Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs

Abstract

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

“…2,3 Most patients with asthma also have rhinitis, while 10-40% of patients with rhinitis have comorbid asthma. 4 Several mechanisms have been postulated for this close association between upper and lower airway morbidity, including (1) aspiration of inflamed or infected secretions to the lower airway, (2) nasal blockage that leads to mouth breathing cold, dry air increasing allergen entry into the lower airway, (3) systemic absorption of inflammatory mediators in the nasal mucosa, or (4) a nasobronchial reflex. [5][6][7][8] AR practice guidelines highlight the need for allergy evaluation when rhinitis symptoms are persistent, moderate or severe, or impact quality of life.…”

Health-Related Quality of Life and Rhinitis Control Measures in Allergic Rhinitis

“…In addition, there are currently no studies comparing these tools in order to identify which of these would be more applicable for clinical trials and/or clinical practice. As previously recommended by the ARIA guidelines, it is important that methods for measuring severity and control in allergic diseases are uniform [65]. There is also a need to develop control measures applicable to the paediatric population.…”

Impacto de la Inmunoterapia subcutánea con Dermatophagoides farinae y Dermatophagoides pteronyssinus sobre la calidad de vida de pacientes con rinitis y asma alérgica

“…Los criterios de inclusión fueron los siguientes: historia clínica sugestiva de alergia respiratoria a ácaros de polvo establecida por alergólogos con base en los criterios de la Global Initiative for Asthma (GINA) y de la iniciativa Allergic Rhinitis and its Impact on Asthma (ARIA) (8,17), así como en la prueba de punción positiva frente a ácaros de polvo usando extractos alergénicos estandarizados para aeroalérgenos comunes de acuerdo con la normativa internacional (18), el pico de flujo nasal inspiratorio y el pico de flujo espiratorio (19), también determinados según los parámetros internacionales estandarizados (20). Los criterios de exclusión fueron aquellos propuestos por la World Allergy Organization (WAO) para la inmunoterapia alergénica (21).…”

“…Es así como en el consenso de la Organización Mundial de la Salud de 1998 (7) y en el reporte del 2008 relativo a la guía de rinitis alérgica y su impacto sobre el asma (ARIA) (8), quedó establecido que la inmunoterapia específica con alérgenos puede modificar enfermedades alérgicas tales como la rinitis alérgica y el asma producida por pólenes (9). Además, se ha determinado que la inmunoterapia subcutánea específica con alérgenos es eficaz como tratamiento a largo plazo en sujetos con rinitis alérgica y asma sensibilizados a ácaros del género Dermatophagoides.…”