W. J. Fokkens

Chronic rhinosinusitis in Europe--an underestimated disease. A GA²LEN study.

To cite this article: Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, Bousquet PJ, Brozek G, Bruno A, Dahlén SE, Forsberg B, Gunnbjörnsdóttir M, Kasper L, Krämer U, Kowalski ML, Lange B, Lundbäck B, Salagean E, Todo‐Bom A, Tomassen P, Toskala E, van Drunen CM, Bousquet J, Zuberbier T, Jarvis D, Burney P. Chronic rhinosinusitis in Europe – an underestimated disease. A GA2LEN study. Allergy 2011; 66: 1216–1223.

Practical guide to skin prick tests in allergy to aeroallergens

To cite this article: Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, Canonica GW, Carlsen KH, Cox L, Haahtela T, Lodrup Carlsen KC, Price D, Samolinski B, Simons FER, Wickman M, Annesi‐Maesano I, Baena‐Cagnani CE, Bergmann KC, Bindslev‐Jensen C, Casale TB, Chiriac A, Cruz AA, Dubakiene R, Durham SR, Fokkens WJ, Gerth‐van‐Wijk R, Kalayci O, Kowalski ML, Mari A, Mullol J, Nazamova‐Baranova L, O’Hehir RE, Ohta K, Panzner P, Passalacqua G, Ring J, Rogala B, Romano A, Ryan D, Schmid‐Grendelmeier P, Todo‐Bom A, Valenta R, Woehrl S, Yusuf OM, Zuberbier T, Demoly P. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012; 67: 18–24.

Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper

u2002Nonallergic rhinitis (NAR) can be defined as a chronic nasal inflammation which is not caused by systemic IgE‐dependent mechanisms. It is common and probably affects far more than 200 million people worldwide. Both children and adults are affected. However, its exact prevalence is unknown and its phenotypes need to be evaluated using appropriate methods to better understand its pathophysiology, diagnosis and management. It is important to differentiate between infectious rhinitis, allergic/NAR and chronic rhinosinusitis, as management differs for each of these cases. Characterization of the phenotype, mechanisms and management of NAR represents one of the major unmet needs in allergic and nonallergic diseases. Studies on children and adults are required in order to appreciate the prevalence, phenotype, severity and co‐morbidities of NAR. These studies should compare allergic and NAR and consider different age group populations including elderly subjects. Mechanistic studies should be carried out to better understand the disease(s) and risk factors and to guide towards an improved diagnosis and therapy. These studies need to take the heterogeneity of NAR into account. It is likely that neuronal mechanisms, T cells, innate immunity and possibly auto‐immune responses all play a role in NAR and may also contribute to the symptoms of allergic rhinitis.

Factors responsible for differences between asymptomatic subjects and patients presenting an IgE sensitization to allergens. A GA2LEN project

The synthesis of allergen‐specific IgE is required for the development of allergic diseases including allergic rhinitis and allergic asthma (patients), but many individuals with allergen‐specific IgE do not develop symptoms (asymptomatic subjects). Differences may exist between asymptomatic subjects and patients. Whether the presence of allergen‐specific IgE translates into clinical allergy most likely depends on a complex interplay of multiple factors. These include a family history of atopy, the levels of total serum IgE and, allergen‐specific IgE or IgG, epitope‐specificity of IgE and their degree of polyclonality (mono‐ vs polysensitized), as yet unidentified serum factors, the balance of T regulatory cells (Treg) and Th1/Th2 cells, the polymorphisms of the high affinity receptor for IgE (FcɛRI) and other factors regulating the activation of FcɛRI‐bearing cells. Asymptomatic subjects may be more often monosensitized than patients who may be more often polysensitized. There are many unanswered important questions that need to be addressed in order to better understand how IgE sensitization translates into clinical allergy. The assessment of differences between the asymptomatic and symptomatic groups of subjects represent one of the scientific programs of Global Allergy and Asthma European Network funded by the European Union and the hypotheses underlying these differences are presented in this paper.

Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN)

The pharmacologic treatment of allergic rhinitis proposed by ARIA is an evidence‐based and step‐wise approach based on the classification of the symptoms. The ARIA workshop, held in December 1999, published a report in 2001 and new information has subsequently been published. The initial ARIA document lacked some important information on several issues. This document updates the ARIA sections on the pharmacologic and anti‐IgE treatments of allergic rhinitis. Literature published between January 2000 and December 2004 has been included. Only a few studies assessing nasal and non‐nasal symptoms are presented as these will be discussed in a separate document.

Primary care: the cornerstone of diagnosis of allergic rhinitis

Allergic rhinitis (AR) is a very common disease with over 600 million people (200 million of them with concomitant asthma) worldwide suffering from it. The majority of patients who seek medical advice are seen in primary care. Although there is a selection of guidelines focused on the management of AR, there is a paucity of guidance on how best to identify patients who would most benefit from treatment. The aim of this paper was to review the best practice for primary care with respect to the diagnosis of AR within that clinical environment.

Rhinitis and asthma represent hot topics for Allergy

Rhinitis and asthma represent hot topics and there are still more questions than answers (1). We urgently need a common international approach, in particular for severe diseases (2). In this issue of the journal, Cooper et al. (3) report on asthma in Latin America and show that this is a public health challenge with interesting research opportunities. The global map of the prevalence of symptoms of rhinoconjunctivitis in children is reported in this issue of the journal by the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three (4). Interesting results are found since elevated prevalence rates are found around the world and not only in developed countries. Important research questions in allergy and related diseases is a new series of the Journal attempting to identify topics of interest for future programs (5). Among the first question published, nonallergic rhinitis (6) appears to be of great relevance due to the very large number of patients (probably hundreds of million around the world) (7, 8), the difficulty to understand the mechanisms (9–18), the importance of occupational agents (19), the links with lower airway disease (20–22), under diagnosis (23), and the lack of adequate treatment. It is important to differentiate nonallergic rhinitis from chronic rhinosinusitis (24). It is possible that the stress response is dysregulated in nonallergic rhinitis as it has been proposed in a challenging hypothesis in asthma (25). Novel therapeutic approaches are needed for the control of nonallergic patients. In this issue of the journal it has been reported that topical corticosteroids down-regulate COX-1 positive cells in nasal polyps (26). The relationship between chronic rhinosinusitis and asthma is still unclear and it is important to find predictors of bronchial hyperresponsiveness in patients with chronic rhinosinusitis (27). Airway remodeling is another important topic and it is needed to differentiate persistence vs progression (28–30). The treatment of severe asthma by anti-IgE is still a hot topic (31–33) including the cost-effectiveness of expensive interventions (34). In the present issue, Humbert et al. (35) show that patients who achieve greatest benefit for their asthma experience with omalizumab therapy also experience greatest benefit for rhinitis. This is the first time that such links are found. The socioeconomic burden of allergic diseases and asthma need to be re-emphasized (36) and Simoens et al. J. Bousquet, T. Bieber, W. Fokkens, M. L. Kowalski, M. Humbert, B. Niggemann, H.-U. Simon University Hospital and Inserm UMR 780, Montpellier, France; Department of Dermatology and Allergy, University of Bonn, Bonn, Germany; Department of Otorhinolanyngology, University of Amsterdam, Amsterdam, the Netherlands; Department of Immunology, Rheumatology and Allergy, Medical University of Ł dź, Ł dź, Poland; Service de Pneumologie, H pital Antoine-B cl re, Universit Paris-Sud, Clamart, France; German Red Cross Hospital, Berlin, Germany; Institute of Pharmacology, University of Bern, Bern, Switzerland

Tissue remodelling in upper airways: where is the link with lower airway remodelling?

Tissue remodelling reported in upper airways include epithelial hyperplasia, increased matrix deposition in the nasal or paranasal lining, matrix degradation and accumulation of plasma proteins. Genetic influences, foetal exposures and early life events may contribute to structural changes such as subepithelial fibrosis from an early age. Other structural alterations are related to duration of the disease and long‐term uncontrolled inflammation. Structural changes may increase alteration of the protective functions of the upper airways namely by affecting mucociliary clearance and conditioning of inspired air. The sequences of tissue changes during wound repair of upper airway mucosa after surgery are illustrative of the complexicity of tissue modelling and remodelling and could be considered as an important source of information for a better understanding of the complex relationship between inflammatory reaction, of the subsequent tissue damages and fibroblast metabolism of upper airways.

Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA2LEN taskforce position paper

To cite this article: Baiardini I, Braido F, Bindslev‐Jensen C, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, Giménez‐Arnau A, Godse K, Grattan C, Grob JJ, La Grutta S, Kalogeromitros D, Kocatürk E, Lombardi C, Mota‐Pinto A, Ridolo E, Saini SS, Sanchez‐Borges M, Senna GE, Terreehorst I, Todo Bom A, Toubi E, Bousquet J, Zuberbier T, Maurer M. Recommendations for assessing patient‐reported outcomes and health‐related quality of life in patients with urticaria: a GA2LEN taskforce position paper. Allergy 2011; 66: 840–844.

Efficacy of desloratadine in persistent allergic rhinitis - a GA²LEN study.

Background: The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent or persistent) rather than on the time of allergen exposure (seasonal or perennial). There had been no placebo-controlled, randomized, clinical trial of desloratadine (DL) in patients with persistent allergic rhinitis to date. Objectives: To assess the efficacy and safety of DL in patients with persistent allergic rhinitis based on the ARIA classification. Methods: Patients 12 years of age and older with persistent allergic rhinitis were assessed over 85 days of treatment with DL 5 mg once daily (n = 360) or placebo (n = 356). The primary endpoint was the AM/PM reflective total 5-symptom score (T5SS) averaged over days 1–29. Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity assessed by a visual analogue scale and quality of life. Results: The mean reduction in AM/PM reflective T5SS was significantly greater with DL than placebo over days 1–29 (–3.76 vs. –2.87, p < 0.001) and on each individual day (p < 0.05). The mean AM instantaneous T5SS was significantly reduced with DL compared with placebo as early as day 2 (–1.90 vs. –1.46; p < 0.001). The therapeutic response and improvement in quality of life were significantly greater with DL than placebo (p < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (10.0%) and placebo (8.4%). Conclusions: This study showed DL to be effective and safe in the treatment of persistent allergic rhinitis.