Highlighting Gaps in Allergic Rhinitis Care, Allergen Immunotherapy Access

Patients with moderate to severe allergic rhinitis (AR) often experience years of uncontrolled symptoms, worsened quality of life, and fragmented care before learning about or accessing allergen immunotherapy (AIT), according to a new qualitative study published in JACI Global.¹

The study, conducted at a tertiary hospital center in Sydney, Australia, interviewed 25 adults to explore patient experiences with AR and their perceptions of available treatment options, including AIT. Despite the availability of multiple pharmacologic therapies, participants consistently described prolonged diagnostic journeys and incomplete symptom control. AR is an allergic reaction to airborne allergens characterized by sneezing, congestion, itchy nose, and watery eyes.²

Researchers identified 3 overarching themes: a prolonged journey with symptoms, multiple trials of therapy with inadequate control, and diverse experiences with AIT.¹ Many participants reported experiencing symptoms such as sneezing, nasal congestion, rhinorrhea, and ocular irritation for years or even decades before receiving a formal diagnosis. Delays were attributed to misdiagnosis, limited access to allergy specialists, long public hospital wait times, and out-of-pocket costs for private care.

Participants also described underestimating the impact of AR, often influenced by social norms that frame the condition as trivial. Several reported that family members, coworkers, and even clinicians dismissed symptoms as “just hay fever,” contributing to delayed care-seeking. Once recognized, the burden of disease was substantial, affecting sleep, work productivity, school performance, and social participation. Many participants reported absenteeism, presenteeism, and emotional distress, particularly following the COVID-19 pandemic, when visible respiratory symptoms carried social stigma.

Most participants had tried multiple symptomatic treatments, including oral antihistamines, intranasal corticosteroids, and eye drops, with limited or transient effectiveness. Concerns about medication tolerance and dependence were common, leading some individuals to cycle therapies or reduce use despite persistent symptoms. No participants reported sustained symptom control with pharmacotherapy alone.

Although AIT is the only disease-modifying treatment for AR, awareness was low among participants prior to specialist consultation. Those who initiated AIT typically did so after years of refractory symptoms. Expectations varied widely: treatment-naïve patients often anticipated a complete cure, whereas those with AIT experience described more modest goals, such as partial symptom improvement or reduced medication reliance.

“Those with AIT experience understood the treatment timeline, acknowledging that benefits emerged gradually over months to years, whereas treatment-naive participants often expected immediate symptom resolution,” the authors wrote. “Some participants reported that their expectations for symptom improvement were met, whereas others hoped for more benefit with continued therapy. Most participants reported satisfaction with AIT efficacy.”

Barriers to AIT access emerged as a central finding. Participants cited high out-of-pocket costs, lack of government reimbursement, limited geographic availability of prescribers, and logistical challenges such as frequent clinic visits. Employment status appeared to influence access, with unemployed participants less likely to initiate or continue therapy.

The study had several limitations, the authors noted. Patients were recruited from a tertiary hospital allergy clinic, which overrepresented those with moderate to severe AR and may limit the study’s generalizability. Responses may also have been influenced by recall bias, although the researchers tried to minimize recall bias by asking probing and clarifying questions.

The authors concluded that AR remains underrecognized as a condition with significant functional and economic consequences. They emphasized the need for improved public awareness, clearer patient education regarding treatment expectations, and policy-level interventions to expand equitable access to AIT.

“The uptake of AIT is constrained by direct medication costs, insufficient public awareness, and limited prescriber availability,” the authors concluded. “The findings of this study offer insights for health care professionals and policymakers to formulate strategies to enhance AR management and improve AIT access for eligible patients.”

References

1. Jacob J, Joyce C, Lloyd M, Lowe A, Katelaris C. Patient perspectives of allergic rhinitis and allergen immunotherapy: A qualitative study. J Allergy Clin Immunol Glob. 2025;5(2):100621. doi:10.1016/j.jacig.2025.100621

2. Allergic Rhinitis (Hay Fever). Cleveland Clinic. Updated September 21, 2023. Accessed January 23, 2026. https://my.clevelandclinic.org/health/diseases/8622-allergic-rhinitis-hay-fever