{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:39:31Z","timestamp":1791214771502,"version":"4.1.0"},"reference-count":21,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Inmunotek SL, Spain"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Allergen immunotherapy (AIT) is the only disease-modifying treatment for grass pollen allergy. However, the proportion of patients interested in AIT who meet guideline-defined eligibility criteria remains unclear. This study aimed to characterise symptom burden, medication use, and AIT eligibility in adult patients with grass pollen allergy during the peak pollen season. Methods: In this multicentre, prospective, non-interventional epidemiological study, 479 adults with confirmed grass pollen allergy recorded daily nasal, ocular, and systemic symptoms, as well as anti-allergic medication use, via a validated electronic diary (CCC STUDY Diary) over a 30-day period in June\/July 2025. A combined symptom\u2013medication score (CSMS) was calculated daily, with a predefined threshold of \u22651.5 indicating clinically relevant symptom severity and potential eligibility for AIT. Both additive and weighted calculation approaches for the CSMS and the daily medication score (dMS) were evaluated to assess methodological robustness and reproducibility. Results: The mean additive CSMS was 2.14, indicating moderate symptom burden. Overall, 63.3% of participants exceeded the CSMS threshold of 1.5 and were considered eligible for AIT. Sensitivity analyses demonstrated excellent concordance between additive and weighted CSMS\/dMS calculations (Spearman\u2019s \u03c1 &gt;0.98; p &lt; 0.001), and Bland\u2013Altman analysis confirmed minimal bias (0.157) and narrow limits of agreement. Asthma was reported as a comorbidity in 36% of patients, generally associated with mild to moderate daily respiratory symptoms. Limitations included the self-reported nature of the data and a slightly reduced sample size; however, the results are representative of adult patients seeking care in specialised allergy centres in Germany. Conclusions: The CSMS also in its additive and therefore modernised form is a reliable, reproducible, and clinically meaningful tool for quantifying symptom severity and identifying patients suitable for AIT. Approximately two-thirds of adults interested in grass pollen AIT exhibited moderate to severe symptoms and were eligible for treatment according to current guideline recommendations.<\/jats:p>","DOI":"10.3390\/jcm15114035","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:06:08Z","timestamp":1779465968000},"page":"4035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective Evaluation of Symptom Burden and Medication Use in Seasonal Allergic Rhinitis\/Rhinoconjunctivitis Patients Considering Allergen-Specific Immunotherapy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5306-5412","authenticated-orcid":false,"given":"Anna","family":"Rybachuk","sequence":"first","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9323-6887","authenticated-orcid":false,"given":"Christian","family":"Neuhof","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Curtius","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cengizhan","family":"Acikel","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9863-1876","authenticated-orcid":false,"given":"Susann","family":"Fragel","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hacer","family":"Sahin","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Katzke","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9616-6942","authenticated-orcid":false,"given":"Kijawash","family":"Shah-Hosseini","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silke","family":"Allekotte","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Raskopf","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, 50668 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3391","DOI":"10.1111\/all.70063","article-title":"Subcutaneous Allergen Immunotherapy in Adults Allergic to House Dust Mites: A Phase 3 Randomized Controlled Trial","volume":"80","author":"Bachert","year":"2025","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1111\/all.12383","article-title":"Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: An EAACI Position Paper","volume":"69","author":"Pfaar","year":"2014","journal-title":"Allergy"},{"key":"ref_3","first-page":"990","article-title":"A randomized, double-blind, placebo-controlled trial with mannan-conjugated birch pollen allergoids","volume":"79","author":"Zeyen","year":"2023","journal-title":"Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13601-019-0303-6","article-title":"Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: An EAACI position paper","volume":"10","author":"Hox","year":"2020","journal-title":"Clin. 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