Bayer, non-financial support from Bionorica, personal fees from FAES, personal fees from GSK, personal fees from MSD, personal fees from Johnson&Johnson, personal fees from Meda, personal fees and non-financial support from Novartis, non-financial support from Otonomy, personal fees from Stada, personal fees from UCB, non-financial support from Ferrero, grants from BitopAG, grants from Hulka, personal fees from Nuvo, grants from Ursapharm, outside the submitted work. O. Pfaar has received research grants for his institution and/or personal fees for lecturing and/or educational material and/or consultancy and/or coordinating investigator services and/or travelling for the last 3 years from ALK-Abello, Allergopharma, Stallergenes, HAL Allergy, Allergy Therapeutics, Bencard, Lofarma, Novartis, Leti, Biomay, MEDA, Nuvo, Circassia, Anergis, Biotech Tools s. a., Sanofi, Mobile Chamber Experts (a GA2LEN Partner) and Pohl-Boskamp. He is the current chairman of the Immunotherapy Interest Group (IT IG) of the European Academy of Allergy and Clinical Immunology (EAACI), extended board member of the German Society for Allergology and Clinical Immunology (DGAKI), the secretary of the ENT section of DGAKI and chairman or member of different guideline-/task force initiatives of EAACI and DGAKI. P. Hellings, H. Olze, and W. Schlenter declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Practical application of visual analogue scales (VAS) in the MACVIA-ARIA app. (Users have to answer to the question indicated. When the user touches the indicated line, a marker bar appears. The marker bar can be moved backwards and forwards with a finger and placed at the appropriate point. Once the appropriate point on the line has been found, the user presses “Next” in order to proceed to the next VAS. Each VAS needs to be completed once daily)

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