Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-2008-update-13eqfzaw4u.pdf

Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)69283-0.pdf

Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys

Authors Jan L. Brozek, MD, PhD – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada Jean Bousquet, MD, PhD – Service des Maladies Respiratoires, Hopital Arnaud de Villeneuve, Montpellier, France, INSERM, CESP U1018, Respiratory and Environmental Epidemiology Team, France, and WHO Collaborating Center for Rhinitis and Asthma Carlos E. Baena-Cagnani, MD – Faculty of Medicine, Catholic University of Cordoba, Cordoba, Argentina Sergio Bonini, MD – Institute of Neurobiology and Molecular Medicine – CNR, Rome, Italy and Department of Medicine, Second University of Naples, Naples, Italy G. Walter Canonica, MD – Allergy & Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy Thomas B. Casale, MD – Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Nebraska, USA Roy Gerth van Wijk, MD, PhD – Section of Allergology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands Ken Ohta, MD, PhD – Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan Torsten Zuberbier, MD – Department of Dermatology and Allergy, Charite Universitatsmedizin Berlin, Berlin, Germany Holger J. Schunemann, MD, PhD, MSc – Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada

/pdf/allergic-rhinitis-and-its-impact-on-asthma-20b4c7y0pr.pdf

Allergic Rhinitis and Its Impact on Asthma

Despite considerable research, the aetiology of asthma and allergic disease remains poorly understood. The International Study of Asthma and Allergies In Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease by establishing a standardized methodology and facilitating international collaboration. It has achieved its specific aims which are to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres and to make comparisons within and between countries; to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and to provide a framework for further aetiological research into genetic, lifestyle, environmental and medical care factors affecting these diseases.

 The ISAAC design comprises three phases. Phase One used simple core written questionnaires for two age groups, and was completed in 156 collaborating centres in 56 countries and a total of 721 601 children participated. In the 13–14 years age group 155 centres from 56 countries participated, of which 99 centres completed a video questionnaire. For the 6–7 years age group there were 91 collaborating centres in 38 countries. ISAAC Phase One has demonstrated a large variation in the prevalence of asthma symptoms in children throughout the world including hitherto unstudied populations. It is likely that environmental factors were responsible for major differences between countries. The results provide a framework for studies between populations in contrasting environ-ments which are likely to yield new clues about the aetiology of asthma. ISAAC Phase Two will investigate possible aetiological factors, particularly those suggested by the findings of Phase One. ISAAC Phase Three will be a repetition of Phase One in the year 2000 to assess trends in prevalence.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2222.1998.028s5052.x

The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steering Committee.

Background: Allergic rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally. Objective: To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of allergic rhinitis on the basis of current best evidence. Methods: The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group. Results: This article presents recommendations about the prevention of allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with allergic rhinitis as well as patients with both allergic rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals. Conclusion: These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-guidelines-3pawic20n9.pdf

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision

Background: As part of the International Study of Asthma and Allergies in Childhood (ISAAC), prevalence surveys were conducted among representative samples of school children from locations in Europe, Asia, Africa, Australasia, North and South America


Subjects: 257,800 children aged 6-7 years from 91 centres in 38 countries, and 463,801 children aged 13-14 years from 155 centres in 56 countries Methods: Written symptom questionnaires were translated from English into the local language for self-completion by the 13-14-year-olds and completion by the parents of the 6-7-year-olds Rhinitis was described as a problem with sneezing, or a runny, or blocked nose when you (your child) DID NOT have a cold or the flu Additional questions were asked about rhinitis associated with itchy-watery eyes, interference with activities and a history of hay fever ever


Results: The prevalence of rhinitis with itchy-watery eyes (“rhinoconjunctivitis”) in the past year varied across centres from 08%(to 149% in the 6-7-year-olds and from 14% to 397% in the 13-14-year-olds Within each age group, the global pattem was broadly consistent across each of the symptom categories In centres of higher prevalence there was great variability in the proportion of rhinoconjunctivitis labelled as hay fever The lowest prevalences of rhinoconjunctivitis were found in parts of eastern Europe south and central Asia High prevalences were reported from centres in several regions


Conclusion: These results suggest substantial worldwide variations in the prevalence and labelling of symptoms of allergic rhinoconjunctivitis which require further study These differences, if real, may offer important clues to environmental influences on allergy

Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Chapter 16 – Epidemiology of Allergic Disease

4 – Epidemiology of allergy and asthma

Objectives-To comparethe prevalence of asthmaandallergic disorders amongchildren in Munich,westernGermany,andLeipzig, eastern Germany, whereenvironmental exposure, particularly airconcentrations ofsulphur dioxide and particulate matter,andliving conditions have differed overthepast45years. Design-Prevalence surveysamong schoolchildren aged9-11years inLeipzig andMunich. Self completion ofwritten questionnaire bythechildren's parents andlungfunction measurements. Subjects-1051 children inLeipzig and5030in Munich. Setting-Primary schools. Main outcomemeasures-Reported lifetime prevalence ofasthmaandallergic disorders, and bronchial hyperresponsiveness assessed bycoldair inhalation challenge. Results-The lifetime prevalence ofasthmadiagnosedbyadoctor was7.3%(72) inLeipzig and9.3% (435) inMunich; prevalences ofwheezing were20% (191) and17%(786) respectively. Theprevalence of diagnosed bronchitis washigher inLeipzig than Munich(30.9% (303) v 15.9%(739); p 9%) after cold airchallenge wasmeasured in6.4%(57) of children inLeipzig andin7.7%(345) ofthosein Munich. Hayfever (2.4% (24) v8-6%(410); p<0.01) andtypical symptomsofrhinitis (16.6% (171) v 19.7%(961); p<0-05) werereported lessoften in Leipzig thaninMunich. Conclusions-No significant differences were seeninthelifetime prevalence ofasthma, wheezing, andbronchial hyperresponsiveness between childreninLeipzig andMunich. Thelifetime prevalence ofbronchitis washigher inLeipzig thaninMunich. Thelowerprevalence ratesofallergic disorders in Leipzig couldpoint toward aetiological factors that areassociated withWesternlifestyle andliving conditions.

Prevalence ofasthmaandallergic disorders among children inunited Germany: adescriptive comparison

Die individuelle Luftschadstoff-Exposition ist in epidemiologischen Studien mit unterschiedlichen Methoden geschatzt worden. Daten von Monitoren in groserem Abstand von grosen Strasen geben im wesentlichen Hintergrundimmissionen wieder wahrend Fragebogenangaben und Verkehrszahlungen im wesentlichen direkte Exposition mit verkehrsbezogenen Schadstoffen reprasentieren. Keine Studie hat bislang differenziert untersucht, ob diese beiden Expositions-Komponenten unterschiedlich mit Atemwegsgesundheit assoziiert sind. Wir verglichen die Assoziationen von a) individueller Hintergrundexposition mit NO2 und b) NO2 Exposition, die durch ein Verkehrs-bezogenes Modell geschatzt wurde, mit der Atemwegsgesundheit von 5421 Schulkindern (5-7 und 9-11 Jahre alt. Die Kinder wurden im Rahmen der Internationalen Studie zu Asthma und Allergien im Kindesalter (ISAAC) Phase II untersucht. Hintergrundexposition mit NO2 war starker mit morgendlichem Husten assoziiert als Expositionsschatzungen, die aus Informationen uber den Verkehr an der Wohnadresse abgeleitet worden waren. Dieses Ergebnis konnte damit erklart werden, dass Verkehrs-bezogene Expositionsschatzungen ein Missklassifikation einschliesen, wenn sie die taglichen Aktivitatsmuster von Kindern nicht berucksichtigen.

https://link.springer.com/content/pdf/10.1007%2FBF02955903.pdf

Die NO2 Hintergrund-exposition an der wohnadresse ist stärker mit atemwegssymptomen assoziiert als mit expositionsschätzungen, die aus informationen über den verkehr gewonnen wurden

Erika von Mutius

Papers

Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Chapter 16 – Epidemiology of Allergic Disease

4 – Epidemiology of allergy and asthma

Prevalence ofasthmaandallergic disorders among children inunited Germany: adescriptive comparison

Die NO2 Hintergrund-exposition an der wohnadresse ist stärker mit atemwegssymptomen assoziiert als mit expositionsschätzungen, die aus informationen über den verkehr gewonnen wurden