***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess quality of life and cost-effectiveness of additional acupuncture treatment for allergic rhinitis , patients were r and omly allocated to 2 groups ; both received usual care , but one group received an additional 10 acupuncture sessions .  Quality of life ( according to the SF-36 Health Survey ) , and direct and indirect costs , were assessed at baseline and after 3 months , and the incremental cost-effectiveness ratio of acupuncture treatment was calculated . This German study ( December 2000-June 2004 ) involved 981 patients ( 64 % women , mean age 40.9 years ( st and ard deviation , 11.2 ) ; 36 % men , mean age 43.2 years ( st and ard deviation , 13.0 ) ) . At 3 months , quality of life was higher in the acupuncture group than in the control group ( mean Physical Component Score 51.99 ( st and ard error ( SE ) , 0.33 ) vs. 48.25 ( SE , 0.33 ) , P < 0.001 ; mean Mental Component Score 48.55 ( SE , 0.42 ) vs. 45.35 ( SE , 0.42 ) , respectively , P < 0.001 ) . Overall costs in the acupuncture group were significantly higher than those in the control group ( Euro ( euro ; 1 euro = US $ 1.27 ) 763 , 95 % confidence interval : 683 , 844 vs. 332 euro , 95 % confidence interval : 252 , 412 ; mean difference 432 euro , 95 % confidence interval : 318 , 545 ) . The incremental cost-effectiveness ratio was 17,377 euro per quality -adjusted life year ( women , 10,155 euro ; men , 44,871 euro ) and was robust in sensitivity analyses . Acupuncture , supplementary to routine care , was beneficial and , according to international benchmarks , cost-effective . However , because of the study design , it remains unclear whether the effects are acupuncture specific Asthma and rhinitis are common chronic conditions that affect adults of working age . Little is known about their relative impacts on work loss and decreased productivity . Using r and om digit telephone dialing , we carried out a population -survey of adults in Northern California aged 18 - 50 years . We interviewed 125 persons with asthma ( with or without concomitant rhinitis ) and 175 persons with rhinitis alone . Study eligibility was based on subject report of a physician 's diagnosis of asthma and /or a rhinitis-related condition .  Any adult labor force participation since condition onset was lower among those with asthma ( 88 % ) than among those with rhinitis alone ( 97 % ) ( P = 0.002 ) . In contrast , among those still employed , decreased job effectiveness was more frequently reported in the rhinitis group ( 43 of 121 ; 36 % ) compared to those with asthma ( 14 of 72 ; 19 % ) ( P = 0.02 ) . Condition-attributed lost work was common in both groups , with more than 20 % reporting one or more complete or partial work days lost in the 4 weeks previous to interview . Taking into account age , gender , race , and smoking status , those with asthma were more likely to have no labor force participation after diagnosis ( OR = 3.0 ; 95 % CI 1.1 - 7.7 ) and less likely to report decreased job effectiveness among those remaining employed ( OR = 0.4 ; 95 % CI 0.2 - 0.9 ) . Excluding subjects from the rhinitis group most likely to have unreported asthma based on past medication use had little impact on these associations . Both asthma and rhinitis negatively affect work productivity . Those with asthma are less likely to be employed at all , while among those remaining on the job , rhinitis is a more potent cause of decreased work effectiveness . The economic impact of asthma and rhinitis and related conditions may be under-appreciated Background : Environmental control has been put forward as an integral part of the management of house dust mite ( HDM ) allergy in sensitized patients . To vali date this statement allergic disorders involved in HDM allergy – allergic asthma , rhinitis and atopic eczema/dermatitis syndrome ( AEDS ) – should be taken together and studied in terms of the efficacy of environmental control . Because a generic quality of life question naire exceeds the border of disease , this may be used as major outcome parameter Background Modification of allergens by glutaraldehyde in extracts used for immunotherapy reduces the risk for side effects , but therapeutic efficacy of such extracts requires further evaluation . The aim of this study was to evaluate the efficacy and safety of immunotherapy with PURETHAL Mites ( PM ) , a single-strength glutaraldehyde-modified aluminum hydroxide – adsorbed extract of house-dust mites ( HDM ) . Methods In a multicenter , r and omized , placebo-controlled double-blind setting , HDM-allergic subjects ( n = 140 ) were treated with modified allergen extract or placebo over a 1-year period . The primary outcome parameter was a combined symptom and medication score ( clinical index score [ CIS ] ) . Secondary efficacy parameters were the result of a titrated conjunctival provocation test ( CPT ) , rhinitis/rhinoconjunctivitis quality of life ( RQL ) score , and serum concentrations of IgE and IgG against specific HDM allergens and a documentation of adverse events ( AE ) . Results We evaluated 140 patients ( 66 treatment and 74 placebo ) for clinical efficacy . The allergoid treatment for 1 year result ed in significantly greater CIS improvement and higher RQL scores . The response threshold in the titrated CPT ( p = 0.009 ) and the serum concentrations of IgG4 ( p < 0.001 ) against Dermatophagoides pteronyssinus allergens after treatment were also significantly different between groups . In total , 88 patients ( 46 PM/42 placebo ) out of a safety population of 145 reported 278 ( 158 PM/120 placebo ) AE . Except for local reactions , no specific AE appeared to be associated with PURETHAL Mites ( HAL-Allergy , Leiden , The Netherl and s ) . Conclusion The findings of this study indicate that allergen injection therapy with modified HDM extract is superior to placebo in allergic rhinitis therapy . The treatment was well tolerated and no serious drug-related AE were observed The effect of cetirizine on quality of life ( QOL ) in subjects with perennial allergic rhinitis ( PAR ) has been previously evaluated using generic instruments . While generic QOL tools are used across various conditions , disease-specific instruments evaluate the impact of treatment on areas that are affected by that particular condition . This study evaluated the effect of cetirizine on symptom severity and health-related QOL , using a disease-specific instrument , in adults with PAR . This r and omized , double-blind , placebo-controlled study was conducted at 15 U.S. centers outside the pollen allergy season . After a 1-week placebo run-in period , qualified subjects aged 18 - 65 years with PAR were r and omized to once-daily cetirizine 10 mg ( n = 158 ) or placebo ( n = 163 ) for 4 weeks . Change from baseline in total symptom severity complex ( TSSC ) and overall Rhinitis Quality of Life Question naire ( RQLQ ) scores were primary efficacy end points . Cetirizine produced significantly greater improvements in mean TSSC for each treatment week ( p < 0.05 ) and for the entire 4-week treatment period ( p = 0.005 ) compared with placebo . After 4 weeks , cetirizine-treated subjects reported significantly greater overall improvement in RQLQ scores compared with placebo-treated subjects ( p = 0.004 ) . After 1 week , cetirizine produced significant improvements in the nasal symptoms , practical problems , and activities RQLQ domain scores compared with placebo ( p < 0.05 ) . After 4 weeks , cetirizine-treated subjects reported significant reductions in these RQLQ domain scores and in emotion domain scores compared with placebo-treated subjects ( p < 0.05 ) . Cetirizine 10 mg daily produced significant improvements in symptom severity and allergic rhinitis-related QOL compared with placebo in adults with PAR Objective To assess the efficacy of enzyme potentiated desensitisation in the treatment of severe summer hay fever poorly controlled by pharmacotherapy . Design Double blind r and omised placebo controlled parallel group study . Setting Hospital in Hampshire . Participants 183 participants aged between 18 and 64 with a history of severe summer hay fever for at least two years ; all were skin prick test positive to timothy grass pollen . 90 r and omised to active treatment ; 93 r and omised to placebo . Interventions Active treatment : two injections of enzyme potentiated desensitisation , given between eight and 11 weeks apart , each comprising 200 Fishman units of β glucuronidase , 50 pg 1,3-cyclohexanediol , 50 ng protamine sulphate , and a mixed inhaled allergen extract ( pollen mixes for trees , grasses , and weeds ; allergenic fungal spores ; cat and dog d and ers ; dust and storage mites ) in a total volume of 0.05 ml of buffered saline . Placebo : two injections of 0.05 ml buffered saline solution . Main outcome measures Proportion of problem-free days ; global rhinoconjunctivitis quality of life scores assessed weekly during pollen season . Results The active treatment group and the placebo group did not differ in the proportion of problem-free days , quality of life scores , symptom severity scores , change in quantitative skin prick provocation threshold , or change in conjunctival provocation threshold . No clinical ly significant adverse reactions occurred . Conclusions Enzyme potentiated desensitisation showed no treatment effect in this study Background Allergic Rhinitis is an inflammatory disease which is characterised by burdensome nasal and /or ocular symptoms . This study aim ed to assess the impact of symptoms ( number of symptom-free days ( SFD ) and Quality of Life ( QoL ) ) in patients with Seasonal Allergic Rhinitis ( SAR ) being treated with fluticasone furoate ( FF ) , mometasone furoate ( MF ) or fluticasone propionate ( FP ) . Methods In a cross-sectional , non-interventional , cohort analysis , primary care physicians and allergy specialists in France , Germany , and Spain were recruited via telephone interviews . Each physician prospect ively recruited 4 SAR patients - 2 receiving FF , 1 receiving MF and 1 receiving FP - during June 2009 . Patients answered questions on symptoms and completed question naires on QoL ( mini-rhinoconjunctivitis Quality of Life Question naire , RQLQ ) and burden of illness ( Pittsburgh Sleep Quality Index ) . Results A total of 540 patients were recruited during June 2009 . 88 patients were subsequently found to be ineligible and excluded from the analyses . In the 4 weeks prior to assessment , patients reported a mean of 14.58 ( ±8.42 ) SFD . Patients receiving FF had more SFD ( mean 15.45 ±8.29 ) than patients receiving MF ( adjusted mean difference -1.22 , 95 % Confidence Interval ( CI ) [ -3.16 to 0.72 ] , p=0.434 ) or FP ( adjusted mean difference -1.95 , 95 % CI [ -3.87 to -0.03 ] , p=0.092 ) , although statistical significance was not achieved . The mean RQLQ score was 1.54 ( ±1.06 ) . Patients receiving FF had a better quality of life in the previous week ( mini-RQLQ score : mean 1.42 , ±1.04 ) than patients receiving MF ( adjusted mean difference 0.28 , 95 % CI [ 0.03 to 0.52 ] , p=0.052 ) or FP ( adjusted mean difference 0.18 , 95 % CI [ -0.05 to 0.41 ] , p=0.244 ) . Again , none of these results achieved statistical significance . Conclusions At the height of the allergy season , patients with SAR suffer symptoms approximately 50 % of the time , and report an impact on their QoL. No significant differences were observed between FF , FP and MF related to SFD or QoL.Trial registration Clinical Trials.gov identifier : Background One fourth of the adult population in Europe suffer from respiratory allergy . Subcutaneous-allergen-specific-immunotherapy ( SCIT ) has long-term disease modifying effect on disease specific Health-Related Quality of Life ( HRQoL ) . The purpose of this study was to assess the effect of SCIT on alternative disease outcomes in patients with grass-pollen and /or house dust mite induced allergic rhino-conjunctivitis and /or an asthma diagnosis . Focus was on expressing outcomes in terms of generic quality of life ( Quality -Adjusted-Life-Years ( QALY ) ) and reductions in sick days . Methods The study was a multi-centre study with prospect i ve follow-up . 248 patients were initiated on SCIT .  The disease specific Rhino-conjunctivitis Quality of Life Question naire ( RQLQ ) and two generic ( HRQoL ) instruments 15D and EQ-5D were used at baseline and at follow-up . The outcome measures included change in ; disease severity , RQLQ-scores , number of days with symptoms- 
    Output:
    
Summary estimates obtained by meta- analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy , when measured by both disease-specific and generic HRQL instruments , and was reflected by an impact on both physical and mental health .
A systematic review of cost data on AR and AA in selected European countries demonstrated that the majority of the economic burden was indirectly caused by high levels of absenteeism and presenteeism ; there was little or no evidence of increasing or decreasing cost trends .