Construction of an Atopic Symptom Questionnaire and Evaluation of Peri-menstrual Atopy in Women of Reproductive Age

Background: Atopic disorders, such as asthma, atopic dermatitis (AD), and allergic rhinitis (AR), are rising globally. In reproductive-age women, hormonal fluctuations during the menstrual cycle can trigger or worsen symptoms, a condition termed perimenstrual atopy (PMA). Despite its prevalence, PMA remains under-recognized, especially in healthy females, and no standardized tool exists for its comprehensive assessment. Objective: To determine PMA occurrence in females with and without diagnosed atopy and to develop and validate the Atopic Symptom Score Questionnaire (ASQ) for PMA evaluation. Methods: This observational study included 145 reproductive-age females (54 atopic, 91 non-atopic) with regular menstrual cycles. The ASQ was constructed by integrating validated tools for asthma, AD, and AR. Content validity was confirmed by experts, and internal reliability was strong. After pilot testing, the finalized ASQ was administered via face-to-face interviews. Participants rated symptom severity and indicated the timing of symptom onset in relation to menstrual phases. Mean ASQ scores and the frequency of PMA were analyzed, and the comparison between atopic and non-atopic groups was conducted. Results: PMA was reported in 29.9% of participants, more often in atopic (40.7%) than non-atopic females (23.3%). The most common symptoms were breathlessness, throat discomfort, and nasal congestion. ASQ scores were significantly higher in atopic individuals (11.5 vs. 2.41, p<0.001), with most exacerbations during menstrual and premenstrual phases. Conclusions: The ASQ is a valid tool for assessing PMA. PMA is common and underdiagnosed, even among non-atopic females, highlighting the need for greater clinical awareness and standardized evaluation.