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J Allergy Clin Immunol. 2017 Oct;140(4):950-958. doi: 10.1016/j.jaci.2017.03.050. Epub 2017 Jun 8.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision.

Author information

1
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: jan.l.brozek@gmail.com.
2
University Hospital, Montpellier, France.
3
Faculty of Medicine, Transylvania University, Brasov, Romania.
4
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; School of Medicine, University of Toronto, Toronto, Ontario, Canada.
5
Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium.
6
Woolcock Institute, University of Sydney, Sydney, Australia.
7
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
8
Asthma & Allergy Clinic, Humanitas University, Rozzano, Milan, Italy.
9
Division of Allergy and Immunology, University of South Florida, Tampa, Fla.
10
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
11
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, and ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
12
ProAR-Center of Excellence for Asthma, Federal University of Bahia, Salvador, Brazil.
13
University Hospital of Montpellier, Montpellier, and Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.
14
Section of Allergy and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo.
15
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Dirección de Investigación e Innovación Sanitaria, Departamento de Salud, Gobierno Vasco-Eusko Jaurlaritza, Vitoria-Gasteiz, Spain.
16
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, University of Antioquia, Medellin, Colombia.
17
Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands.
18
CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto & Allergy, CUF Porto Hospital and Instituto, Porto, Portugal.
19
Department of Otorhinolaryngology, University Hospitals Leuven, and the Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
20
Center of Rhinology and Allergology, Wiesbaden, Germany.
21
Division of Internal Medicine Asthma and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland.
22
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
23
Hospital Médica Sur, Mexico City, Mexico.
24
Department of Paediatrics, Oslo University Hospital, University of Oslo, Oslo, Norway.
25
Department of Medicine, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland.
26
Department of Pediatrics, Division of Allergy & Immunology, University of California, San Diego, Calif.
27
Unitat de Rinologia i Clínica de l'Olfacte, Servei d'ORL, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.
28
Department of Women and Child Health & Food Allergy Referral Centre Veneto Region, University of Padua, Padua, Italy.
29
Alfred Hospital and Monash University, Melbourne, Australia.
30
National Hospital Organization Tokyo National Hospital, Kiyose-city, Tokyo, Japan.
31
Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic.
32
Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom.
33
Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea.
34
Allergy and Respiratory Diseases, IRCCS San Martino, IST, University of Genoa, Genoa, Italy.
35
Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
36
University of Aberdeen, Aberdeen, United Kingdom.
37
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
38
Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
39
HIV/STI Surveillance Research Center, and World Health Organization Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
40
Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.
41
Allergy Unit, Department of Dermatology, University Hospital of Zürich and Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland.
42
Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
43
Asthma and Inflammation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
44
Department of Pneumology and Allergy, Immunoallèrgia Respiratòria Clínica I Experimental (IDIBAPS), Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
45
Vilnius University Clinic of Children's Diseases and Public Health Institute, Vilnius, and the European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium.
46
Department of Lung Diseases and Clinical Immunology, University of Turku and Allergy Clinic Terveystalo Turku, Turku, Finland.
47
Nova Southeastern University, Fort Lauderdale, Fla.
48
Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
49
Department of Pediatrics, Sachs' Children's Hospital, South General Hospital and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
50
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; School of Medicine, University of Antioquia, Medellín, Colombia.
51
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China.
52
University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
53
Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
54
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

BACKGROUND:

Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update.

OBJECTIVE:

We sought to provide a targeted update of the ARIA guidelines.

METHODS:

The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations.

RESULTS:

The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient.

CONCLUSIONS:

Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

KEYWORDS:

Allergic rhinitis; practice guideline

PMID:
28602936
DOI:
10.1016/j.jaci.2017.03.050
[Indexed for MEDLINE]

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