OBJECTIVES: The use of rhinitis total symptom scores (RTSS) is the recommended method for documenting clinical effect of interventions in allergic rhinitis and conjunctivitis. For cost utility analysis a patient preference measure (health state utility) is needed. We explore whether the disutility of allergic rhinitis can be estimated from RTSS. METHODS: We explored the properties of the RTSS and compared these to the properties of the Rhinitis Symptoms Utility Index (RSUI) - a multi-attribute utility function of rhinitis health states.  Furthermore, we simulated the outcome of a 2 week period with allergic rhinitis and compared the variation in RSUI associated with each RTSS score to minimal important difference (MID) for utility.  RESULTS: RTSS is a linear mapping of daily reported rhinitis symptoms with respect to frequency, type, and severity of symptoms. RSUI is multiplicative mapping of frequency, type and severity. This makes the RSUI a non-monotone mapping of RTSS which rules out direct one-to-one mapping from RTSS score to RSUI utility score. The simulation showed that a specific RTSS score can result in very different RSUI values; e.g. a RTSS score of 2.21 (fairly low symptom load) can be associated with a RSUI in the range from 0.376 to 0.784. Since the span of possible RSUI associated with each RTSS score is larger than the MID for utility by any standards, no approximated mapping is not possible without making further assumption on type of symptoms. CONCLUSIONS: The RTSS is a standard, recommended measure of clinical effect in rhinitis and conjunctivitis intervention studies; however, further research is needed before patient health state preferences and utility gains from interventions can be estimated from RTSS. These findings emphasize the importance of using validated methods/tools when estimating and comparing utility gains from separate interventions.