We're going to talk a little bit today about rhinitis. Now many of you are aware of rhinitis, but many of you may not be aware of all the different facets and all the different approaches to the treatment of rhinitis. So we have titled this, Rhinitis it's not what you think and we're going to have a debate. Now doctor's of all, we used to look in envy when we used to see on TV. it's academic. And we would say god, I could do that, that's easy. Or, I remember as a kid concentration or double jeopardy. Well you have four panelists here who were picked by their high school valedictorian to represent them and they're at the top of the class. To my right is Dr. and your left, op no starting with Phil. Phil Lieberman. Phil Lieberman as you know has written extensively on both allergic and non-allergic rhinitis. He is a former president of The American Academy of Allergy, loves to wear orange and comes from Tennessee. I don't think I can bear to hear anymore of how great they are at the University of Tennessee. He's probably going to try to slip something in.

Our next panelist, here he comes, Dr. William Storms, he knows we didn't put them in any particular order. Dr. William Storms has also written extensively about allergic and non-allergic rhinitis. He is very interested in outcomes, farm economics and he is in clinical practice, so he is like most of you a real doctor. He is also at the University of Colorado as a clinical professor and we're very delighted to have him as part of our panel.

Next, is Dr. Mark Dykewicz, who is on the faculty at St. Louis University and you might recognize Dr. Dykewicz's name. He is the lead author on the practice parameters on allergic rhinitis, done by the joint task force on practice parameters. So this is the famous Dykewicz, of the Dykewicz paper. And then the second author is Dr. Stan Fineman, certainly not second but they had to have somebody go first, I guess it was alphabetical. Dr. Fineman is also one of the authors of the allergic rhinitis practice parameters of the joint task force on practice parameters.

So we have a very esteemed panel, and our program today is going to be interactive. Now all of you should have pads on your table. And we would like each one of you to take one. We're going to allow you to vote. Okay, we originally though that we would consider this the weakest link, but my concern was that you were going to vote me off first. So, I decided not to go in that direction. But, we're going to allow you to vote on different issues.

To get right into it, let's go with the first question: We would like you to vote if you suffer from allergic rhinitis. Yes is one, no is two. So on your pad go ahead and vote. Yes is A, B is no, we should have one of those da da da da, and I think we're going to get the results of this, are we going to get the results of this coming up Cath? Here it is, "Do you suffer from allergic rhinitis?" Interesting 57% of the audience of allergists and people in the field have allergic rhinitis.
43% of you don't. All right let's go to the next question.

Do you suffer from non-allergic rhinitis? Often referred to as vasomotor rhinitis.
A yes, B no. I'll give you a count 5,4,3,2,1. Half of you have non-allergic rhinitis are the half that said they have allergic rhinitis. The incidence of non-allergic rhinitis is increasing. Are we seeing more non-allergic rhinitis in the population? A true, B false, I'll give you a countdown, 5,4,3,2,1, so you feel the incidence of non-allergic rhinitis is increasing. Ok, here is a question I think would be interesting. Are allergist's seeing more patients with non-allergic rhinitis? A is true, B is false, 5,4,3,2,1, very interesting. So most of you believe, the majority 77% allergistis believe they are seeing more non-allergic rhinitis. So now I'm going to go to our panel, and we're going to start off with Dr. Lieberman and Dr. Dykewicz as to how they feel about the question "is the incidence of non-allergic rhinitis increasing?" Do you have a pen mic? Oh, your going to come up here. I thought this was mine. I am the weakest link.

You know actually, we have no data to tell us one way or not if the incidence is increasing. I think my intuitive impression, we really have no comparative data compared to the instance of that over the years. So we really have no definitive answer to that question. I think intuitively, I like you seem to be seeing more non-allergic rhinitis, but that's the next question so I won't delve into it. But I would like to take this opportunity to show you the data we have on the incidence of non-allergic rhinitis. Cathy if you could show that table with the four studies with good data on the instance of non-allergic rhinitis. There are actually five studies, but we have four on the table for you. The first one started with Malarkey, and then Touis and then Inbird. And then there were a national task force, composed of 19 allergists. Then there was a European health study. And these four of those five studies. And as you can see on this table, in the Malarkey study, these are patients referred to an allergy clinic with a diagnosis of rhinitis. In the Malarkey study, you had the highest instance that was 52%, in the Touis study which was from Hopkins, was the lowest, which was 17%. In the European Epidemiologic study the instance was 25% and in the national task force which was 19 allergists based across the United States, it was 23%. And also, what you can see in this study is something that I thought we have neglected for a number of years, and I think it's now assuming more importance in our writing and I don't think we have a ICD-N code for and I think we should have an ICD-N code for is mixed rhinitis. The mention of mixed rhinitis which we really haven't appreciated in the past perhaps, can be quite high about a third to you'll see later about 50% to 60 %. And I think the very important point and I think Mark Dykewicz is going to talk to you a little about this, is that there is an under-recognized