Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study

J Allergy Clin Immunol. 2007 Aug;120(2):381-7. doi: 10.1016/j.jaci.2007.03.034. Epub 2007 Jun 8.


Background: Seasonal allergic rhinitis is common globally, and symptoms have been shown to impair learning ability in children in laboratory conditions. Critical examinations in children are often held in the summer during the peak grass pollen season.

Objective: To investigate whether seasonal allergic rhinitis adversely impacts examination performance in United Kingdom teenagers.

Methods: Case-control analysis of 1,834 students (age 15-17 years; 50% girls) sitting for national examinations. Cases were those who dropped 1 or more grades in any of 3 core subjects (mathematics, English, and science) between practice (winter) and final (summer) examinations; controls were those whose grades were either unchanged or improved. Associations between allergic rhinitis symptoms, clinician-diagnosed allergic rhinitis, and allergic rhinitis-related medication use, recorded on examination days immediately before the examination, were assessed using multilevel regression models.

Results: Between 38% and 43% of students reported symptoms of seasonal allergic rhinitis on any 1 of the examination days. There were 662 cases (36% of students) and 1,172 controls. After adjustment, cases were significantly more likely than controls to have had allergic rhinitis symptoms during the examination period (odds ratio [OR], 1.4; 95% CI, 1.1-1.8; P = .002), to have taken any allergic rhinitis medication (OR, 1.4; 95% CI, 1.1-1.7; P = .01), or to have taken sedating antihistamines (OR, 1.7; 95% CI, 1.1-2.8; P = .03).

Conclusion: Current symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations.

Clinical implications: This is the first time the relationship between symptomatic allergic rhinitis and poor examination performance has been demonstrated, which has significant implications for clinical practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Allergic Agents / adverse effects
  • Anti-Allergic Agents / therapeutic use
  • Case-Control Studies
  • Educational Measurement*
  • Female
  • Histamine H1 Antagonists / adverse effects
  • Histamine H1 Antagonists / therapeutic use
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Male
  • Regression Analysis
  • Rhinitis, Allergic, Seasonal / drug therapy
  • Rhinitis, Allergic, Seasonal / physiopathology
  • Rhinitis, Allergic, Seasonal / psychology*
  • Surveys and Questionnaires
  • Task Performance and Analysis*
  • United Kingdom


  • Anti-Allergic Agents
  • Histamine H1 Antagonists
  • Hypnotics and Sedatives