Clinical Relevance of Cluster Analysis in Phenotyping Allergic Rhinitis in a Real-Life Study

Abstract

Background: Disease stratification, using phenotypic characterization performed either by hypothesis- or data-driven methods, was developed to improve clinical decisions. However, cluster analysis has not been used for allergic rhinitis. Objective: To define clusters in allergic rhinitis and to compare them with ARIA (Allergic Rhinitis and Its Impact on Asthma), a hypothesis-driven approach. Methods: A French observational prospective multicenter study (EVEIL: Echelle visuelle analogique dans la rhinite allergique) was carried out on 990 patients consulting general practitioners for allergic rhinitis and treated as per clinical practice. In this study, changes in symptom scores, visual analogue scales and quality of life were measured at baseline and after 14 days of treatment. A post hoc analysis was performed to identify clusters of patients with allergic rhinitis - using Ward's hierarchical method - and to define their clinical relevance at baseline and after 14 days of treatment. The cluster approach was compared to the ARIA approach. Results: Patients were clustered into 4 phenotypes which partly followed the ARIA classes. These phenotypes differed in their disease severity including symptoms and quality of life. Physicians in real-life practice prescribed medication regardless of the phenotype and severity, with the exception of patients with ocular symptoms. Prescribed treatments were comparable in hypothesis- and data-driven analyses. The prevalence of uncontrolled patients during treatment was similar in the 4 clusters, but was significantly different according to the ARIA classes. Conclusion: Cluster analysis using demographic and clinical parameters only does not appear to add relevant information for disease stratification in allergic rhinitis.

Allergic and Nonallergic Asthma Have Distinct Phenotypic and Genotypic Features

“…An association between a genetic risk factor and a particular disease phenotype might not appear when one addresses the population of all asthmatic patients [46,47]. Identification of a probable association between the HLA system and allergic and nonallergic asthma phenotypes is important to better understand the pathophysiology of the disease, particularly the nonallergic phenotype, and to improve clinical decisions based on the mechanism of the disease [48,49]. …”

Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis – A EUFOREA‐ARIA‐EPOS‐AIRWAYS ICP statement

“…Many AR patients use OTC drugs and only a fraction have a medical consultation. The vast majority of patients visiting GPs or specialists have moderate/severe rhinitis . Integrated care pathways differ from practice guidelines as they are utilized by a multidisciplinary team and have a focus on the quality and coordination of care, thus corresponding ideally to the requests of PM implementation at the point of care .…”

Resumen ejecutivo de ARIA 2016: vías integradas de atención para la medicina predictiva a lo largo del ciclo de vida en Argentina

“…18,19,20 Además, los pacientes también pueden optar por la medicina alternativa o la inmunoterapia alérgeno específica. 21 Es por ello que las vías de atención integradas (IPCs) deberían considerar un enfoque multidisciplinario que incluya el automanejo, como fuera propuesto por Airways ICPs (Figura 2).…”

“…La gravedad de la enfermedad está asociada con varios efectos sobre la sa-lud, incluyendo la calidad de vida. 18,19,20 La clasificación de rinitis (intermitente/grave-persistente) es un indicador importante de la multimorbilidad del asma (solo en algunos estudios), 22 así como de la duración y eficacia del tratamiento de la rinitis alérgica. 23 Sin embargo, la mayoría de los pacientes recibe combinaciones de antihistamínicos orales y corticoides nasales, las cuales no están suficientemente evaluadas en guías que usen una metodología apropiada.…”