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Allergic rhinitis (AR), the most prevalent immunological disease, affects approximately 400 million individuals globally and can significantly impact quality of life (QoL). Despite nearly 25 years of guidelines, AR remains largely under- diagnosed, suboptimally treated and poorly controlled. In the light of new knowledge and treatment options, there is a necessity to update or revise fundamental AR definitions to facilitate communication across diverse specialties engaged in its treatment and to improve patient care. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) convened a meeting of experts and patient representatives to deliberate the optimal methodology for measuring AR treatment responses and establishing novel treatment goals. This paper presents a consensus on revised AR definitions, including control, severe allergic rhinoconjunctivitis (SARC), refractory severe allergic rhinoconjunctivitis (R-SARC), remission, resolution, improvement, exacerbation, treatable traits (TTs), treat to target, relapse, progression, disease modification, and prevention., Competing Interests: GKS: Honoraria for articles, speaker and advisory boards: ALK, Bayer, Chiesi, GlaxoSmithKline, Haleon, Noucor, Sanofi- Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Vice President and AR lead for EUFOREA, and Chair/ member Data Monitoring Committees on SLIT for ALK. DMC: Serves as Academic Manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and as Review Editor at Frontiers in Allergy, Rhinology Section. SS: Serves as the Patient Education Manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA). VB: Has received research grants, participated in advisory boards, and developed pharmaceutical studies for GSK, AstraZeneca, Sanofi, Regeneron, Novartis, MSD, Pharmaxis, ALK Abello, Birk NPC, Chiesi and Menarini. MB: Consultation and Advisory Boards: GSK, TerSera Pharma. Bryn Pharma, Soundhealth, Prollergy, and ALK. Speakers Bureau: AstraZeneca, Sanofi, Regeneron, and ALK. AKE: has participated in advisory boards for Abbvie, ALK-Abelló, AstraZeneca, Bausch Health, Circassia Ltd, laxoSmithKline, LEO Pharma, Johnson & Johnson, Merck, Miravo, Mylan, Novartis, Pediapharm and Pfizer, has been a speaker for ALK, Aralez, AstraZeneca, Bausch Health, Boehringer-Ingelheim, CACME, Meda, Medexus, Mylan, Merck, Novartis, Pfizer, The ACADEMY, and Takeda. Her institution has received research grants from AstraZeneca, Bayer, LLC, Circassia Ltd, Green Cross Pharmaceuticals, GlaxoSmithKline, Sun Pharma, Merck, Novartis, Pfizer, Regeneron and Sanofi. She has also served as an independent consultant to Allergy Therapeutics, Bayer, LLC, Ora Inc., and Regeneron in the past. WF: The department of Otorhino. SN: speaker and advisory boards for ALK and Astra Zeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2025 Scadding, Conti, Scheire, Backer, Blaiss, Cardell, De Yun, Ellis, Fokkens, Fox, Gilbert Kruz, Halken, Hellings, Hox, Kalogjera, Lau, Marinho, McDonald, Mösges, Mullol, Nasser, Pawankar, Price, Ryan, Scadding, Smith, Sosa Kostrábová, Vazquez-Ortiz, Wahn, Zhang and Gevaert.)

Chronic upper airway inflammation is amongst the most prevalent chronic disease entities in the Western world with prevalence around 30% (rhinitis) and 11% (rhinosinusitis). Chronic rhinitis and rhinosinusitis may severely impair the quality of life, leading to a significant socio-economic burden. It becomes more and more clear that the respiratory mucosa which forms a physiological as well as chemical barrier for inhaled particles, plays a key role in maintaining homeostasis and driving disease. In a healthy state, the mucosal immune system provides protection against pathogens as well as maintains a tolerance toward non-harmful commensal microbes and benign environmental substances such as allergens. One of the most important players of the mucosal immune system is immunoglobulin (Ig) A, which is well-studied in gut research where it has emerged as a key factor in creating tolerance to potential food allergens and maintaining a healthy microbiome. Although, it is very likely that IgA plays a similar role at the level of the respiratory epithelium, very little research has been performed on the role of this protein in the airways, especially in chronic upper airway diseases. This review summarizes what is known about IgA in upper airway homeostasis, as well as in rhinitis and rhinosinusitis, including current and possible new treatments that may interfere with the IgA system. By doing so, we identify unmet needs in exploring the different roles of IgA in the upper airways required to find new biomarkers or therapeutic options for treating chronic rhinitis and rhinosinusitis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sánchez Montalvo, Gohy, Rombaux, Pilette and Hox.)