Abstract
Objective
This study aimed to identify the top 100 most influential articles in the field of allergic rhinitis (AR).
Methods
Web of Science was queried for 1970 to 2018. Articles were sorted in descending order of the citation count. All titles and abstracts were screened to identify the top 100 articles.
Results
The top 100 most influential articles in AR were identified. The earliest article was published in 1975, and the most recent in 2015. The most prolific decade was the 2000s, with 59 articles published. Twenty-nine journals contributed to the top 100 articles, with the Journal of Allergy and Clinical Immunology contributing most of the articles (n = 34). The top three countries of article origin were the United States (n = 34), followed by the United Kingdom and France (n = 14 each). The type of article covered clinical research (n = 68), reviews (n = 22), and basic research (n = 10). For the clinical research articles, there were 6 studies with level 1 evidence, 25 with level 2 evidence, 11 with level 3 evidence, and 26 with level 4 evidence.
Conclusions
This study identified the top 100 most influential articles in the area of AR. Recognition of important historical contributions to this field may guide future investigations into AR.
Keywords
Introduction
Allergic rhinitis (AR) represents a global health problem for all age groups. To improve our understanding of AR and our ability to manage and control it effectively, a great number of articles have been published on the epidemiology, pathogenesis, diagnosis, and treatment of AR. However, it is difficult to identify the most influential articles among numerous publications.
Bibliometrics are statistical and quantitative analyses that are designed to analyze the academic impact and publication characteristics within a certain field. 1 Citation analysis is one method of bibliometric analysis that evaluates the influence and importance of an article by analyzing the citation count.2,3 It is widely recognized in various disciplines, such as medicine, 4 respiratory medicine, 5 and neurosurgery. 6
To the best of our knowledge, there has been no citation analysis performed in the field of AR. Therefore, we performed a citation analysis to identify the top 100 most influential articles on AR and analyzed their characteristics.
Methods
Search strategy
We used the advanced search “TI = ((allergi * rhiniti*) OR (pollen allerg*) OR (pollinos*) OR (hay fever) OR (hayfever))” in the Web of Science (WoS) core collection. The publication range was from January 1970 to August 2018 and the document types were original articles and reviews. Conference proceedings and Letters to the Editor were excluded. We also excluded some studies that did not involve AR, such as chronic idiopathic urticaria, chronic sinusitis, and grass sensitization. No language was restricted in this search. Two researchers (Q.-W.W. and R.Z.) reviewed and screened the titles and abstracts of the articles. The retrieved articles were ranked from the highest to the lowest based on the number of citations. Because no human subjects were enrolled, ethics approval was not required in this study.
Data extraction
After the articles were screened, we extracted the contents including the title of each article, the number of citations, the source of the journal, and the first author and their country. Next, based on the type of article, the publications were further divided into basic research, clinical research, and review article groups. Levels of evidence for clinical research articles were based on The Oxford 2011 Levels of Evidence. 7 The Levels of Evidence Table focuses on the issues of prevalence, diagnosis, prognosis, treatment and screening, and has been frequently used in bibliometric research. For example, a systematic review of randomized trials that is graded level 1 represents the highest level.
Statistical analysis
The data were analyzed using IBM SPSS 22.0 package (IBM Corp., Armonk, NY, USA). Descriptive statistics were quantified as counts or percentages of parameters. This study did not involve statistically significant differences.
Results
Our literature search yielded 14,270 articles between 1970 and 2018, which were further screened for the top 100 articles (Table 1).
List of the top 100 most influential articles on allergic rhinitis.
Number of articles published
Among the top 100 articles, the oldest article was published in 1975 and the most recent was published in 2015 (Figure 1). Among these 100 articles, the most prolific decade was the 2000s (n = 59), followed by the 1990s (n = 25), the 1980s (n = 8), the 2010s (n = 7), and the 1970s (n = 1).
Decades of publication.
Number of citations
Among these 100 articles, the highest citation count was 2130 and the lowest was 102. The average citation count for a single article in the 1970s, 1980s, 1990s, 2000s, and 2010s was 231.0, 166.0, 197.2, 238.0, and 227.6, respectively.
Published journals
The 100 most influential articles were published in 29 journals. Among these journals, those with more than one article published and its impact factor are listed in Table 2. The top journals were Journal of Allergy and Clinical Immunology (n = 34), Allergy (n = 12), Clinical and Experimental Allergy (n = 5), and Annals of Allergy Asthma & Immunology (n = 5).
Journals with more than one published article.
Origins
These articles were mainly from 17 countries. Among these countries (Figure 2), the top three were the USA (n = 34), the UK (n = 14), and France (n = 14). The second tier of countries included Italy (n = 6), which was followed by Canada (n = 6), Belgium (n = 6), The Netherlands (n = 4), Germany (n = 3), Sweden (n = 2), and Japan (n = 2). An equal number of articles originated from Spain, Norway, Israel, The Netherlands, China, Australia, and Argentina (n = 1, each).
Article counts by origin with >1 published article.
First authors
There were 80 first authors who contributed to these articles. There were nine first authors who had published more than 1 article (Table 3). The top three authors included Bousquet J (n = 9), Meltzer EO (n = 5), and Casale TB (n = 3). The number of publications for Bachert C, Bauchau V, Braunstahl GJ, Nathan RA, van Cauwenberge P, and Wilson AM were the same (n = 2, each).
First authors with more than one published article
Institutions
These articles came from 71 different institutions. There were 13 institutions with >1 published article (Table 4). Among them, the top three were Hospital Arnaud de Villeneuve (n = 10), Allergy and Asthma Medical Group and Research Center of San Diego (n = 5), and Ghent University Hospital (n = 4).
Institutions with more than one published article
The type of articles
Among these articles, the number of articles on clinical research, reviews, and basic research was 68, 22, and 10, respectively. Among the reviews, there were six articles about guidelines. Most of the basic research articles focused on immune response.
The level of evidence
Among the clinical research articles, 6, 25, 11, and 26 were graded as having Level 1, Level 2, Level 3, and Level 4 evidence, respectively, based on The Oxford 2011 Levels of Evidence. 7
Study types of clinical articles
The study types of clinical articles mostly included case-series/retrospective studies (n = 26), followed by randomized controlled trials (n = 25), non-randomized controlled cohort studies (n = 11), and systematic reviews/meta-analyses (n = 6). There were 27 of 68 articles that used a questionnaire, such as health-related quality of life (HRQoL) or the rhinoconjunctivitis quality of life questionnaire (RQLQ).
Based on the treatment modalities for clinical research articles, most were immunity therapy (n = 22), followed by intranasal corticosteroids and quality of daily life (n = 10, each).
Discussion
In our study, bibliometric analysis was used to identify the top 100 most influential articles in AR. These articles are representative of the many landmarks in AR over the past decades.
The top three articles were guidelines on Allergic Rhinitis and its Impact on Asthma (ARIA). The results demonstrate that guidelines are the most cited articles, but this is different from other bibliometric studies. These bibliometric studies often reported that basic research articles and clinical research articles are the most cited articles.5,6,8 Because of the time-dependent citation analysis, 9 recent important articles might not have sufficient citations. For example, the ARIA guidelines 2016 revision 10 and the ARIA score for AR using mobile technology that correlates with the quality of life 11 was not in this top 100 list. This indicates that the number of citations that a paper has received may not reflect its overall historical importance.
With the exception of the 2010s, the number of articles increased by decade. Thus, more than half of the articles in our study were published in the 2000s. The mean number of citations also tended to increase by decade except for the 1970s. These findings are consistent with those of other bibliometric studies.6,8,12 The results demonstrate that new articles with novel discoveries and advanced technologies continue to be published and receive more citations than previous articles.
Some bibliometric studies reported that journals with high impact factors, such as NEJM and The Lancet, were the leading journals.5,13 However, we found that the Journal of Allergy and Clinical Immunology was the most productive journal, despite its impact factor of 13.3. Other bibliometric studies6,12,14 also reported that specialized journals were the leading journals. The results showed that highly influential articles are also published in specialized journals, and these influential articles are not limited to the most well-known general medical journal.
Among the top 100 list, most articles originated from developed countries in Europe and North America. Only one article on the list came from Taiwan China. Another important article on the list came from mainland China and reported the prevalence of self-reported AR in China. 15 Because biomedical research output is largely dependent on a country’s gross national product (GNP) and the expenditure allotted for research and development (R&D), 16 authors in China will have an increasingly important place in the field of AR because of their increasing GNP and expenditure on R&D.
Some bibliometric articles reported that the most productive authors and institutions always came from the USA.6,13,14 In our study, although authors from the USA contributed most of the studies in the top 100 list, it is notable that Bousquet J was the first author who contributed 9 articles and his affiliated institution, Hospital Arnaud de Villeneuve in France, was the most prolific institution. Examination of the articles showed that he contributed most of the guidelines on ARIA. This finding is consistent with the bibliometric article on asthma. 5
Throughout the top 100 list, most articles were clinical research articles, and basic research articles only accounted for 10% of these publications. This finding is similar to a bibliometric article on asthma. 5 The results may show that referring to clinical evidence is more favored compared with referring to basic research.
Some bibliometric articles on surgical tumors reported that more than half of the articles were low-quality Level 4 and there were many challenges for conducting randomized controlled surgical trials, such as multicenter collaborations, a large number of personnel, and a large funding requirement.14,17 In our study, nearly half of the clinical articles were Level 1 and Level 2 based on the level-of-evidence grading. This result shows that high-quality level of studies for internal medicine is relatively easy to conduct and that these studies will receive more citations compared with low-quality studies.
There are various therapies for AR. In our study, most treatments for clinical research articles are immunity therapy and intranasal corticosteroids. Additionally, the questionnaires, such as HRQoL and RQLQ, were chosen to assess the clinical symptoms in most of the clinical research articles. To some extent, these findings reflect the performance of the guidelines in clinical practice.
Some limitations of this paper must be mentioned. First, the citation count used for citation analysis did not include self-citations and conference reports. Second, because of the influence of certain time factors, most recently published articles would be unfavorably affected in the citation analysis. Third, because of the limitations of our search formula and WoS, some well-known papers may have been missed. 18
Conclusions
To the best of our knowledge, this is the first bibliometric study to identify the most influential articles in the area of AR and to provide a historical perspective on the progress of research on AR. The findings indicate that guidelines and articles with novel discoveries, advanced technologies, and high-quality evidence will receive more citations. Recognition of important historical contributions to this field may guide future investigations into AR.
Supplemental Material
IMR885570 Supplemetal Material - Supplemental material for The top 100 most influential articles in allergic rhinitis from 1970 to 2018: A bibliometric analysis
Supplemental material, IMR885570 Supplemetal Material for The top 100 most influential articles in allergic rhinitis from 1970 to 2018: A bibliometric analysis by Qingwu Wu, Rui Zheng, Weihao Wang, Huijun Qiu, Xuekun Huang and Qintai Yang in Journal of International Medical Research
Footnotes
Author contributions
All authors were involved in the study. Q.-T. Yang conceived and designed the study. Q.-W. Wu analyzed the data and wrote the paper. R. Zheng performed the search strategy and wrote the paper. W.-H. Wang performed the search strategy. H.-J. Qiu and X.-K. Huang collected the data.
Acknowledgements
We thank Lianxiong Yuan for assistance with the statistical analysis.
Declaration of conflicting interest
The authors declare that there is no conflict of interest.
Funding
This work was supported by the National Natural Science Foundation of China (81670912 and 81870704); the China Postdoctoral Science Foundation Grant (2019M653207); and the Medical Scientific Research Foundation of Guangdong Province of China (A2019037).
References
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