OBJECTIVES: It is hypothesised that the presence of ocular symptoms (Oc+Ns) in addition to nasal symptoms (Ns) results in additional resource utilization. This study investigated the impact on burden of illness (BoI) among AR patients in France, Germany, Italy and Spain. METHODS: The data were drawn from a cross-sectional study of consulting patients undertaken in May/June 2008 (Adelphi). Data were collected by doctors who included records relating to the next consecutive 4-5 patients consulting for AR. Patients were invited to fill the WPAI (Work Productivity and Activity Impairment) questionnaire.  Propensity scoring (PS) methods were used to match the two comparison groups (Oc+Ns patients vs Ns only). RESULTS: A total of 1009 patients meeting the inclusion criteria of which 69% (700) presented with both symptoms (Oc+Ns). The Oc+Ns patients were prescribed 15% more AR medications (e.g. inhaled nasal corticosteroids, NSAs; 1.6 vs. 1.4, p<0.05) and required 23% more consultations with health care services concerning their AR condition (4.9 vs. 4.0, p<0.05). Of the 1009, 750 filled in the self-completion questionnaire (including 526 Oc+Ns patients). All work related AR WPAI domains were statistically different with Oc+Ns patients recording greater impact including proportion of work time (hours) missed due to AR in the last 7 days (3.3% vs. 0.7%, p<0.05), impairment while working (hours worked in the last 7 days, 32.6% vs. 21.8%, p<0.05) In addition, Oc+Ns patients recorded more actual days off work due to AR over the preceding 3 months compared with patients with nasal symptoms only (0.8 vs. 0.3 days p<0.05). CONCLUSIONS: AR patients with both ocular and nasal symptoms place a significant additional burden on resource utilisation and experience greater lost productivity than those with nasal symptoms only. Therapies that are proven to specifically address ocular in addition to nasal symptoms would result in benefits from both the direct and indirect costs associated with AR.