Validation of a Novel Allergy-Specific Domain for the 22-Item Sino-Nasal Outcomes Test

Anne Y. Feng, Minjee Kim, Anthony A. Prince, Carleton E. Corrales, Anne Li, Elizabeth Willard, Carly A. Forrester, Jay Piccirillo, Jennifer J. Shin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: To develop and assess the validity of a novel allergy-specific domain for the 22-item sino-nasal outcomes test (SNOT-22), to provide a new tool that efficiently quantifies the impact of allergic rhinitis (AR) concurrent with chronic rhinosinusitis. Study Design: Prospective validation study. Setting: Tertiary care hospital and community-based clinic. Methods: Proposed items were developed based on clinician and patient input, and further assessed via factor analysis and for internal consistency (n = 1987). Items were then additionally assessed for convergent and discriminant validity (n = 415), applying data from concurrent completions of the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE), Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (MiniRQLQ), and validated global health assessments. Assessments of intra-rater reliability, responsiveness to change, and qualitative input were also performed. Results: Factor analysis demonstrated that proposed allergy items mapped to a single domain. Items were internally consistent (Cronbach α: 0.80 within domain, 0.91 within all SNOT). In assessments of convergent validity, domain scores were associated with MiniRQLQ (Spearman's ρ: 0.46, 95% confidence interval [CI]: 0.30-0.59) and NOSE scores (0.36, 95% CI: 0.27-0.44). The novel items also discriminated among clinical states: a 1-point increase in domain score was associated with an 8.32 (95% CI: 5.43-12.75) increase in the odds of prompting a visit for allergy-related symptoms and a 1.52 (95% CI: 1.13-2.05) increase in the odds of positive allergy testing. Intra-rater reliability was substantial (Cohen's κ: 0.8, 95% CI: 0.8-0.9), and responsiveness to change was demonstrated (mean difference: −0.6, 95% CI: −0.8 to −0.4). Conclusions: This novel domain is a valid, efficient measure of AR alongside rhinosinusitis.

Original languageEnglish
Pages (from-to)937-943
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number3
StatePublished - Mar 2024


  • allergic rhinitis
  • chronic rhinosinusitis
  • evidence-based practice
  • factor analysis
  • quality of life
  • rhinoconjunctivitis
  • sino-nasal outcomes test
  • validated instrument


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