OBJECTIVES: It is hypothesised that the presence of ocular manifestations (Oc+Ns) in addition to nasal symptoms (Ns) places an additional burden on Allergic Rhinitis patients. This study investigated the impact on the Quality of Life (QoL) and 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 out self-completion questionnaires: QoL and work productivity measures such as Mini-RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire), PSQI (Pittsburgh Sleep Quality Index) and 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: The total sample size was 750 and 70% of these patients (526) presented with both symptoms (Oc+Ns). The results were consistent in all domains of the QoL tools with Oc+Ns patients displaying poorer QoL. Clinically differences were found in the overall quality of life (RQLQ) score (2.54 vs. 1.96, p<0.01). Regarding sleep quality (measured by the PSQI), the global score showed a statistically difference (5.41 vs. 4.57, p<0.05), with the Oc+Ns group falling in the “poor sleepers” category (score above 5). Regular activities (36% vs. 29%, WPAI:AS percent impairment, P<0.05) and impact on work (0.8 vs. 0.3 days, time off work due to AR in the last 3 months, p<0.05) also showed a higher burden in Oc+Ns patients. CONCLUSIONS: AR patients with both ocular and nasal symptoms have significantly poorer QoL and quality of sleep and take more time off work/usual activities than those with nasal symptoms only. These patients would benefit from therapies that are proven to specifically address ocular symptoms in addition to nasal symptoms.