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1. Time to ACT-UP: Update on precautionary allergen labelling (PAL)

Author

Paul J. Turner, Antonio Bognanni, Stefania Arasi, Ignacio J. Ansotegui, Sabine Schnadt, Sébastien La Vieille, Jonathan O’B. Hourihane, Torsten Zuberbier, Philippe Eigenmann, Motohiro Ebisawa, Mario Morais-Almeida, Julie Barnett, Bryan Martin, Linda Monaci, Graham Roberts, Gary Wong, Ruchi Gupta, Sophia Tsabouri, Clare Mills, Simon Brooke-Taylor, Joan Bartra, Michael Levin, Marion Groetch, Luciana Tanno, Elham Hossny, Barbara Ballmer Weber, Vincenzo Fierro, Ben Remington, Jennifer Gerdts, M. Hazel Gowland, Derek Chu, Marjan Van Ravenhorst, Jennifer Koplin, and Alessandro Fiocchi

Subjects
Food hypersensitivity, Food labelling, Food labelling legislation and jurisprudence, Precautionary allergen labelling, Codex, Risk management, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Precautionary Allergen (“may contain”) Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation — which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL). Objectives: To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards. Methods: A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products. Results: Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows. Conclusions: At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020–2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens.

Published
2024
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2. Concurrent validity, cut‐offs and ability to change of patient‐reported outcome measures for rhinitis and asthma in MASK‐air®

Author

Jean Bousquet, Bernardo Sousa‐Pinto, Josep M. Anto, Anna Bedbrook, Wienczyslawa Czarlewski, Ignacio J. Ansotegui, Karl‐C. Bergmann, Fulvio Braido, Luisa Brussino, Lorenzo Cecchi, Claudia Chaves Loureiro, Alvaro A. Cruz, Philippe Devillier, Alessandro Fiocchi, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Ludger Klimek, Marek Kulus, Piotr Kuna, Maciej Kupczyk, Violeta Kvedariene, Desiree E. Larenas‐Linnemann, Gilles Louis, Renaud Louis, Michael Makris, Mario Morais‐Almeida, Marek Niedoszytko, Ken Ohta, Markus Ollert, Nikolaos Papadopoulos, Vincenzo Patella, Benoit Pétré, Oliver Pfaar, Francesca Puggioni, Santiago Quirce, Frederico S. Regateiro, Nicolas Roche, Philip W. Rouadi, Boleslaw Samolinski, Joaquin Sastre, Florence Schleich, Nicola Scichilone, Luis Taborda‐Barata, Sanna Toppila‐Salmi, Arunas Valiulis, Ilgim Vardaloglu Koyuncu, Maria Teresa Ventura, Arzu Yorgancioglu, Joao A. Fonseca, and Torsten Zuberbier

Subjects
asthma, digital health, EQ‐5D, rhinitis, visual analogue scale, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Patient‐reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person‐centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK‐air® (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut‐offs and responsiveness. Then, a multicentric, multinational, double‐blind, placebo‐controlled, randomised control trial (DB‐PC‐RCT) using an electronic VAS form was carried out. Finally, with the development of MASK‐air® in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ‐5D are included in the app. Additionally, two control‐medication scores for allergic symptoms of asthma (e‐DASTHMA) were validated for their criterion validity, cut‐offs and responsiveness.

Published
2024
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3. Allergic and hypersensitivity condition in the International Patients’ Summary (IPS) standard: The need of updates through the International Classification of Diseases (ICD)-11

Author

Luciana Kase Tanno, MD, PhD, Alain Perie, PhD, Jonathan A. Bernstein, MD, James L. Sublett, MD, Karapet Davtyan, MD, MPH, MBA, Frederic Berard, MD, PhD, Ruby Pawankar, MD, PhD, Marylin Valentin Rostan, MD, Herberto Chong, MD, PhD, Anahi Yañez, MD, Ignacio J. Ansontegui, MD, PhD, Motohiro Ebisawa, MD, PhD, Gary W.K. Wong, MD, PhD, Mario Morais-Almeida, MD, Bryan Martin, MD, Yann Briand, PhD, and Pascal Demoly, MD, PhD

Subjects
Allergy, Anaphylaxis, Classification, Coding, Epidemiology, Hypersensitivity, Immunologic diseases. Allergy, RC581-607
Abstract

In 2010, the United States Human and Health Services (US HHS) and the European Union's (EU) Directorate General for Communications Networks, Content and Technology signed a memorandum of understanding to stimulate cooperation surrounding health-related information communications technology. The key project that emerged from this agreement is the International Patient Summary (IPS), intended to provide succinct clinically relevant patient summaries, which are generalizable and condition-independent, that can be readily used by all clinicians for the care of patients. Although allergies are included in the main information required by the IPS library and framework, it is misrepresented which leads to underdiagnosis or misdiagnosis of patients suffering from allergic and hypersensitivity conditions (A/H). The French and Montpellier World Health Organization (WHO) Collaborating Centres have provided arguments for supporting representation of A/H in the IPS. These are based on the relevance of the new classification of A/H in the WHO International Classification of Diseases 11th version (ICD-11), and the need for alignment of eHealth tools with harmonized health information. We first present the A/H in the IPS initiative with the mission of producing an international information system that can be used globally in electronic health records to standardize clinical diagnoses and facilitate communication between clinicians caring for patients with A/H diseases. It is believed this initiative will provide a strong voice for the allergy community and an effective process for improving the quality of health data that will optimize medical care for our patients worldwide.

Published
2024
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4. Relevance of individual bronchial symptoms for asthma diagnosis and control in patients with rhinitis: A MASK‐air study

Author

Bernardo Sousa‐Pinto, Gilles Louis, Rafael J. Vieira, Wienczyslawa Czarlewski, Josep M. Anto, Rita Amaral, Ana Sá‐Sousa, Luisa Brussino, G. Walter Canonica, Claudia Chaves Loureiro, Alvaro A. Cruz, Bilun Gemicioglu, Tari Haahtela, Maciej Kupczyk, Violeta Kvedariene, Desirée E. Larenas‐Linnemann, Nhân Pham‐Thi, Francesca Puggioni, Frederico S. Regateiro, Jan Romantowski, Joaquin Sastre, Nicola Scichilone, Luis Taborda‐Barata, Maria Teresa Ventura, Ioana Agache, Anna Bedbrook, Alida Benfante, Karl C. Bergmann, Sinthia Bosnic‐Anticevich, Matteo Bonini, Louis‐Philippe Boulet, Guy Brusselle, Roland Buhl, Lorenzo Cecchi, Denis Charpin, Elisio M. Costa, Stefano Del Giacco, Marek Jutel, Ludger Klimek, Piotr Kuna, Daniel Laune, Mika Makela, Mario Morais‐Almeida, Rachel Nadif, Marek Niedoszytko, Nikolaos G. Papadopoulos, Alberto Papi, Oliver Pfaar, Daniela Rivero‐Yeverino, Nicolas Roche, Boleslaw Samolinski, Mohamed H. Shamji, Aziz Sheikh, Charlotte Suppli Ulrik, Omar S. Usmani, Arunas Valiulis, Arzu Yorgancioglu, Torsten Zuberbier, Joao A. Fonseca, Benoit Pétré, Renaud Louis, Jean Bousquet, and MASK‐air think tank

Subjects
asthma, diagnosis, dyspnea, mHealth, wheezing, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Rationale It is unclear how each individual asthma symptom is associated with asthma diagnosis or control. Objectives To assess the performance of individual asthma symptoms in the identification of patients with asthma and their association with asthma control. Methods In this cross‐sectional study, we assessed real‐world data using the MASK‐air® app. We compared the frequency of occurrence of five asthma symptoms (dyspnea, wheezing, chest tightness, fatigue and night symptoms, as assessed by the Control of Allergic Rhinitis and Asthma Test [CARAT] questionnaire) in patients with probable, possible or no current asthma. We calculated the sensitivity, specificity and predictive values of each symptom, and assessed the association between each symptom and asthma control (measured using the e‐DASTHMA score). Results were validated in a sample of patients with a physician‐established diagnosis of asthma. Measurement and Main Results We included 951 patients (2153 CARAT assessments), with 468 having probable asthma, 166 possible asthma and 317 no evidence of asthma. Wheezing displayed the highest specificity (90.5%) and positive predictive value (90.8%). In patients with probable asthma, dyspnea and chest tightness were more strongly associated with asthma control than other symptoms. Dyspnea was the symptom with the highest sensitivity (76.1%) and the one consistently associated with the control of asthma as assessed by e‐DASTHMA. Consistent results were observed when assessing patients with a physician‐made diagnosis of asthma. Conclusions Wheezing and chest tightness were the asthma symptoms with the highest specificity for asthma diagnosis, while dyspnea displayed the highest sensitivity and strongest association with asthma control.

Published
2024
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5. Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study

Author

Bernardo Sousa-Pinto, PhD, Cristina Jácome, PhD, Ana Margarida Pereira, MD, Frederico S Regateiro, MD, Rute Almeida, PhD, Wienczyslawa Czarlewski, MD, Marek Kulus, ProfMD, Mohamed H Shamji, ProfMD, Louis-Philippe Boulet, ProfMD, Matteo Bonini, MD, Luisa Brussino, MD, G Walter Canonica, ProfMD, Alvaro A Cruz, MD, Bilun Gemicioglu, ProfMD, Tari Haahtela, ProfMD, Maciej Kupczyk, MD, Violeta Kvedariene, MD, Desirée Larenas-Linnemann, MD, Renaud Louis, ProfMD, Marek Niedoszytko, ProfMD, Nhân Pham-Thi, MD, Francesca Puggioni, MD, Jan Romantowski, MD, Joaquin Sastre, ProfMD, Nicola Scichilone, ProfMD, Luis Taborda-Barata, ProfMD, Maria Teresa Ventura, MD, Rafael José Vieira, MD, Ioana Agache, ProfMD, Anna Bedbrook, BSc, Karl C Bergmann, MD, Rita Amaral, PhD, Luís Filipe Azevedo, PhD, Sinthia Bosnic-Anticevich, ProfPhD, Guy Brusselle, ProfMD, Roland Buhl, ProfMD, Lorenzo Cecchi, MD, Denis Charpin, MD, Claudia Chaves Loureiro, MD, Frédéric de Blay, ProfMD, Stefano Del Giacco, ProfMD, Philippe Devillier, ProfMD, Ewa Jassem, ProfMD, Guy Joos, ProfMD, Marek Jutel, ProfMD, Ludger Klimek, MD, Piotr Kuna, ProfMD, Daniel Laune, PhD, Jorge Luna Pech, MD, Mika Makela, ProfMD, Mario Morais-Almeida, MD, Rachel Nadif, PhD, Hugo E Neffen, MD, Ken Ohta, ProfMD, Nikolaos G Papadopoulos, ProfMD, Alberto Papi, ProfMD, Benoit Pétré, MD, Oliver Pfaar, MD, Daniela Rivero Yeverino, MD, Carlos Robalo Cordeiro, ProfMD, Nicolas Roche, ProfMD, Ana Sá-Sousa, PhD, Boleslaw Samolinski, ProfMD, Aziz Sheikh, ProfMD, Charlotte Suppli Ulrik, ProfMD, Omar S Usmani, ProfMD, Arunas Valiulis, ProfMD, Olivier Vandenplas, ProfMD, Pedro Vieira-Marques, PhD, Arzu Yorgancioglu, ProfMD, Torsten Zuberbier, ProfMD, Josep M Anto, ProfMD, João A Fonseca, PhD, and Jean Bousquet, ProfMD

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Summary: Background: Validated questionnaires are used to assess asthma control over the past 1–4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). Methods: We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16–90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test–retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. Findings: We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68–0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59–0·68). They also displayed high test–retest reliability (intraclass correlation coefficients range 0·79–0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69–0·79; effect size measures range 0·57–0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61–0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68–0·78). Interpretation: e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. Funding: None.

Published
2023
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6. Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Author

Ignacio J. Ansotegui, Jonathan A. Bernstein, Giorgio W. Canonica, Sandra N. Gonzalez-Diaz, Bryan L. Martin, Mario Morais-Almeida, Margarita Murrieta-Aguttes, and Mario Sanchez Borges

Subjects
Urticaria, Fexofenadine hydrochloride, Clinical guidelines, Second-generation antihistamines, Pediatric, Adults, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Objective The present narrative review provides a comprehensive update of the current knowledge on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride (HCl) as a treatment option. Data source A literature search was conducted on Embase and Medline. Study selection Clinical studies published in English and published between 1999 and 2020 were selected. Results Although the exact pathogenesis of urticaria is not fully understood, multiple pathways of mast cell activation are discussed to explain the existence of phenotypically different clinical manifestations of urticaria. An overview of the worldwide prevalence of chronic urticaria, including disease burden and patient’s quality of life is provided. The impact of urticaria on patient’s life differs on the basis of whether its form is acute or chronic, but pharmacological approaches are most often needed to control the disabling symptoms. A summary of the current management of urticaria recommended by different guidelines across countries (Global; European; American; Australian; Asian; Japanese) is presented. Non-sedating, second-generation H1-antihistamines are the preferred choice of treatment across several guidelines worldwide. Herein, the efficacy and safety of fexofenadine HCl, a representative second-generation H1-antihistamine approved for the treatment of urticaria, is discussed. The occurrence of urticaria manifestations in COVID-19 patients is also briefly presented. Conclusion The burden of acute and chronic urticaria is high for patients. Second generation anti-histamines such as fexofenadine HCl can help managing the symptoms.

Published
2022
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7. Digitally‐enabled, patient‐centred care in rhinitis and asthma multimorbidity: The ARIA‐MASK‐air® approach

Author

Jean Bousquet, Josep M. Anto, Bernardo Sousa‐Pinto, Wienczyslawa Czarlewski, Anna Bedbrook, Tari Haahtela, Ludger Klimek, Oliver Pfaar, Piotr Kuna, Maciej Kupczyk, Frederico S. Regateiro, Boleslaw Samolinski, Arunas Valiulis, Arzu Yorgancioglu, Sylvie Arnavielhe, Xavier Basagaña, Karl C. Bergmann, Sinthia Bosnic‐Anticevich, Luisa Brussino, G. Walter Canonica, Victoria Cardona, Lorenzo Cecchi, Claudia Chaves‐Loureiro, Elisio Costa, Alvaro A. Cruz, Bilun Gemicioglu, Wytske J. Fokkens, Juan Carlos Ivancevich, Helga Kraxner, Violeta Kvedariene, Désirée E. Larenas‐Linnemann, Daniel Laune, Renaud Louis, Michael Makris, Marcus Maurer, Erik Melén, Yann Micheli, Mario Morais‐Almeida, Joaquim Mullol, Marek Niedoszytko, Yoshitaka Okamoto, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham‐Thi, Philip W. Rouadi, Joaquin Sastre, Nicola Scichilone, Aziz Sheikh, Mikhail Sofiev, Luis Taborda‐Barata, Sanna Toppila‐Salmi, Ioanna Tsiligianni, Erkka Valovirta, Maria Teresa Ventura, Rafael José Vieira, Mihaela Zidarn, Rita Amaral, Ignacio J. Ansotegui, Annabelle Bédard, Samuel Benveniste, Michael Bewick, Carsten Bindslev‐Jensen, Hubert Blain, Matteo Bonini, Rodolphe Bourret, Fulvio Braido, Pedro Carreiro‐Martins, Denis Charpin, Ivan Cherrez‐Ojeda, Tomas Chivato, Derek K. Chu, Cemal Cingi, Stefano DelGiacco, Frédéric deBlay, Philippe Devillier, Govert DeVries, Maria Doulaptsi, Virginie Doyen, Gérard Dray, Jean‐François Fontaine, R. Maximiliano Gomez, Jan Hagemann, Enrico Heffler, Maja Hofmann, Ewa Jassem, Marek Jutel, Thomas Keil, Vicky Kritikos, Inger Kull, Marek Kulus, Olga Lourenço, Eve Mathieu‐Dupas, Enrica Menditto, Ralph Mösges, Ruth Murray, Rachel Nadif, Hugo Neffen, Stefania Nicola, Robyn O’Hehir, Heidi Olze, Yuliia Palamarchuk, Jean‐Louis Pépin, Benoit Pétré, Robert Picard, Constantinos Pitsios, Francesca Puggioni, Santiago Quirce, Filip Raciborski, Sietze Reitsma, Nicolas Roche, Monica Rodriguez‐Gonzalez, Jan Romantowski, Ana Sá‐Sousa, Faradiba S. Serpa, Marine Savouré, Mohamed H. Shamji, Milan Sova, Annette Sperl, Cristiana Stellato, Ana Todo‐Bom, Peter Valentin Tomazic, Olivier Vandenplas, Michiel VanEerd, Tuula Vasankari, Frédéric Viart, Susan Waserman, Joao A. Fonseca, and Torsten Zuberbier

Subjects
asthma, digital, MASK‐air, mHealth, rhinitis, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract MASK‐air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK‐air® is a Good Practice of DG Santé on digitally‐enabled, patient‐centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co‐operation and Development). MASK‐air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK‐air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as‐needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom‐medication score (ARIA‐EAACI‐CSMS) has been validated for clinical practice and trials. The implications of the novel MASK‐air® results should lead to change management in rhinitis and asthma.

Published
2023
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8. Real‐world data using mHealth apps in rhinitis, rhinosinusitis and their multimorbidities

Author

Bernardo Sousa‐Pinto, Aram Anto, Markus Berger, Stephanie Dramburg, Oliver Pfaar, Ludger Klimek, Marek Jutel, Wienczyslawa Czarlewski, Anna Bedbrook, Arunas Valiulis, Ioana Agache, Rita Amaral, Ignacio J. Ansotegui, Katharina Bastl, Uwe Berger, Karl C. Bergmann, Sinthia Bosnic‐Anticevich, Fulvio Braido, Luisa Brussino, Victoria Cardona, Thomas Casale, G. Walter Canonica, Lorenzo Cecchi, Denis Charpin, Tomás Chivato, Derek K. Chu, Cemal Cingi, Elisio M. Costa, Alvaro A. Cruz, Philippe Devillier, Stephen R. Durham, Motohiro Ebisawa, Alessandro Fiocchi, Wytske J. Fokkens, Bilun Gemicioğlu, Maia Gotua, Maria‐Antonieta Guzmán, Tari Haahtela, Juan Carlos Ivancevich, Piotr Kuna, Igor Kaidashev, Musa Khaitov, Violeta Kvedariene, Désirée E. Larenas‐Linnemann, Brian Lipworth, Daniel Laune, Paolo M. Matricardi, Mario Morais‐Almeida, Joaquim Mullol, Robert Naclerio, Hugo Neffen, Kristoff Nekam, Marek Niedoszytko, Yoshitaka Okamoto, Nikolaos G. Papadopoulos, Hae‐Sim Park, Giovanni Passalacqua, Vincenzo Patella, Simone Pelosi, Nhân Pham‐Thi, Ted A. Popov, Frederico S. Regateiro, Sietze Reitsma, Monica Rodriguez‐Gonzales, Nelson Rosario, Philip W. Rouadi, Boleslaw Samolinski, Ana Sá‐Sousa, Joaquin Sastre, Aziz Sheikh, Charlotte Suppli Ulrik, Luis Taborda‐Barata, Ana Todo‐Bom, Peter Valentin Tomazic, Sanna Toppila‐Salmi, Salvatore Tripodi, Ioanna Tsiligianni, Erkka Valovirta, Maria Teresa Ventura, Antonio A. Valero, Rafael José Vieira, Dana Wallace, Susan Waserman, Sian Williams, Arzu Yorgancioglu, Luo Zhang, Mihaela Zidarn, Jaron Zuberbier, Heidi Olze, Josep M. Antó, Torsten Zuberbier, João A. Fonseca, and Jean Bousquet

Subjects
allergic rhinitis, app, chronic rhinosinusitis, mHealth, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Digital health is an umbrella term which encompasses eHealth and benefits from areas such as advanced computer sciences. eHealth includes mHealth apps, which offer the potential to redesign aspects of healthcare delivery. The capacity of apps to collect large amounts of longitudinal, real‐time, real‐world data enables the progression of biomedical knowledge. Apps for rhinitis and rhinosinusitis were searched for in the Google Play and Apple App stores, via an automatic market research tool recently developed using JavaScript. Over 1500 apps for allergic rhinitis and rhinosinusitis were identified, some dealing with multimorbidity. However, only six apps for rhinitis (AirRater, AllergyMonitor, AllerSearch, Husteblume, MASK‐air and Pollen App) and one for rhinosinusitis (Galenus Health) have so far published results in the scientific literature. These apps were reviewed for their validation, discovery of novel allergy phenotypes, optimisation of identifying the pollen season, novel approaches in diagnosis and management (pharmacotherapy and allergen immunotherapy) as well as adherence to treatment. Published evidence demonstrates the potential of mobile health apps to advance in the characterisation, diagnosis and management of rhinitis and rhinosinusitis patients.

Published
2022
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9. WAO-ARIA consensus on chronic cough – Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D’ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortego-Martell, MD, Olivia J.Ly Lesslar, MBBS BIR, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Upper airway cough syndrome, Lower airway disease, Reflux cough, Chronic cough management, Neuromodulators, Speech therapy, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.

Published
2022
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10. Allergen immunotherapy in MASK‐air users in real‐life: Results of a Bayesian mixed‐effects model

Author

Bernardo Sousa‐Pinto, Luís Filipe Azevedo, Ana Sá‐Sousa, Rafael José Vieira, Rita Amaral, Ludger Klimek, Wienczyslawa Czarlewski, Josep M. Anto, Anna Bedbrook, Violeta Kvedariene, Maria Teresa Ventura, Ignacio J. Ansotegui, Karl‐Christian Bergmann, Luisa Brussino, G. Walter Canonica, Victoria Cardona, Pedro Carreiro‐Martins, Thomas Casale, Lorenzo Cecchi, Tomás Chivato, Derek K. Chu, Cemal Cingi, Elisio M. Costa, Alvaro A. Cruz, Giulia De Feo, Philippe Devillier, Wytske J. Fokkens, Mina Gaga, Bilun Gemicioğlu, Tari Haahtela, Juan Carlos Ivancevich, Zhanat Ispayeva, Marek Jutel, Piotr Kuna, Igor Kaidashev, Helga Kraxner, Désirée E. Larenas‐Linnemann, Daniel Laune, Brian Lipworth, Renaud Louis, Michaël Makris, Riccardo Monti, Mario Morais‐Almeida, Ralph Mösges, Joaquim Mullol, Mikaëla Odemyr, Yoshitaka Okamoto, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham‐Thi, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Milan Sova, Ana Todo‐Bom, Luis Taborda‐Barata, Peter Valentin Tomazic, Sanna Toppila‐Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, João Almeida Fonseca, Jean Bousquet, and Oliver Pfaar

Subjects
allergic rhinitis, immunotherapy, mobile health, patient‐reported outcomes, real‐life data analysis, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Background Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real‐life studies. Objective To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK‐air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods We assessed the MASK‐air® data of European users with self‐reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales—VASs), and a combined symptom‐medication score (CSMS). We applied Bayesian mixed‐effects models, with clustering by patient, country and pollen season. Results We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT‐tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = −12.1;−2.8), lower VAS Work (average difference = 5.0; 95%CrI = −8.5;−1.5), and a lower CSMS (average difference = 3.7; 95%CrI = −9.3;2.2). When compared to SCIT, SLIT‐tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = −17.2;−2.8), lower VAS Work (average difference = 7.8; 95%CrI = −15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = −18.5;0.2). Conclusion In patients with grass pollen allergy, SLIT‐tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally‐harmonised standards for performing and reporting real‐world data in AIT are needed to better understand its ‘real‐world’ effectiveness.

Published
2022
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11. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation — Updates in COVID-19

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona S. Al-Ahmad, MD, FRCPCP, Anahi Yañez, MD, Maryam Ali Y. Al-Nesf, MD, MSc R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, René Maximiliano Gómez, MD, PhD, Sandra N. Gonzalez Diaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana K. Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, Jose Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
Multifactorial cough, Cough phenotypes, Type 2 inflammation, COVID 19, Reflux-cough, Upper airway cough syndrome, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. Outcomes: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

Published
2021
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12. WAO-ARIA consensus on chronic cough – Part 1: Role of TRP channels in neurogenic inflammation of cough neuronal pathways

Author

Philip W. Rouadi, MD, Samar A. Idriss, MD, Jean Bousquet, MD, PhD, Tanya M. Laidlaw, MD, Cecilio R. Azar, MD, Mona Sulaiman AL-Ahmad, MD, FAAAI, FRCPCP, Anahí Yáñez, MD, Maryam Ali Y. AL-Nesf, MD, MSc, R, CABHS, Talal M. Nsouli, MD, FACAAI, FAAAAI, Sami L. Bahna, MD, DrPH, Eliane Abou-Jaoude, MD, Fares H. Zaitoun, MD, FACAAI, Usamah M. Hadi, MD, FACS, ERS, PARS, Peter W. Hellings, MD, PhD, Glenis K. Scadding, MD, FRCP, Peter K. Smith, BMedSci, MBBS, FRACP, PhD, Mario Morais-Almeida, MD, R. Maximiliano Gómez, MD, PhD, Sandra N. González Díaz, MD, PhD, Ludger Klimek, MD, PhD, Georges S. Juvelekian, MD, FCCP, D'ABSM, Moussa A. Riachy, MD, FCCP, Giorgio Walter Canonica, MD, David Peden, MD, Gary W.K. Wong, MD, James Sublett, MD, Jonathan A. Bernstein, MD, Lianglu Wang, MD, Luciana Kase Tanno, MD, PhD, Manana Chikhladze, PhD, Michael Levin, MD, PhD, Yoon-Seok Chang, MD, PhD, Bryan L. Martin, DO, Luis Caraballo, MD, PhD, Adnan Custovic, MD, PhD, José Antonio Ortega-Martell, MD, Erika Jensen-Jarolim, MD, Motohiro Ebisawa, MD, PhD, Alessandro Fiocchi, MD, and Ignacio J. Ansotegui, MD, PhD

Subjects
TRP channel, P2X3, Pathogenesis, Chronic cough, Chemoreceptors, Mechanoreceptors, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. Outcomes: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases.

Published
2021
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14. ARIA‐EAACI care pathways for allergen immunotherapy in respiratory allergy

Author

Jean Bousquet, Oliver Pfaar, Ioana Agache, Anna Bedbrook, Cezmi A Akdis, G. Walter Canonica, Tomas Chivato, Mona Al‐Ahmad, Amir H Abdul Latiff, Ignacio J Ansotegui, Claus Bachert, Abdullah Baharuddin, Karl‐Christian Bergmann, Carsten Bindslev‐Jensen, Leif Bjermer, Matteo Bonini, Sinthia Bosnic‐Anticevich, Isabelle Bosse, Helen A. Brough, Luisa Brussino, Moises A Calderon, Luis Caraballo, Victoria Cardona, Pedro Carreiro‐Martins, Tomas Casale, Lorenzo Cecchi, Alfonso M Cepeda Sarabia, Ekaterine Chkhartishvili, Derek K Chu, Ieva Cirule, Alvaro A Cruz, Wienczyslawa Czarlewski, Stefano delGiacco, Pascal Demoly, Philippe Devillier, Dejan Dokic, Stephen L Durham, Motohiro Ebisawa, Yehia El‐Gamal✝, Regina Emuzyte, Amiran Gamkrelidze, Jean Luc Fauquert, Alessandro Fiocchi, Wytske J Fokkens, Joao A Fonseca, Jean‐François Fontaine, Radoslaw Gawlik, Asli Gelincik, Bilun Gemicioglu, Jose E Gereda, Roy Gerth van Wijk, R Maximiliano Gomez, Maia Gotua, Ineta Grisle, Maria‐Antonieta Guzmán, Tari Haahtela, Susanne Halken, Enrico Heffler, Karin Hoffmann‐Sommergruber, Elham Hossny, Martin Hrubiško, Carla Irani, Juan Carlos Ivancevich, Zhanat Ispayeva, Kaja Julge, Igor Kaidashev, Omer Kalayci, Musa Khaitov, Ludger Klimek, Edward Knol, Marek L Kowalski, Helga Kraxner, Inger Kull, Piotr Kuna, Violeta Kvedariene, Vicky Kritikos, Antti Lauerma, Susanne Lau, Daniel Laune, Michael Levin, Desiree E Larenas‐Linnemann, Karin C Lodrup Carlsen, Carlo Lombardi, Olga M Lourenço, Bassam Mahboub, Hans‐Jørgen Malling, Patrick Manning, Gailen D Marshall, Erik Melén, Eli O Meltzer, Neven Miculinic, Branislava Milenkovic, Mostafa Moin, Stephen Montefort, Mario Morais‐Almeida, Charlotte G Mortz, Ralph Mösges, Joaquim Mullol, Leyla Namazova Baranova, Hugo Neffen, Kristof Nekam, Marek Niedoszytko, Mikaëla Odemyr, Robyn E O'Hehir, Markus Ollert, Liam O'Mahony, Ken Ohta, Yoshitaka Okamoto, Kimi Okubo, Giovanni B Pajno, Oscar Palomares, Susanna Palkonen, Petr Panzner, Nikolaos GPapadopoulos, Hae‐Sim Park, Giovanni Passalacqua, Vincenzo Patella, Ruby Pawankar, Nhân Pham‐Thi, Davor Plavec, Todor A Popov, Marysia Recto, Frederico S Regateiro, Carmen Riggioni, Graham Roberts, Monica Rodriguez‐Gonzales, Nelson Rosario, Menachem Rottem, Philip W Rouadi, Dermot Ryan, Boleslaw Samolinski, Mario Sanchez‐Borges✝, Faradiba S Serpa, Joaquin Sastre, Glenis K. Scadding, Mohamed H Shamji, Peter Schmid‐Grendelmeier, Holger J Schünemann, Aziz Sheikh, Nicola Scichilone, Juan Carlos Sisul, Mikhail Sofiev, Dirceu Solé, Talant Sooronbaev, Manuel Soto‐Martinez, Manuel Soto‐Quiros, Milan Sova, Jürgen Schwarze, Isabel Skypala, Charlotte Suppli‐Ulrik, Luis Taborda‐Barata, Ana Todo‐Bom, Maria J Torres, Marylin Valentin‐Rostan, Peter‐Valentin Tomazic, Antonio Valero, Sanna Toppila‐Salmi, Ioanna Tsiligianni, Eva Untersmayr, Marilyn Urrutia‐Pereira, Arunas Valiulis, Erkka Valovirta, Olivier Vandenplas, Maria Teresa Ventura, Pakit Vichyanond, Martin Wagenmann, Dana Wallace, Jolanta Walusiak‐Skorupa, De Yun Wang, Susan Waserman, Gary WK Wong, Arzu Yorgancioglu, Osman M Yusuf, Mario Zernotti, Luo Zhang, Mihaela Zidarn, Torsten Zuberbier, and Marek Jutel

Subjects
allergic rhinitis, asthma, immunotherapy, precision medicine, Immunologic diseases. Allergy, RC581-607
Published
2021
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15. Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases

Author

J. Jean Bousquet, Holger J. Schünemann, Alkis Togias, Marina Erhola, Peter W. Hellings, Torsten Zuberbier, Ioana Agache, Ignacio J. Ansotegui, Josep M. Anto, Claus Bachert, Sven Becker, Martin Bedolla-Barajas, Michael Bewick, Sinthia Bosnic-Anticevich, Isabelle Bosse, Louis P. Boulet, Jean Marc Bourrez, Guy Brusselle, Niels Chavannes, Elisio Costa, Alvaro A. Cruz, Wienczyslawa Czarlewski, Wytske J. Fokkens, Joao A. Fonseca, Mina Gaga, Tari Haahtela, Maddalena Illario, Ludger Klimek, Piotr Kuna, Violeta Kvedariene, L. T. T. Le, Desiree Larenas-Linnemann, Daniel Laune, Olga M. Lourenço, Enrica Menditto, Joaquin Mullol, Yashitaka Okamoto, Nikos Papadopoulos, Nhân Pham-Thi, Robert Picard, Hilary Pinnock, Nicolas Roche, Regina E. Roller-Wirnsberger, Christine Rolland, Boleslaw Samolinski, Aziz Sheikh, Sanna Toppila-Salmi, Ioanna Tsiligianni, Arunas Valiulis, Erkka Valovirta, Tuula Vasankari, Maria-Teresa Ventura, Samantha Walker, Sian Williams, Cezmi A. Akdis, Isabella Annesi-Maesano, Sylvie Arnavielhe, Xavier Basagana, Eric Bateman, Anna Bedbrook, K. S. Bennoor, Samuel Benveniste, Karl C. Bergmann, Slawomir Bialek, Nils Billo, Carsten Bindslev-Jensen, Leif Bjermer, Hubert Blain, Mateo Bonini, Philippe Bonniaud, Jacques Bouchard, Vitalis Briedis, Christofer E. Brightling, Jan Brozek, Roland Buhl, Roland Buonaiuto, Giorgo W. Canonica, Victoria Cardona, Ana M. Carriazo, Warner Carr, Christine Cartier, Thomas Casale, Lorenzo Cecchi, Alfonso M. Cepeda Sarabia, Eka Chkhartishvili, Derek K. Chu, Cemal Cingi, Elaine Colgan, Jaime Correia de Sousa, Anne Lise Courbis, Adnan Custovic, Biljana Cvetkosvki, Gennaro D’Amato, Jane da Silva, Carina Dantas, Dejand Dokic, Yves Dauvilliers, Antoni Dedeu, Giulia De Feo, Philippe Devillier, Stefania Di Capua, Marc Dykewickz, Ruta Dubakiene, Motohiro Ebisawa, Yaya El-Gamal, Esben Eller, Regina Emuzyte, John Farrell, Antjie Fink-Wagner, Alessandro Fiocchi, Jean F. Fontaine, Bilun Gemicioğlu, Peter Schmid-Grendelmeir, Amiran Gamkrelidze, Judith Garcia-Aymerich, Maximiliano Gomez, Sandra González Diaz, Maia Gotua, Nick A. Guldemond, Maria-Antonieta Guzmán, Jawad Hajjam, John O’B Hourihane, Marc Humbert, Guido Iaccarino, Despo Ierodiakonou, Juan C. Ivancevich, Guy Joos, Ki-Suck Jung, Marek Jutel, Igor Kaidashev, Omer Kalayci, Przemyslaw Kardas, Thomas Keil, Mussa Khaitov, Nikolai Khaltaev, Jorg Kleine-Tebbe, Marek L. Kowalski, Vicky Kritikos, Inger Kull, Lisa Leonardini, Philip Lieberman, Brian Lipworth, Karin C. Lodrup Carlsen, Claudia C. Loureiro, Renaud Louis, Alpana Mair, Gert Marien, Bassam Mahboub, Joao Malva, Patrick Manning, Esteban De Manuel Keenoy, Gailen D. Marshall, Mohamed R. Masjedi, Jorge F. Maspero, Eve Mathieu-Dupas, Poalo M. Matricardi, Eric Melén, Elisabete Melo-Gomes, Eli O. Meltzer, Jacques Mercier, Neven Miculinic, Florin Mihaltan, Branislava Milenkovic, Giuliana Moda, Maria-Dolores Mogica-Martinez, Yousser Mohammad, Steve Montefort, Ricardo Monti, Mario Morais-Almeida, Ralf Mösges, Lars Münter, Antonella Muraro, Ruth Murray, Robert Naclerio, Luigi Napoli, Leila Namazova-Baranova, Hugo Neffen, Kristoff Nekam, Angelo Neou, Enrico Novellino, Dieudonné Nyembue, Robin O’Hehir, Ken Ohta, Kimi Okubo, Gabrielle Onorato, Solange Ouedraogo, Isabella Pali-Schöll, Susanna Palkonen, Peter Panzner, Hae-Sim Park, Jean-Louis Pépin, Ana-Maria Pereira, Oliver Pfaar, Ema Paulino, Jim Phillips, Davor Plavec, Ted A. Popov, Fabienne Portejoie, David Price, Emmanuel P. Prokopakis, Benoit Pugin, Filip Raciborski, Rojin Rajabian-Söderlund, Sietze Reitsma, Xavier Rodo, Antonino Romano, Nelson Rosario, Menahenm Rottem, Dermot Ryan, Johanna Salimäki, Mario M. Sanchez-Borges, Juan-Carlos Sisul, Dirceu Solé, David Somekh, Talant Sooronbaev, Milan Sova, Otto Spranger, Cristina Stellato, Rafael Stelmach, Charlotte Suppli Ulrik, Michel Thibaudon, Teresa To, Ana Todo-Bom, Peter V. Tomazic, Antonio A. Valero, Rudolph Valenta, Marylin Valentin-Rostan, Rianne van der Kleij, Olivier Vandenplas, Giorgio Vezzani, Frédéric Viart, Giovanni Viegi, Dana Wallace, Martin Wagenmann, De Y. Wang, Susan Waserman, Magnus Wickman, Dennis M. Williams, Gary Wong, Piotr Wroczynski, Panayiotis K. Yiallouros, Arzu Yorgancioglu, Osman M. Yusuf, Heahter J. Zar, Stéphane Zeng, Mario Zernotti, Luo Zhang, Nan S. Zhong, Mihaela Zidarn, the ARIA Study Group, and the MASK Study Group

Subjects
Health care transformation, Care pathways, Rhinitis, ARIA, MASK, POLLAR, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Background In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.

Published
2019
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16. Growth and mouth breathers

Author

Mario Morais‐Almeida, Gustavo Falbo Wandalsen, and Dirceu Solé

Subjects
Pediatrics, RJ1-570
Abstract

Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers. Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: “mouth breathing”, “adenotonsilar hypertrophy”, “allergic rhinitis”, “sleep disturbance” AND “growth impairment”, “growth hormone”, “failure to thrive”, “short stature”, or “failure to thrive”. Data summary: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). Conclusions: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner. Resumo: Objetivo: Avaliar a relação entre respiração oral e distúrbios do crescimento entre crianças e adolescentes. Fonte de dados: Busca na base de dados do MEDLINE, nos últimos 10 anos, com o emprego dos seguintes termos: “mouth breathing” ou “adenotonsilar hypertrophy”, ou “allergic rhinitis” ou sleep disturbance” AND “growth impairment” ou “growth hormone” ou “failure to thrive” ou “short stature” ou “failure to thrive”. Síntese dos dados: Foram identificados 247 artigos, que após a leitura dos títulos foram reduzidos a 45, cujos resumos foram lidos e desses 20 foram considerados de importância e integraram a revisão. Além desses, referências por eles citadas e livros‐texto específicos sobre respiração oral considerados importantes foram incluídos. A hipertrofia de tonsilas palatinas e/ou faríngeas, associada ou não à rinite alérgica, assim como a rinite alérgica mal controlada, é a principal causa de respiração oral na criança. Distúrbios respiratórios do sono são frequentes entre esses pacientes. Vários estudos associam a respiração oral à redução do crescimento, bem como à redução de liberação de hormônio do crescimento, que são restabelecidos após o tratamento efetivo da respiração oral (clínico e/ou cirúrgico). Conclusões: A respiração oral deve ser cogitada como possível causa de retardo de crescimento em crianças e cabe ao pediatra a tarefa de investigar esses pacientes de forma mais abrangente. Keywords: Allergic rhinitis, Adenoid hypertrophy, Tonsillar hypertrophy, Mouth breather, Growth, Palavras‐chave: Rinite alérgica, Hipertrofia de adenoide, Hipertrofia de amígdala, Respirador oral, Crescimento

Published
2019
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18. Allergy and coronavirus disease (COVID-19) international survey: Real-life data from the allergy community during the pandemic

Author

Luciana Kase Tanno, Pascal Demoly, Bryan Martin, Jonathan Berstein, Mario Morais-Almeida, Michael Levin, Alessandro Fiocchi, Mario Sánchez-Borges, Luis R. Caraballo, Gary Wong, José Antonio Ortega-Martell, Philip Rouadi, Anahí Yáñez, Liang Lu Wang, David B. Peden, Manana Chikhladze, Sandra N. González-Díaz, Jean-François Fontaine, James Sublett, Yoon-Seok Chang, Giovanni Passalacqua, Ignacio J. Ansotegui, Motohiro Ebisawa, Gianenrico Senna, and Marco Caminati

Subjects
Allergy, Allergen immunotherapy, Asthma, Biological agents, Coronavirus, COVID-19, Immunologic diseases. Allergy, RC581-607
Abstract

Background: The COVID-19 outbreak brought an unprecedented challenge to the world. Knowledge in the field has been increasing exponentially and the main allergy societies have produced guidance documents for better management of allergic patients during this period. However, few publications so far have provided real-life data from the allergy community concerning allergy practice during the COVID-19 outbreak. Therefore, we proposed an international survey on the management of allergic patients during the current pandemic. Methods: We performed an online survey undertaken to reach out the worldwide allergy community by e-mail and social media. The web-based questionnaire contained 24 questions covering demographic data from the participants, clinical practice during this period, and questions related to the new international classification and coding tools addressed for COVID-19. It was circulated for 8 weeks and had anonymous and volunteer context. Results: Data are presented for 635 participants from 78 countries of all continents. Allergists with long-term professional experience were the main audience. As expected, we received many responses as “I have no data” or “I don't know” to the questions of the survey. However, most with more experience on managing allergic patients during the pandemic agreed that patients suffering from allergic or hypersensitivity conditions have no increased risk of contracting COVID-19 or developing SARS CoV-2. Also, participants mentioned that none of the allergy treatments (inhaled corticosteroids, allergen immunotherapy, biological agents) increased the risk of contracting COVID-19 infection including severe presentations. Conclusion: The data presented are a starting point in the process of getting feedback on all the recommendations provided by the allergy societies; it could also be the basis of new strategies to support health professionals while new COVID-19 specific treatments and vaccines are being explored. The information here presented intends to be helpful to the community but represents a course of action in a highly specific situation due to the state of emergency, and it should be helpful to health systems.

Published
2021
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19. Acute asthma management during SARS-CoV2-pandemic 2020

Author

Michael Levin, Ignacio J. Ansotegui, Jonathan Bernstein, Yoon-Seok Chang, Manana Chikhladze, Motohiro Ebisawa, Alessandro Fiocchi, Enrico Heffler, Bryan Martin, Mario Morais-Almeida, Nikolaos G. Papadopoulos, David Peden, and Gary W.K. Wong

Subjects
Asthma, COVID-19, Exacerbation, Infectious risk, Inhalers, Protocol, Immunologic diseases. Allergy, RC581-607
Abstract

Background: The current COVID-19 pandemic has changed many medical practices in order to provide additional protection to both our patients and healthcare providers. In many cases this includes seeing patients through electronic means such as telehealth or telephone rather than seeing them in person. Asthma exacerbations cannot always be treated in this way. Problem: Current emergency unit asthma guidelines recommend bronchodilators be administered by metered dose inhaler (MDI) and spacer for mild-moderate asthma and include it as a choice even in severe asthma, but many emergency units continue to prefer nebulised therapy for patients who urgently require beta-agonists. The utilization of nebulised therapy potentially increases the risk of aerosolization of the coronavirus. Since nosocomial transmission of respiratory pathogens is a major threat in the context of the SARS-CoV-2 pandemic, use of nebulised therapy is of even greater concern due to the potential increased risk of infection spread to nearby patients and healthcare workers. Practical implications: We propose a risk stratification plan that aims to avoid nebulised therapy, when possible, by providing an algorithm to help better delineate those who require nebulised therapy. Protocols that include strategies to allow flexibility in using MDIs rather than nebulisers in all but the most severe patients should help mitigate this risk of aerosolised infection transmission to patients and health care providers. Furthermore, expedient treatment of patients with high dose MDI therapy augmented with more rapid initiation of systemic therapy may help ensure patients are less likely to deteriorate to the stage where nebulisers are required.

Published
2020
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20. Still Fighting for Breath: a patient survey of the challenges and impact of severe asthma

Author

Paraskevi Katsaounou, Mikaela Odemyr, Otto Spranger, Michael E. Hyland, Claus Kroegel, Lorena Garcia Conde, Robin Gore, Francesco Menzella, Christian Domingo Ribas, Mario Morais-Almeida, Matthias Gasser, and Ismail Kasujee

Subjects
Medicine
Abstract

We conducted a large global survey, Still Fighting for Breath, in patients with severe persistent asthma, 10 years after the Fighting for Breath survey to assess the impact of disease on patients' lives and to determine if control and management have changed in recent years. Data were collected from 1333 adults (aged >18 years) and caregivers of children (aged 6–17 years) with severe persistent asthma from nine countries through an online survey conducted in 2016 by GfK. A decade after the first survey, our results showed that the impact of severe asthma has not changed significantly and a high proportion of patients with severe asthma remain inadequately controlled. A large discrepancy was observed between the proportion of patients who perceived their asthma to be well controlled (42%) and the proportion of patients who reported to be well controlled as per the Global Initiative for Asthma (GINA) assessment (6%). Although most patients perceived their asthma to be controlled, many experienced frequent symptoms that affected their daily lives. Thus, there is a need for improved management (support and strategies) of patients with severe persistent asthma and improved coordination of efforts that would enable these patients to achieve better disease control.

Published
2018
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21. The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis

Author

Jean Bousquet, Mondher Toumi, Bernardo Sousa-Pinto, Josep M. Anto, Anna Bedbrook, Wienczyslawa Czarlewski, Arunas Valiulis, Ignacio J. Ansotegui, Sinthia Bosnic-Anticevich, Luisa Brussino, G. Walter Canonica, Lorenzo Cecchi, Ivan Cherrez-Ojeda, Tomas Chivato, Elísio M. Costa, Alvaro A. Cruz, Stefano Del Giacco, Joao A. Fonseca, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Marek Jutel, Igor Kaidashev, Ludger Klimek, Violeta Kvedariene, Piotr Kuna, Désirée E. Larenas-Linnemann, Brian Lipworth, Mario Morais-Almeida, Joaquim Mullol, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham-Thi, Frederico S. Regateiro, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Luis Taborda-Barata, Maria Teresa Ventura, Arzu Yorgancioglu, Mihaela Zidarn, and Torsten Zuberbier

Subjects
Treatment, Value-added medicine, Allergic rhinitis, MASK-air, Repurposing, Humans, Disease Management, Immunology and Allergy, Rhinitis, Allergic, Mobile Applications, Asthma, Telemedicine
Abstract

Drug repurposing is a major field of value-added medicine. It involves investigating and evaluating existing drugs for new therapeutic purposes that address unmet healthcare needs. Several unmet needs in allergic rhinitis could be improved by drug repurposing. This could be game-changing for disease management. Current medications for allergic rhinitis are centered on continuous long-term treatment, and medication registration is based on randomized controlled trials carried out for a minimum of 14 days with adherence of 70% or greater. A new way of treating allergic rhinitis is to propose as-needed treatment depending on symptoms, rather than classical continuous treatment. This rostrum will discuss existing clinical trials on as-needed treatment for allergic rhinitis and real-world data obtained by the mobile health app MASK-air, which focuses on digitally-enabled, patient-centered care pathways.

Published
2022

22. Patient-centred digital biomarkers for allergic respiratory diseases and asthma:the ARIA-EAACI approach

Author

Jean Bousquet, Mohamed H. Shamji, Josep M. Anto, Holger J. Schünemann, G. Walter Canonica, Marek Jutel, Stefano Del Giacco, Torsten Zuberbier, Oliver Pfaar, Joao A. Fonseca, Bernardo Sousa‐Pinto, Ludger Klimek, Wienczyslawa Czarlewski, Anna Bedbrook, Rita Amaral, Ignacio J. Ansotegui, Sinthia Bosnic‐Anticevich, Fulvio Braido, Claudia Chaves Loureiro, Bilun Gemicioglu, Tari Haahtela, Marek Kulus, Piotr Kuna, Maciej Kupczyk, Paolo M. Matricardi, Frederico S. Regateiro, Boleslaw Samolinski, Mikhail Sofiev, Sanna Toppila‐Salmi, Arunas Valiulis, Maria Teresa Ventura, Cristina Barbara, Karl C. Bergmann, Michael Bewick, Hubert Blain, Matteo Bonini, Louis‐Philippe Boulet, Rodolphe Bourret, Guy Brusselle, Luisa Brussino, Roland Buhl, Victoria Cardona, Thomas Casale, Lorenzo Cecchi, Denis Charpin, Ivan Cherrez‐Ojeda, Derek K. Chu, Cemal Cingi, Elisio M. Costa, Alvaro A. Cruz, Philippe Devillier, Stephanie Dramburg, Wytske J. Fokkens, Maia Gotua, Enrico Heffler, Zhanat Ispayeva, Juan Carlos Ivancevich, Guy Joos, Igor Kaidashev, Helga Kraxner, Violeta Kvedariene, Désirée E. Larenas‐Linnemann, Daniel Laune, Olga Lourenço, Renaud Louis, Mika Makela, Michael Makris, Marcus Maurer, Erik Melén, Yann Micheli, Mario Morais‐Almeida, Joaquim Mullol, Marek Niedoszytko, Robyn O’Hehir, Yoshitaka Okamoto, Heidi Olze, Nikolaos G. Papadopoulos, Alberto Papi, Vincenzo Patella, Benoit Pétré, Nhân Pham‐Thi, Francesca Puggioni, Santiago Quirce, Nicolas Roche, Philip W. Rouadi, Ana Sá‐Sousa, Hironori Sagara, Joaquin Sastre, Nicola Scichilone, Aziz Sheikh, Milan Sova, Charlotte Suppli Ulrik, Luis Taborda‐Barata, Ana Todo‐Bom, Maria J. Torres, Ioanna Tsiligianni, Omar S. Usmani, Erkka Valovirta, Tuula Vasankari, Rafael José Vieira, Dana Wallace, Susan Waserman, Mihaela Zidarn, Arzu Yorgancioglu, Luo Zhang, Tomas Chivato, and Markus Ollert

Subjects
Immunology, Immunology and Allergy
Abstract

Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the center of the health system and is likely to optimize the practice of allergy. Allergic Rhinitis and its Impact on Asthma (ARIA) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomized controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, was embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of-life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.

Published
2023

23. Development and validation of combined symptom-medication scores for allergic rhinitis*

Author

Bernardo Sousa‐Pinto, Luís Filipe Azevedo, Marek Jutel, Ioana Agache, G. Walter Canonica, Wienczyslawa Czarlewski, Nikolaos G. Papadopoulos, Karl‐Christian Bergmann, Philippe Devillier, Daniel Laune, Ludger Klimek, Aram Anto, Josep M. Anto, Patrik Eklund, Rute Almeida, Anna Bedbrook, Sinthia Bosnic‐Anticevich, Helen A. Brough, Luisa Brussino, Victoria Cardona, Thomas Casale, Lorenzo Cecchi, Denis Charpin, Tomás Chivato, Elisio M. Costa, Alvaro A. Cruz, Stephanie Dramburg, Stephen R. Durham, Giulia De Feo, Roy Gerth van Wijk, Wystke J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Maddalena Illario, Juan Carlos Ivancevich, Violeta Kvedariene, Piotr Kuna, Désirée E. Larenas‐Linnemann, Michael Makris, Eve Mathieu‐Dupas, Erik Melén, Mario Morais‐Almeida, Ralph Mösges, Joaquim Mullol, Kari C. Nadeau, Nhân Pham‐Thi, Robyn O’Hehir, Frederico S. Regateiro, Sietze Reitsma, Boleslaw Samolinski, Aziz Sheikh, Cristiana Stellato, Ana Todo‐Bom, Peter Valentin Tomazic, Sanna Toppila‐Salmi, Antonio Valero, Arunas Valiulis, Maria Teresa Ventura, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Govert De Vries, Michiel van Eerd, Petra Zieglmayer, Torsten Zuberbier, Oliver Pfaar, João Almeida Fonseca, Jean Bousquet, Internal Medicine, HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, University of Helsinki, Ear, Nose and Throat, AII - Inflammatory diseases, Publica, Sousa-Pinto, B., Azevedo, L. F., Jutel, M., Agache, I., Canonica, G. W., Czarlewski, W., Papadopoulos, N. G., Bergmann, K. -C., Devillier, P., Laune, D., Klimek, L., Anto, A., Anto, J. M., Eklund, P., Almeida, R., Bedbrook, A., Bosnic-Anticevich, S., Brough, H. A., Brussino, L., Cardona, V., Casale, T., Cecchi, L., Charpin, D., Chivato, T., Costa, E. M., Cruz, A. A., Dramburg, S., Durham, S. R., De Feo, G., Gerth van Wijk, R., Fokkens, W. J., Gemicioglu, B., Haahtela, T., Illario, M., Ivancevich, J. C., Kvedariene, V., Kuna, P., Larenas-Linnemann, D. E., Makris, M., Mathieu-Dupas, E., Melen, E., Morais-Almeida, M., Mosges, R., Mullol, J., Nadeau, K. C., Pham-Thi, N., O'Hehir, R., Regateiro, F. S., Reitsma, S., Samolinski, B., Sheikh, A., Stellato, Cristiana, Todo-Bom, A., Tomazic, P. V., Toppila-Salmi, S., Valero, A., Valiulis, A., Ventura, M. T., Wallace, D., Waserman, S., Yorgancioglu, A., De Vries, G., van Eerd, M., Zieglmayer, P., Zuberbier, T., Pfaar, O., Almeida Fonseca, J., and Bousquet, J.

Subjects
Work, medication score, quality-of-life, rhinitis, symptom score, work, Respiratory Medicine and Allergy, Immunology, QUESTIONNAIRE, RESPONSIVENESS, Humans, Immunology and Allergy, IMMUNOTHERAPY, VALIDITY, Lungmedicin och allergi, Rhinitis, Medication score, EQ-5D, Reproducibility of Results, IMPAIRMENT, Rhinitis, Allergic, WORK PRODUCTIVITY, Symptom score, rhiniti, TRIALS, 3121 General medicine, internal medicine and other clinical medicine, RELIABILITY, Quality of Life, ASTHMA, Quality-of-life, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Background: Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air® app to generate and validate hypothesis- and data-driven CSMSs. Methods: We used MASK-air® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air®, and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]). Results: We assessed 317,176 days of MASK-air® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820). Conclusion: The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.

Published
2022

24. Improvement of daily allergy control by sublingual immunotherapy: A <scp>MASK</scp> ‐air® study

Author

Jean Bousquet, Bernardo Sousa‐Pinto, Mohamed H. Shamji, Josep M. Anto, Ludger Klimek, G. Walter Canonica, Wienczyslawa Czarlewski, Philippe Devillier, Tari Haahtela, Daniel Laune, Joaquim Mullol, Luisa Brussino, Lorenzo Cecchi, Violeta Kvedariene, Mario Morais‐Almeida, Ralph Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham‐Thi, Boleslaw Samolinski, Luis Taborda‐Barata, Sanna Toppila‐Salmi, Joaquin Sastre, Arunas Valiulis, Maria Teresa Ventura, Marek Jutel, Piotr Kuna, Erkka Valovirta, Torsten Zuberbier, Joao A. Fonseca, and Oliver Pfaar

Subjects
Immunology, Immunology and Allergy
Abstract

Data de publicació electrònica: 17-04-2023

Published
2023

25. Cut-off values of MASK-air® Patient-Reported Outcome Measures (PROMs)

Author

Bernardo, Sousa-Pinto, Ana, Sá-Sousa, Rafael José, Vieira, Rita, Amaral, Ana Margarida, Pereira, Josep M, Anto, Ludger, Klimek, Wienczyslawa, Czarlewski, Joaquim, Mullol, Oliver, Pfaar, Anna, Bedbrook, Luisa, Brussino, Violeta, Kvedariene, Desirée E, Larenas-Linnemann, Yoshitaka, Okamoto, Maria Teresa, Ventura, Ignacio J, Ansotegui, Sinthia, Bosnic-Anticevich, G Walter, Canonica, Victoria, Cardona, Lorenzo, Cecchi, Tomas, Chivato, Cemal, Cingi, Elísio M, Costa, Alvaro A, Cruz, Stefano, Del Giacco, Philippe, Devillier, Wytske J, Fokkens, Bilun, Gemicioglu, Tari, Haahtela, Juan Carlos, Ivancevich, Piotr, Kuna, Igor, Kaidashev, Helga, Kraxner, Daniel, Laune, Renaud, Louis, Michael, Makris, Riccardo, Monti, Mario, Morais-Almeida, Ralph, Mösges, Marek, Niedoszytko, Nikolaos G, Papadopoulos, Vincenzo, Patella, Nhân, Pham-Thi, Frederico S, Regateiro, Sietze, Reitsma, Philip W, Rouadi, Boleslaw, Samolinski, Aziz, Sheikh, Milan, Sova, Luis, Taborda-Barata, Sanna, Toppila-Salmi, Joaquin, Sastre, Ioanna, Tsiligianni, Arunas, Valiulis, Arzu, Yorgancioglu, Mihaela, Zidarn, Torsten, Zuberbier, Joao A, Fonseca, and Jean, Bousquet

Abstract

In clinical and epidemiological studies, cut-offs of Patient-Reported Outcome Measures (PROMs) can be used to classify patients into groups of statistical and clinical relevance. However, visual analog scale (VAS) cut-offs in MASK-air® have not been tested.To calculate cut-offs for VAS global, nasal, ocular, and asthma symptoms.In a cross-sectional study design of all MASK-air® participants, we compared (i) approaches based on the percentiles (tertiles or quartiles) of VAS distributions, and (ii) data-driven approaches based on clusters of data from two comparators (VAS work and VAS sleep). We then performed sensitivity analyses for individual countries and for VAS levels corresponding to full allergy control. Finally, we tested the different approaches using MASK-air® real-world cross-sectional and longitudinal data to assess the most relevant cut-offs.We assessed 395,223 days from 23,201 MASK-air® users with self-reported allergic rhinitis. The percentile-oriented approach resulted in lower cut-off values than the data-driven approach. We obtained consistent results in the data-driven approach. Following the latter, the proposed cut-off differentiating "controlled" and "partly-controlled" patients was similar to the cut-off value which had been arbitrarily used (20/100). However, a lower cut-off was obtained to differentiate between "partly-controlled" and "uncontrolled" patients (35 versus the arbitrarily-used value of 50/100).Using a data-driven approach, we were able to define cut-off values for MASK-air® VASs on allergy and asthma symptoms. This may allow for a better classification of rhinitis and asthma patients according to different levels of control, supporting improved disease management.

Published
2022

26. Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference

Author

Bernardo Sousa‐Pinto, Holger J. Schünemann, Ana Sá‐Sousa, Rafael José Vieira, Rita Amaral, Josep M. Anto, Ludger Klimek, Wienczyslawa Czarlewski, Joaquim Mullol, Oliver Pfaar, Anna Bedbrook, Luisa Brussino, Violeta Kvedariene, Desirée Larenas‐Linnemann, Yoshitaka Okamoto, Maria Teresa Ventura, Ioana Agache, Ignacio J. Ansotegui, Karl C. Bergmann, Sinthia Bosnic‐Anticevich, Jan Brozek, G. Walter Canonica, Victoria Cardona, Pedro Carreiro‐Martins, Thomas Casale, Lorenzo Cecchi, Tomas Chivato, Derek K. Chu, Cemal Cingi, Elísio M. Costa, Alvaro A. Cruz, Stefano Del Giacco, Philippe Devillier, Patrik Eklund, Wytske J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Zhanat Ispayeva, Marek Jutel, Piotr Kuna, Igor Kaidashev, Musa Khaitov, Helga Kraxner, Daniel Laune, Brian Lipworth, Renaud Louis, Michael Makris, Riccardo Monti, Mario Morais‐Almeida, Ralph Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham‐Thi, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Milan Sova, Ana Todo‐Bom, Luis Taborda‐Barata, Sanna Toppila‐Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Olivier Vandenplas, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, Joao A. Fonseca, Jean Bousquet, Ear, Nose and Throat, AII - Inflammatory diseases, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (MGD) Service de pneumologie, Comprehensive Health Research Centre (CHRC) - pólo NMS, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Publica

Subjects
allergic rhinitis, real-world data, allergen immunotherapy, co-medication, multivariable mixed-effects model, Immunology, Allergen immunotherapy, Rhinitis, Allergic, Adrenal Cortex Hormones, Desensitization, Immunologic, HDE ALER, Immunology and Allergy, Fluticasone, Humans, Rhinitis
Abstract

Funding Information: IA reports personal fees from Roxall, Menarini, UCB, Faes Farma, Sanofi, Bial, Amgen, Abbott, Bayer, Organon. SBA reports grants from TEVA, personal fees from TEVA, AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, Mylan. JB reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi‐Aventis, Takeda, Teva, Uriach, other from KYomed‐Innov, personal fees from Purina, other from MASK‐air. VC reports personal fees from Thermofisher. PCM reports personal fees from Abbvie, AZ, Bial, GSK, Mylan, Medinfar, Novartis, Sanofi. LC reports personal fees from Malesci, Menarini, Astra Zeneca, Novartis. AC reports grants and personal fees from Astrazeneca, GSK, Sanofi, personal fees from Boehringer‐Ingelheim, Chiesi, Glenmark, Novartis, personal fees from Mylan, Abdi‐Ibrahim. PD reports personal fees and non‐financial support from Stallergenes Greer, ALK‐Abello, Astra Zeneca, CHIESI, MYLAN/Meda Pharma, Novartis, GlaxoSmithKline, Sanofi, IQVIA personal fees from MENARINI. JAFonseca reports participation in SME that has mHealth technologies for patients with asthma. JCI reports personal fees from Abbott Ecuador, Bago Bolivia, Faes Farma, Laboratorios Casasco, Sanofi. LK reports grants and personal fees from Allergopharma, LETI Pharma,MEDA/Mylan, Sanofi, personal fees from HAL Allergie, Allergy Therapeut., Cassella med, grants from ALK Abelló, Stallergenes, Quintiles, ASIT biotech, Lofarma, AstraZeneca, GSK, Inmunotk, and Membership: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO‐BV, GPA, EAACI. VK reports other from Norameda, BerlinCHemie Menarini. PK reports personal fees from Adamed, AstraZeneca, Berlin Chemie Menarini, Boehringer Ingelheim, Chiesi, GSK, Novartis, Polpharma. DLL reports personal fees from Allakos, Amstrong, Astrazeneca, Chiesi, DBV Technologies, Grunenthal, GSK, Mylan/Viatris, Menarini, MSD, Novartis, Pfizer, Sanofi, Siegfried, UCB, Alakos, Gossamer, Carnot, grants from Sanofi, Astrazeneca, Novartis, Circassia, UCB, GSK, Purina institute, Abvvie, Lilly, Pfizer. BL reports grants and personal fees from Meda, personal fees from Glenamrk. RL reports grants and personal fees from GSK, AZ, Chiesi, personal fees from Novartis, Sanofi. MM reports personal fees from Novartis, Gsk, Menarini, Az, Chiesi, Sanofi, Pfizer. RM reports personal fees from Angelini Pharma ALK, Allergopharma, Allergy Therapeutics, Friulchem, Hexal, Servier, Klosterfrau, Bayer, FAES, GSK, MSD, Johnson&Johnson, Meda, Stada, UCB, Nuvo, Menarini, Mundipharma, Pohl‐Boskamp, Laboratoire de la Mer, Sidroga, Lek, PRO‐AdWise, grants and personal fees from Bencard, Stallergenes, Ursapharm, HAL BV, grants from Leti, Optima, BitopAG, Hulka, Inmunotek, Cassella‐med GmbH & Co. KG, ASIT biotech, grants, personal fees and non‐financial support from Lofarma, non‐financial support from Roxall, Atmos, Bionorica, Otonomy, Ferrero, personal fees and non‐financial support from Novartis. OP reports grants and personal fees from ALK‐Abelló, Allergopharma, Stallergenes Greer HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., Laboratorios LETI/LETI Pharma, Anergis S.A., GlaxoSmithKline, personal fees from MEDA Pharma/MYLAN, Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies, Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi‐Aventis and Sanofi‐Genzyme, Med Update Europe GmbH, streamedup! GmbH, John Wiley and Sons, AS, Paul‐Martini‐Stiftung (PMS), Regeneron Pharmaceuticals Inc., RG Aerztefortbildung, Institut für Disease Management, Springer GmbH, AstraZeneca, IQVIA Commercial, Ingress Health, grants from Pohl‐Boskamp, Inmunotek S.L., Biomay, Circassia. NGPapadopoulos reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare. ATB reports personal fees from AstraZeneca, GSK, Novartis, IQVIA/Abbvie, Mylan, Bial, Leti, grants and personal fees from Teva. STS reports personal fees from ERT, Roche products, Novartis, Sanofi Pharma, AstraZeneca, ALK‐ Abelló grants from Glaxo Smith Kline. IT reports grants from GSK, Boehringer Ingelheim, AZ, personal fees from Novartis, Astra Zeneca, Chiesi, TZ reports Organizational affiliations: Committee member: WHO‐Initiative “Allergic Rhinitis and Its Impact on Asthma” (ARIA); Member of the Board: German Society for Allergy and Clinical Immunology (DGAKI); Head: European Centre for Allergy Research Foundation (ECARF). President: Global Allergy and Asthma European Network (GA2LEN); Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO). Funding Information: MASK‐air® has been supported by EU grants (POLLAR, EIT Health; Structural and Development Funds, Twinning, EIP on AHA and H2020) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis and Uriach 1 1 Publisher Copyright: © 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. Background: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., “real-world data”). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. Methods: We assessed the MASK-air® app data (May 2015–December 2020) by users self-reporting AR (16–90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication. Results: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71–0.80). Conclusion: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines. publishersversion published

Published
2022

27. Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air

Author

Bernardo, Sousa-Pinto, Ana, Sá-Sousa, Rafael José, Vieira, Rita, Amaral, Ludger, Klimek, Wienczyslawa, Czarlewski, Josep M, Antó, Oliver, Pfaar, Anna, Bedbrook, Violeta, Kvedariene, Maria Teresa, Ventura, Ignacio J, Ansotegui, Karl-Christian, Bergmann, Luisa, Brussino, G Walter, Canonica, Victoria, Cardona, Pedro, Carreiro-Martins, Tomas, Casale, Lorenzo, Cecchi, Tomás, Chivato, Derek K, Chu, Cemal, Cingi, Elísio M, Costa, Alvaro A, Cruz, Giulia, De Feo, Philippe, Devillier, Wytske J, Fokkens, Mina, Gaga, Bilun, Gemicioğlu, Tari, Haahtela, Juan Carlos, Ivancevich, Zhanat, Ispayeva, Marek, Jutel, Piotr, Kuna, Igor, Kaidashev, Helga, Kraxner, Désirée E, Larenas-Linnemann, Daniel, Laune, Brian, Lipworth, Renaud, Louis, Michael, Makris, Riccardo, Monti, Mario, Morais-Almeida, Ralph, Mösges, Joaquim, Mullol, Mikaëla, Odemyr, Yoshitaka, Okamoto, Nikolaos G, Papadopoulos, Vincenzo, Patella, Nhân, Pham-Thi, Frederico S, Regateiro, Sietze, Reitsma, Philip W, Rouadi, Boleslaw, Samolinski, Milan, Sova, Ana, Todo-Bom, Luis, Taborda-Barata, Peter Valentin, Tomazic, Sanna, Toppila-Salmi, Joaquin, Sastre, Ioanna, Tsiligianni, Arunas, Valiulis, Olivier, Vandenplas, Dana, Wallace, Susan, Waserman, Arzu, Yorgancioglu, Mihaela, Zidarn, Torsten, Zuberbier, João A, Fonseca, and Jean, Bousquet

Subjects
Europe, Habits, Histamine Antagonists, Humans, Rhinitis, Allergic, Rhinitis
Abstract

Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data.We analysed 2015-2020 MASK-airWe analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral HAllergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.

Published
2022

28. Consistent trajectories of rhinitis control and treatment in 16,177 weeks: The MASK-air® longitudinal study

Author

Bernardo Sousa‐Pinto, Holger J. Schünemann, Ana Sá‐Sousa, Rafael José Vieira, Rita Amaral, Josep M. Anto, Ludger Klimek, Wienczyslawa Czarlewski, Joaquim Mullol, Oliver Pfaar, Anna Bedbrook, Luisa Brussino, Violeta Kvedariene, Désirée E. Larenas‐Linnemann, Yoshitaka Okamoto, Maria Teresa Ventura, Ioana Agache, Ignacio J. Ansotegui, Karl C. Bergmann, Sinthia Bosnic‐Anticevich, G. Walter Canonica, Victoria Cardona, Pedro Carreiro‐Martins, Thomas Casale, Lorenzo Cecchi, Tomas Chivato, Derek K. Chu, Cemal Cingi, Elísio M. Costa, Alvaro A. Cruz, Stefano Del Giacco, Philippe Devillier, Patrik Eklund, Wytske J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Zhanat Ispayeva, Marek Jutel, Piotr Kuna, Igor Kaidashev, Musa Khaitov, Helga Kraxner, Daniel Laune, Brian Lipworth, Renaud Louis, Michael Makris, Riccardo Monti, Mario Morais‐Almeida, Ralph Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham‐Thi, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Milan Sova, Ana Todo‐Bom, Luis Taborda‐Barata, Sanna Toppila‐Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Olivier Vandenplas, Dana Wallace, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, Joao A. Fonseca, Jean Bousquet, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (MGD) Service de pneumologie, Ear, Nose and Throat, AII - Inflammatory diseases, HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, Helsinki University Hospital Area, and Department of Pathology

Subjects
Patient-reported outcomes, real-world data, Respiratory Medicine and Allergy, Immunology, Oto-rino-laryngologi, Rhinitis* / epidemiology, Real-world data, rhinitis, Otorhinolaryngology, patient-reported outcomes, Surveys and Questionnaires, HDE ALER, 3121 General medicine, internal medicine and other clinical medicine, Humans, Immunology and Allergy, Longitudinal Studies, Mobile health, mobile health, Telemedicine, Lungmedicin och allergi, Rhinitis
Abstract

Data de publicació electrònica: 03-11-2022 Introduction: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. Methods: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. Results: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. Conclusions: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.

Published
2022

29. Cutoff Values of MASK-air Patient-Reported Outcome Measures

Author

Bernardo Sousa-Pinto, Ana Sá-Sousa, Rafael José Vieira, Rita Amaral, Ana Margarida Pereira, Josep M. Anto, Ludger Klimek, Wienczyslawa Czarlewski, Joaquim Mullol, Oliver Pfaar, Anna Bedbrook, Luisa Brussino, Violeta Kvedariene, Desirée E. Larenas-Linnemann, Yoshitaka Okamoto, Maria Teresa Ventura, Ignacio J. Ansotegui, Sinthia Bosnic-Anticevich, G. Walter Canonica, Victoria Cardona, Lorenzo Cecchi, Tomas Chivato, Cemal Cingi, Elísio M. Costa, Alvaro A. Cruz, Stefano Del Giacco, Philippe Devillier, Wytske J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Piotr Kuna, Igor Kaidashev, Helga Kraxner, Daniel Laune, Renaud Louis, Michael Makris, Riccardo Monti, Mario Morais-Almeida, Ralph Mösges, Marek Niedoszytko, Nikolaos G. Papadopoulos, Vincenzo Patella, Nhân Pham-Thi, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Milan Sova, Luis Taborda-Barata, Sanna Toppila-Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, Joao A. Fonseca, and Jean Bousquet

Subjects
Asthma, Conjunctivitis, Cutoffs, MASK-air, Rhinitis, Immunology and Allergy
Published
2022

30. Development and Validation of an Electronic Daily Control Score for Asthma (e-DASTHMA)

Author

Bernardo Sousa-Pinto, Cristina Jácome, Ana Margarida Pereira, Frederico S. Regateiro, Rute Almeida, Wienczyslawa Czarlewski, Marek Kulus, Mohamed Shamji, Louis Philippe Boulet, Matteo Bonini, Luisa Brussino, G. Walter Canonica, Álvaro Cruz, Bilun Gemicioglu, Tari Haahtela, Maciej Kupczyk, Violeta Kvedariene, Desirée Larenas-Linnemann, Renaud Louis, Marek Niedoszytko, Nhân Pham-Thi, Francesca Puggioni, Jan Romantowski, Joaquin Sastre, Nicola Scichilone, Luis Taborda-Barata, Maria Teresa Ventura, Rafael José Vieira, Ioana Agache, Anna Bedbrook, Karl C. Bergmann, Rita Amaral, Luís Filipe Azevedo, Sinthia Bosnic-Anticevich, Guy Brusselle, Roland Buhl, Lorenzo Cecchi, Denis Charpin, Claudia Chaves Loureiro, Frédéric de Blay, Stefano Del Giacco, Philippe Devillier, Ewa Jassem, Guy Joos, Marek Jutel, Ludger Klimek, Piotr Kuna, Daniel Laune, Jorge Luna Pech, Mika Makela, Mario Morais-Almeida, Rachel Nadif, Hugo E. Neffen, Ken Ohta, Nikolaos G. Papadopoulos, Alberto Papi, Benoit Pétré, Oliver Pfaar, Daniela Rivero Yeverino, Carlos Robalo-Cordeiro, Nicolas Roche, Ana Sá-Sousa, Boleslaw Samolinski, Aziz Sheikh, Charlotte Suppli Ulrik, Omar Usmani, Arunas Valiulis, Olivier Vandenplas, Pedro Vieira-Marques, Arzu Yorgancioglu, Torsten Zuberbier, Josep M. Antó, Joao A. Fonseca, and Jean Bousquet

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022

31. Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride

Author

Ignacio J, Ansotegui, Jonathan A, Bernstein, Giorgio W, Canonica, Sandra N, Gonzalez-Diaz, Bryan L, Martin, Mario, Morais-Almeida, Margarita, Murrieta-Aguttes, and Mario, Sanchez Borges

Abstract

The present narrative review provides a comprehensive update of the current knowledge on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride (HCl) as a treatment option.A literature search was conducted on Embase and Medline.Clinical studies published in English and published between 1999 and 2020 were selected.Although the exact pathogenesis of urticaria is not fully understood, multiple pathways of mast cell activation are discussed to explain the existence of phenotypically different clinical manifestations of urticaria. An overview of the worldwide prevalence of chronic urticaria, including disease burden and patient's quality of life is provided. The impact of urticaria on patient's life differs on the basis of whether its form is acute or chronic, but pharmacological approaches are most often needed to control the disabling symptoms. A summary of the current management of urticaria recommended by different guidelines across countries (Global; European; American; Australian; Asian; Japanese) is presented. Non-sedating, second-generation HThe burden of acute and chronic urticaria is high for patients. Second generation anti-histamines such as fexofenadine HCl can help managing the symptoms.

Published
2021

32. Academic Productivity of Young People With Allergic Rhinitis: A MASK-air Study

Author

Rafael José Vieira, Nhân Pham-Thi, Josep M. Anto, Wienczyslawa Czarlewski, Ana Sá-Sousa, Rita Amaral, Anna Bedbrook, Sinthia Bosnic-Anticevich, Luisa Brussino, G. Walter Canonica, Lorenzo Cecchi, Alvaro A. Cruz, Wytske J. Fokkens, Bilun Gemicioglu, Tari Haahtela, Juan Carlos Ivancevich, Ludger Klimek, Piotr Kuna, Violeta Kvedariene, Désirée Larenas-Linnemann, Mario Morais-Almeida, Joaquim Mullol, Marek Niedoszytko, Yoshitaka Okamoto, Nikolaos G. Papadopoulos, Vincenzo Patella, Oliver Pfaar, Frederico S. Regateiro, Sietze Reitsma, Philip W. Rouadi, Boleslaw Samolinski, Aziz Sheikh, Luis Taborda-Barata, Sanna Toppila-Salmi, Joaquin Sastre, Ioanna Tsiligianni, Arunas Valiulis, Maria Teresa Ventura, Susan Waserman, Arzu Yorgancioglu, Mihaela Zidarn, Torsten Zuberbier, João A. Fonseca, Jean Bousquet, Bernardo Sousa-Pinto, Publica, Ear, Nose and Throat, and AII - Inflammatory diseases

Subjects
Adolescent, Visual Analog Scale, MASK, Academic productivity, Allergic rhinitis, Mobile health, Real-world data, Efficiency, Rhinitis, Allergic, Surveys and Questionnaires, Quality of Life, Humans, Immunology and Allergy, Rhinitis
Abstract

Background: Several studies have suggested an impact of allergic rhinitis on academic productivity. However, large studies with real-world data (RWD) are not available. Objective: To use RWD to assess the impact of allergic rhinitis on academic performance (measured through a visual analog scale [VAS] education and the Work Productivity and Activity Impairment Questionnaire plus Classroom Impairment Questions: Allergy Specific [WPAI+CIQ:AS] questionnaire), and to identify factors associated with the impact of allergic rhinitis on academic performance. Methods: We assessed data from the MASK-air mHealth app of users aged 13 to 29 years with allergic rhinitis. We assessed the correlation between variables measuring the impact of allergies on academic performance (VAS education, WPAI+CIQ:AS impact of allergy symptoms on academic performance, and WPAI+CIQ:AS percentage of education hours lost due to allergies) and other variables. In addition, we identified factors associated with the impact of allergic symptoms on academic productivity through multivariable mixed models. Results: A total of 13,454 days (from 1970 patients) were studied. VAS education was strongly correlated with the WPAI+CIQ:AS impact of allergy symptoms on academic productivity (Spearman correlation coefficient = 0.71 [95% confidence interval (CI) = 0.58; 0.80]), VAS global allergy symptoms (0.70 [95% CI = 0.68; 0.71]), and VAS nose (0.66 [95% CI = 0.65; 0.68]). In multivariable regression models, immunotherapy showed a strong negative association with VAS education (regression coefficient = -2.32 [95% CI = -4.04; -0.59]). Poor rhinitis control, measured by the combined symptom-medication score, was associated with worse VAS education (regression coefficient = 0.88 [95% CI = 0.88; 0.92]), higher impact on academic productivity (regression coefficient = 0.69 [95% CI = 0.49; 0.90]), and higher percentage of missed education hours due to allergy (regression coefficient = 0.44 [95% CI = 0.25; 0.63]). Conclusion: Allergy symptoms and worse rhinitis control are associated with worse academic productivity, whereas immunotherapy is associated with higher productivity.

Published
2022

33. Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies

Author

Bousquet, Jean, Cristol, Jean-Paul, Czarlewski, Wienczyslawa, Anto, Josep M, Martineau, Adrian, Haahtela, Tari, Fonseca, Susana C, Iaccarino, Guido, Blain, Hubert, Fiocchi, Alessandro, Canonica, G Walter, Fonseca, Joao A, Vidal, Alain, Choi, Hak-Jong, Kim, Hyun Ju, Le Moing, Vincent, Reynes, Jacques, Sheikh, Aziz, Akdis, Cezmi A, Zuberbier, Torsten, Amir Hamzah Abdul Latiff, Baharudin, Abdullah, Werner, Aberer, Nancy, Abusada, Ian, Adcock, Alejandro, Afani, Ioana, Agache, Xenofon, Aggelidis, Jenifer, Agustin, Cezmi, A Akdis, Mübeccel, Akdis, Mona, Al-Ahmad, Abou Al-Zahab Bassam, Hussam, Alburdan, Oscar, Aldrey-Palacios, Emilio Alvarez Cuesta, Hiba Alwan Salman, Ashraf, Alzaabi, Salma, Amade, Gene, Ambrocio, Rosana, Angles, Isabella, Annesi-Maesano, Ignacio, J Ansotegui, Josep, M Anto, Paula Ara Bardajo, Stefania, Arasi, Margarete, Arrais, Hasan, Arshad, Maria-Cristina, Artesani, Estrella, Asayag, Francesca, Avolio, Khuzama, Azhari, Claus, Bachert, Diego, Bagnasco, Ilaria, Baiardini, Nissera, Bajrović, Petros, Bakakos, Sergio Bakeyala Mongono, Christine, Balotro-Torres, Sergio, Barba, Cristina, Barbara, Elsa, Barbosa, Bruno, Barreto, Joan, Bartra, Xavier, Basagana, Eric, D Bateman, Lkhagvaa, Battur, Anna, Bedbrook, Martín Bedolla Barajas, Bianca, Beghé, Antra, Bekere, Elizabeth, Bel, Ali Ben Kheder, Mikael, Benson, Elena-Camelia, Berghea, Karl-Christian, Bergmann, Roberto, Bernardini, David, Bernstein, Mike, Bewick, Slawomir, Bialek, Artur, Białoszewski, Thomas, Bieber, Nils, E Billo, Maria-Beatrice, Bilo, Carsten, Bindslev-Jensen, Leif, Bjermer, Hubert, Blain, Irina, Bobolea, Malgorzata Bochenska Marciniak, Christine, Bond, Attilio, Boner, Matteo, Bonini, Sergio, Bonini, Sinthia, Bosnic-Anticevich, Isabelle, Bosse, Sofia, Botskariova, Jacques, Bouchard, Louis-Philippe, Boulet, Rodolphe, Bourret, Philippe, Bousquet, Fulvio, Braido, Andrew, Briggs, Christopher, E Brightling, Jan, Brozek, Luisa, Brussino, Roland, Buhl, Roxana, Bumbacea, Rosalva, Buquicchio, María-Teresa Burguete Cabañas, Andrew, Bush, William, W Busse, Jeroen, Buters, Fernan, Caballero-Fonseca, Moïses, A Calderon, Mario, Calvo, Paulo, Camargos, Thierry, Camuzat, R Canevari, F, Antonio, Cano, G Walter Canonica, Arnaldo, Capriles-Hulett, Luis, Caraballo, Vicky, Cardona, Kai-Hakon, Carlsen, Jonas Carmona Pirez, Jorge, Caro, Warner, Carr, Pedro, Carreiro-Martins, Fredelita, Carreon-Asuncion, Ana-Maria, Carriazo, Carme Carrion, Y Ribas, Thomas, Casale, Mary-Ann, Castor, Elizabeth, Castro, G Caviglia, A, Lorenzo, Cecchi, Alfonso Cepeda Sarabia, Maciej, Chalubinski, Ramanathan, Chandrasekharan, Yoon-Seok, Chang, Victoria, Chato-Andeza, Lida, Chatzi, Christina, Chatzidaki, Niels, H Chavannes, Claudia Chaves Loureiro, Aurora-Alejandra Chavez Garcia, Marta, Chelninska, Yuzhi, Chen, Lei, Cheng, Sharon, Chinthrajah, Tomas, Chivato, Ekaterine, Chkhartishvili, George, Christoff, Henry, Chrystyn, Derek, K Chu, Antonio, Chua, Alexander, Chuchalin, Kian Fan Chung, Alberto, Cicerán, Cemal, Cingi, Giorgio, Ciprandi, Ieva, Cirule, Ana-Carla, Coelho, Enrico, Compalati, Jannis, Constantinidis, Jaime Correia de Sousa, Elisio Manuel Costa, David, Costa, María Del Carmen Costa Domínguez, André, Coste, Cottini, M, Linda, Cox, Carlos, Crisci, Maria Angiola Crivellaro, Alvaro, A Cruz, John, Cullen, Adnan, Custovic, Biljana, Cvetkovski, Wienczyslawa, Czarlewski, Gennaro, D'Amato, Jane da Silva, Ronald, Dahl, Sven-Erik, Dahlen, Vasilis, Daniilidis, Louei Darjazini Nahhas, Ulf, Darsow, Janet, Davies, Frédéric de Blay, Giulia De Feo, Eloisa De Guia, José-Ricardo De la Torre Navarrete, Chato De Los Santos, Esteban De Manuel Keenoy, Govert De Vries, Diana, Deleanu, Pascal, Demoly, Judah, Denburg, Philippe, Devillier, Alain, Didier, Sanja Dimic Janjic, Maria, Dimou, Anh Tuan Dinh-Xuan, Ratko, Djukanovic, Maria Do Ceu Texeira, Dejan, Dokic, Margarita Gabriela Domínguez Silva, Habib, Douagui, Nikolaos, Douladiris, Maria, Doulaptsi, Gérard, Dray, Ruta, Dubakiene, Eve, Dupas, Stephen, Durham, Marzia, Duse, Mark, Dykewicz, Didier, Ebo, Natalija, Edelbaher, Thomas, Eiwegger, Patrik, Eklund, Yehia, El-Gamal, Zeinab, A El-Sayed, Shereen, S El-Sayed, Magda, El-Seify, Regina, Emuzyte, Lourdes, Enecilla, Marina, Erhola, Heidilita, Espinoza, Jesús Guillermo Espinoza Contreras, John, Farrell, Lenora, Fernandez, Paola Fimbres Jimenez, Antje Fink Wagner, Alessandro, Fiocchi, Wytske, J Fokkens, Lenia, Folletti, Joao, A Fonseca, Jean-François, Fontaine, Francesco, Forastiere, Jose Miguel Fuentes Pèrez, Emily, Gaerlan-Resureccion, Mina, Gaga, José Luis Gálvez Romero, Amiran, Gamkrelidze, Alexis, Garcia, Cecilia Yvonne García Cobas, María de la Luz Hortensia García Cruz, Valeria Garcia Ortiz, Jacques, Gayraud, Matteo, Gelardi, Bilun, Gemicioglu, Dimitra, Gennimata, Sonya, Genova, José, Gereda, Roy Gerth van Wijk, Antonio, Giuliano, René-Maximiliano, Gomez, Miguel-Ange Gonzalez Ballester, Sandra González Diaz, Maia, Gotua, Christos, Grigoreas, Ineta, Grisle, Marta, Guidacci, Nick, Guldemond, Zdenek, Gutter, Antonieta, Guzmán, Tari, Haahtela, Ramsa, Halloum, David, Halpin, Eckard, Hamelmann, Suleiman, Hammadi, Richard, Harvey, Enrico, Heffler, Joachim, Heinrich, Adnan, Hejjaoui, Birthe, Hellquist-Dahl, Luiana Hernández Velázquez, Mark, Hew, Elham, Hossny, Peter, Howarth, Martin, Hrubiško, Yunuen Rocío Huerta Villalobos, Marc, Humbert, Salina, Husain, Michael, Hyland, Guido, Iaccarino, Moustafa, Ibrahim, Nataliya, Ilina, Maddalena, Illario, Cristoforo, Incorvaia, Antonio, Infantino, Carla, Irani, Zhanat, Ispayeva, Juan Carlos Ivancevich, Edgardo Ej Jares, Deborah, Jarvis, Ewa, Jassem, Klemen, Jenko, Rubén Darío Jiméneracruz Uscanga, Sebastian, L Johnston, Guy, Joos, Maja, Jošt, Kaja, Julge, Ki-Suck, Jung, Jocelyne, Just, Marek, Jutel, Igor, Kaidashev, Omer, Kalayci, Fuat, Kalyoncu, Jeni, Kapsali, Przemyslaw, Kardas, Jussi, Karjalainen, Carmela, A Kasala, Michael, Katotomichelakis, Loreta, Kavaliukaite, Kazi, S Bennoor, Thomas, Keil, Paul, Keith, Musa, Khaitov, Nikolai, Khaltaev, You-Young, Kim, Bruce, Kirenga, Jorg, Kleine-Tebbe, Ludger, Klimek, Fanny, W Ko, Bernard Koffi N'Goran, Evangelia, Kompoti, Peter, Kopač, Gerard, Koppelman, Anja Koren Jeverica, Seppo, Koskinen, Mitja, Košnik, Tomasz, Kostka, Kosta, V Kostov, Marek, L Kowalski, Tanya, Kralimarkova, Karmen Kramer Vrščaj, Helga, Kraxner, Samo, Kreft, Vicky, Kritikos, Dmitry, Kudlay, Mikael, Kuitunen, Inger, Kull, Piotr, Kuna, Maciej, Kupczyk, Violeta, Kvedariene, Marialena, Kyriakakou, Nika, Lalek, Massimo, Landi, Stephen, Lane, Désiree, E Larenas-Linnemann, Susanne, Lau, Daniel, Laune, Jorge, Lavrut, Lan, Le, Martina, Lenzenhuber, Gualtiero, Leo, Marcus, Lessa, Michael, Levin, Jing, Li, Philip, Lieberman, Giuseppe, Liotta, Brian, Lipworth, Xuandao, Liu, Rommel, Lobo, Karin, C Lodrup Carlsen, Carlo, Lombardi, Renaud, Louis, Stelios, Loukidis, Olga, Lourenço, Jorge, A Luna Pech, Bojan, Madjar, Enrico, Maggi, Antoine, Magnan, Bassam, Mahboub, Alpana, Mair, Anke-Hilse Maitland van der Zee, Mika, Makela, Michael, Makris, Hans-Jorgen, Malling, Mariana, Mandajieva, Patrick, Manning, Manolis, Manousakis, Pavlos, Maragoudakis, Gianluigi, Marseglia, Gailen, Marshall, Mohammad Reza Masjedi, Jorge, F Máspero, Juan José Matta Campos, Marcus, Maurer, Sandra, Mavale-Manuel, Cem, Meço, Erik, Melén, Giovanni, Melioli, Elisabete, Melo-Gomes, Eli, O Meltzer, Enrica, Menditto, Andrew, Menzies-Gow, Hans, Merk, Jean-Pierre, Michel, Yann, Micheli, Neven, Miculinic, Luís, Midão, Florin, Mihaltan, Nikolaos, Mikos, Manlio, Milanese, Branislava, Milenkovic, Dimitrios, Mitsias, Bassem, Moalla, Giuliana, Moda, María Dolores Mogica Martínez, Yousser, Mohammad, Frances-Montserrat, Moharra, Mostafa, Moin, Mathieu, Molimard, Isabelle, Momas, Monique, Mommers, Alessandro, Monaco, Stephen, Montefort, Lucia-Elvira, Montenegro, Riccardo, Monti, Dory, Mora, Mario, Morais-Almeida, Ralph, Mösges, Badr Eldin Mostafa, Joaquim, Mullol, Lars, Münter, Antonella, Muraro, Ruth, Murray, Antonio, Musarra, Tihomir, Mustakov, Robert, Naclerio, Kari, C Nadeau, Rachel, Nadif, Alla, Nakonechna, Leyla, Namazova-Baranova, Gretchen, Navarro-Locsin, Hugo, Neffen, Kristof, Nekam, Angelos, Neou, Eustachio, Nettis, Daniel, Neuberger, Laurent, Nicod, Stefania, Nicola, Verena, Niederberger-Leppin, Marek, Niedoszytko, Antonio, Nieto, Ettore, Novellino, Elizabete, Nunes, Dieudonné, Nyembue, Robyn, E O'Hehir, Cvetanka, Odjakova, Ken, Ohta, Yoshitaka, Okamoto, Kimi, Okubo, Brian, Oliver, Gabrielle, L Onorato, Maria Pia Orru, Solange, Ouédraogo, Kampadilemba, Ouoba, Francisco-Javier, Padilla, Pier Luigi Paggiaro, Aris, Pagkalos, Pajno, Giovanni Battista, Gianni, Pala, P Palaniappan, S, Isabella, Pali-Schöll, Susanna, Palkonen, Stephen, Palmer, Carmen Panaitescu Bunu, Petr, Panzner, Nikos, G Papadopoulos, Vasilis, Papanikolaou, Alberto, Papi, Bojidar, Paralchev, Giannis, Paraskevopoulos, Hae-Sim, Park, Giovanni, Passalacqua, Vincenzo, Patella, Ian, Pavord, Ruby, Pawankar, Soren, Pedersen, Susete, Peleve, Simona, Pellegino, Ana, Pereira, Mariana, Pereira, Tamara, Pérez, Andrea, Perna, Diego, Peroni, Oliver, Pfaar, Nhân, Pham-Thi, Bernard, Pigearias, Isabelle, Pin, Konstantina, Piskou, Constantinos, Pitsios, Davor, Plavec, Dagmar, Poethig, Wolfgang, Pohl, Antonija Poplas Susic, Todor, A Popov, Fabienne, Portejoie, Paul, Potter, Lars, Poulsen, Alexandra, Prados-Torres, Fotis, Prarros, David, Price, Emmanuel, Prokopakis, Francesca, Puggioni, Elisa, Puig-Domenech, Robert, Puy, Klaus, Rabe, Silvia, Rabotti, Filip, Raciborski, Josephine, Ramos, Cristina, Recalcati, Marysia, T Recto, Shereen, M Reda, Frederico, S Regateiro, Norbert, Reider, Sietze, Reitsma, Susana, Repka-Ramirez, Erminia, Ridolo, Janet, Rimmer, Daniela Rivero Yeverino, José Angelo Rizzo, Carlos, Robalo-Cordeiro, Graham, Roberts, Karen, Robles, Nicolas, Roche, Mónica Rodríguez González, Eréndira Rodríguez Zagal, Giovanni, Rolla, Christine, Rolland, Regina, Roller-Wirnsberger, Miguel Roman Rodriguez, Antonino, Romano, Jan, Romantowski, Philippe, Rombaux, Joel, Romualdez, Jose, Rosado-Pinto, Nelson, Rosario, Lanny, Rosenwasser, Oliviero, Rossi, Menachem, Rottem, Philip, W Rouadi, Nikoleta, Rovina, Irma Rozman Sinur, Mauricio, Ruiz, Lucy Tania Ruiz Segura, Dermot, Ryan, Hironori, Sagara, Daiki, Sakai, Daiju, Sakurai, Wafaa, Saleh, Johanna, Salimaki, Konstantinos, Samitas, Boleslaw, Samolinski, María Guadalupe Sánchez Coronel, Mario, Sanchez-Borges, Jaime, Sanchez-Lopez, Melissa, Sansonna, Codrut, Sarafoleanu, Faradiba Sarquis Serpa, Joaquin, Sastre, Eleonora, Savi, Agne, Savonyte, Bisher, Sawaf, Glenis, K Scadding, Sophie, Scheire, Peter, Schmid-Grendelmeier, Juan Francisco Schuhl, Holger, Schunemann, Maria, Schvalbová, Jorgen, Schwarze, Nicola, Scichilone, Gianenrico, Senna, Cecilia, Sepúlveda, Elie, Serrano, Sara, Shamai, Aziz, Sheikh, Mike, Shields, Vasil, Shishkov, Nikos, Siafakas, Alexander, Simeonov, Estelle Fer Simons, Juan Carlos Sisul, Brigita, Sitkauskiene, Ingelbjorg, Skrindo, Tanja Soklič Košak, Dirceu, Solé, Martin, Sondermann, Talant, Sooronbaev, Manuel, Soto-Martinez, Manuel, Soto-Quiros, Barnaro Sousa Pinto, Milan, Sova, Michael, Soyka, Krzysztof, Specjalski, Annette, Sperl, Otto, Spranger, Sofia, Stamataki, Lina, Stefanaki, Cristiana, Stellato, Rafael, Stelmach, Timo, Strandberg, Petra, Stute, Abirami, Subramaniam, Charlotte Suppli Ulrik, Michael, Sutherland, Silvia, Sylvestre, Aikaterini, Syrigou, Luis Taborda Barata, Nadejda, Takovska, Rachel, Tan, Frances, Tan, Vincent, Tan, Ing Ping Tang, Masami, Taniguchi, Line, Tannert, Pongsakorn, Tantilipikorn, Jessica, Tattersall, Filippo, Tesi, Uta, Thieme, Carel, Thijs, Mike, Thomas, Teresa, To, Ana Maria Todo-Bom, Alkis, Togias, Peter-Valentin, Tomazic, Vesna, Tomic-Spiric, Sanna, Toppila-Salmi, Maria-José Torres Jaen, Elina, Toskala, Massimo, Triggiani, Nadja, Triller, Katja, Triller, Ioanna, Tsiligianni, Uberti, M, Ruxandra, Ulmeanu, Jure, Urbancic, Marilyn Urrutia Pereira, Martina, Vachova, Felipe, Valdés, Rudolf, Valenta, Marylin Valentin Rostan, Antonio, Valero, Arunas, Valiulis, Mina, Vallianatou, Erkka, Valovirta, Michiel Van Eerd, Eric Van Ganse, Marianne van Hage, Olivier, Vandenplas, Tuula, Vasankari, Dafina, Vassileva, Cesar Velasco Munoz, Maria Teresa Ventura, Cécilia, Vera-Munoz, Frédéric, Viart, Dilyana, Vicheva, Pakit, Vichyanond, Petra, Vidgren, Giovanni, Viegi, Claus, Vogelmeier, Leena Von Hertzen, Theodoros, Vontetsianos, Dimitris, Vourdas, Vu Tran Thien Quan, Martin, Wagenmann, Samantha, Walker, Dana, Wallace, Yun De Wang, Susan, Waserman, Katrin, Wehner, Magnus, Wickman, Sian, Williams, Dennis, Williams, Nicola, Wilson, Gary, Wong, Kent, Woo, Lucyna, Wozniak, John, Wright, Piotr, Wroczynski, Paraskevi, Xepapadaki, Plamen, Yakovliev, Masao, Yamaguchi, Kwok, Yan, Yoke Yeow Yap, Mais, Yassin, Barbara, Yawn, Panayiotis, Yiallouros, Arzu, Yorgancioglu, Shigemi, Yoshihara, Ian, Young, Osman, B Yusuf, Asghar, Zaidi, Fares, Zaitoun, Petra, Zalud, Heather, Zar, T Zedda, M, Mario, E Zernotti, Luo, Zhang, Nanshan, Zhong, Mihaela, Zidarn, Torsten, Zuberbier, Celia, Zubrinich, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Humboldt University Of Berlin, Berlin Institute of Health (BIH), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), IMIM-Hospital del Mar, Generalitat de Catalunya, Universitat Pompeu Fabra [Barcelona] (UPF), CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Global - Institute For Global Health [Barcelona] (ISGlobal), Center for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra [Barcelona] (UPF)-Catalunya ministerio de salud, Barts & The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Helsinki University Central Hospital [Finland] (HUCH), Departamento de Geociencias, Ambiente e Ordenamento do Territorio (DGAOT), Universidade do Porto = University of Porto, University of Naples Federico II = Università degli studi di Napoli Federico II, Euromov (EuroMov), Université de Montpellier (UM), IRCCS Ospedale Pediatrico Bambino Gesù [Roma], Istituto Clinico Humanitas [Milan] (IRCCS Milan), Humanitas University [Milan] (Hunimed), Center of Research in Health Technologies and Information Systems (CINTESIS), AgroParisTech, World Institute of Kimchi [Gwangju], Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), University of Edinburgh, Universität Zürich [Zürich] = University of Zurich (UZH), Humboldt-Universität zu Berlin, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Universidade do Porto, University of Naples Federico II, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), MORNET, Dominique, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (MGD) Service de pneumologie, Bousquet J., Cristol J.-P., Czarlewski W., Anto J.M., Martineau A., Haahtela T., Fonseca S.C., Iaccarino G., Blain H., Fiocchi A., Canonica G.W., Fonseca J.A., Vidal A., Choi H.-J., Kim H.J., Le Moing V., Reynes J., Sheikh A., Akdis C.A., Zuberbier T., Abdul Latiff A.H., Abdullah B., Aberer W., Abusada N., Adcock I., Afani A., Agache I., Aggelidis X., Agustin J., Akdis M., Al-Ahmad M., Al-Zahab Bassam A., Alburdan H., Aldrey-Palacios O., Alvarez Cuesta E., Alwan Salman H., Alzaabi A., Amade S., Ambrocio G., Angles R., Annesi-Maesano I., Ansotegui I.J., Ara Bardajo P., Arasi S., Arrais M., Arshad H., Artesani M.-C., Asayag E., Avolio F., Azhari K., Bachert C., Bagnasco D., Baiardini I., Bajrovic N., Bakakos P., Bakeyala Mongono S., Balotro-Torres C., Barba S., Barbara C., Barbosa E., Barreto B., Bartra J., Basagana X., Bateman E.D., Battur L., Bedbrook A., Bedolla Barajas M., Beghe B., Bekere A., Bel E., Ben Kheder A., Benson M., Berghea E.-C., Bergmann K.-C., Bernardini R., Bernstein D., Bewick M., Bialek S., Bialoszewski A., Bieber T., Billo N.E., Bilo M.-B., Bindslev-Jensen C., Bjermer L., Bobolea I., Bochenska Marciniak M., Bond C., Boner A., Bonini M., Bonini S., Bosnic-Anticevich S., Bosse I., Botskariova S., Bouchard J., Boulet L.-P., Bourret R., Bousquet P., Braido F., Briggs A., Brightling C.E., Brozek J., Brussino L., Buhl R., Bumbacea R., Buquicchio R., Burguete Cabanas M.-T., Bush A., Busse W.W., Buters J., Caballero-Fonseca F., Calderon M.A., Calvo M., Camargos P., Camuzat T., Canevari F., Cano A., Canonican G.W., Capriles-Hulett A., Caraballo L., Cardona V., Carlsen K.-H., Carmona Pirez J., Caro J., Carr W., Carreiro-Martins P., Carreon-Asuncion F., Carriazo A.-M., CarrionyRibas C., Casale T., Castor M.-A., Castro E., Caviglia A.G., Cecchi L., Cepeda Sarabia A., Chalubinski M., Chandrasekharan R., Chang Y.-S., Chato-Andeza V., Chatzi L., Chatzidaki C., Chavannes N.H., Chaves Loureiro C., Chavez Garcia A.-A., Chelninska M., Chen Y., Cheng L., Chinthrajah S., Chivato T., Chkhartishvili E., Christoff G., Chrystyn H., Chu D.K., Chua A., Chuchalin A., Chung K.F., Ciceran A., Cingi C., Ciprandi G., Cirule I., Coelho A.-C., Compalati E., Constantinidis J., Correia de Sousa J., Costa E.M., Costa D., del Carmen Costa Dominguez M., Coste A., Cottini M., Cox L., Crisci C., Crivellaro M.A., Cruz A.A., Cullen J., Custovic A., Cvetkovski B., D'Amato G., da Silva J., Dahl R., Dahlen S.-E., Daniilidis V., Darjazini Nahhas L., Darsow U., Davies J., de Blay F., De Feo G., De Guia E., De la Torre Navarrete J.-R., De los Santos C., De Manuel Keenoy E., De Vries G., Deleanu D., Demoly P., Denburg J., Devillier P., Didier A., Dimic Janjic S., Dimou M., Dinh-Xuan A.T., Djukanovic R., Do Ceu Texeira M., Dokic D., Dominguez Silva M.G., Douagui H., Douladiris N., Doulaptsi M., Dray G., Dubakiene R., Dupas E., Durham S., Duse M., Dykewicz M., Ebo D., Edelbaher N., Eiwegger T., Eklund P., El-Gamal Y., El-Sayed Z.A., El-Sayed S.S., El-Seify M., Emuzyte R., Enecilla L., Erhola M., Espinoza H., Espinoza Contreras J.G., Farrell J., Fernandez L., Fimbres Jimenez P., Fink Wagner A., Fokkens W.J., Folletti L., Fontaine J.-F., Forastiere F., Fuentes Perez J.M., Gaerlan-Resureccion E., Gaga M., Galvez Romero J.L., Gamkrelidze A., Garcia A., Garcia Cobas C.Y., de la Luz Hortensia Garcia Cruz M., Ortiz V.G., Gayraud J., Gelardi M., Gemicioglu B., Gennimata D., Genova S., Gereda J., Gerth van Wijk R., Giuliano A., Gomez R.-M., Gonzalez Ballester M.-A., Gonzalez Diaz S., Gotua M., Grigoreas C., Grisle I., Guidacci M., Guldemond N., Gutter Z., Guzman A., Halloum R., Halpin D., Hamelmann E., Hammadi S., Harvey R., Heffler E., Heinrich J., Hejjaoui A., Hellquist-Dahl B., Hernandez Velazquez L., Hew M., Hossny E., Howarth P., Hrubisko M., Huerta Villalobos Y.R., Humbert M., Husain S., Hyland M., Ibrahim M., Ilina N., Illario M., Incorvaia C., Infantino A., Irani C., Ispayeva Z., Ivancevich J.C., Jares E.E., Jarvis D., Jassem E., Jenko K., Jimeneracruz Uscanga R.D., Johnston S.L., Joos G., Jost M., Julge K., Jung K.-S., Just J., Jutel M., Kaidashev I., Kalayci O., Kalyoncu F., Kapsali J., Kardas P., Karjalainen J., Kasala C.A., Katotomichelakis M., Kavaliukaite L., Bennoor K.S., Keil T., Keith P., Khaitov M., Khaltaev N., Kim Y.-Y., Kirenga B., Kleine-Tebbe J., Klimek L., Ko F.W., Koffi N'Goran B., Kompoti E., Kopac P., Koppelman G., Koren Jeverica A., Koskinen S., Kosnik M., Kostka T., Kostov K.V., Kowalski M.L., Kralimarkova T., Kramer Vrscaj K., Kraxner H., Kreft S., Kritikos V., Kudlay D., Kuitunen M., Kull I., Kuna P., Kupczyk M., Kvedariene V., Kyriakakou M., Lalek N., Landi M., Lane S., Larenas-Linnemann D.E., Lau S., Laune D., Lavrut J., Le L., Lenzenhuber M., Leo G., Lessa M., Levin M., Li J., Lieberman P., Liotta G., Lipworth B., Liu X., Lobo R., Lodrup Carlsen K.C., Lombardi C., Louis R., Loukidis S., Lourenco O., Luna Pech J.A., Madjar B., Maggi E., Magnan A., Mahboub B., Mair A., Maitland van der Zee A.-H., Makela M., Makris M., Malling H.-J., Mandajieva M., Manning P., Manousakis M., Maragoudakis P., Marseglia G., Marshall G., Masjedi M.R., Maspero J.F., Matta Campos J.J., Maurer M., Mavale-Manuel S., Meco C., Melen E., Melioli G., Melo-Gomes E., Meltzer E.O., Menditto E., Menzies-Gow A., Merk H., Michel J.-P., Micheli Y., Miculinic N., Midao L., Mihaltan F., Mikos N., Milanese M., Milenkovic B., Mitsias D., Moalla B., Moda G., Mogica Martinez M.D., Mohammad Y., Moharra F.-M., Moin M., Molimard M., Momas I., Mommers M., Monaco A., Montefort S., Montenegro L.-E., Monti R., Mora D., Morais-Almeida M., Mosges R., Mostafa B.E., Mullol J., Munter L., Muraro A., Murray R., Musarra A., Mustakov T., Naclerio R., Nadeau K.C., Nadif R., Nakonechna A., Namazova-Baranova L., Navarro-Locsin G., Neffen H., Nekam K., Neou A., Nettis E., Neuberger D., Nicod L., Nicola S., Niederberger-Leppin V., Niedoszytko M., Nieto A., Novellino E., Nunes E., Nyembue D., O'Hehir R.E., Odjakova C., Ohta K., Okamoto Y., Okubo K., Oliver B., Onorato G.L., Orru M.P., Ouedraogo S., Ouoba K., Padilla F.-J., Paggiaro P.L., Pagkalos A., Pajno G., Pala G., Palaniappan S., Pali-Scholl I., Palkonen S., Palmer S., Panaitescu Bunu C., Panzner P., Papadopoulos N.G., Papanikolaou V., Papi A., Paralchev B., Paraskevopoulos G., Park H.-S., Passalacqua G., Patella V., Pavord I., Pawankar R., Pedersen S., Peleve S., Pellegino S., Pereira A., Pereira M., Perez T., Perna A., Peroni D., Pfaar O., Pham-Thi N., Pigearias B., Pin I., Piskou K., Pitsios C., Plavec D., Poethig D., Pohl W., Poplas Susic A., Popov T.A., Portejoie F., Potter P., Poulsen L., Prados-Torres A., Prarros F., Price D., Prokopakis E., Puggioni F., Puig-Domenech E., Puy R., Rabe K., Rabotti S., Raciborski F., Ramos J., Recalcati C., Recto M.T., Reda S.M., Regateiro F.S., Reider N., Reitsma S., Repka-Ramirez S., Ridolo E., Rimmer J., Rivero Yeverino D., Rizzo J.A., Robalo-Cordeiro C., Roberts G., Robles K., Roche N., Rodriguez Gonzalez M., Rodriguez Zagal E., Rolla G., Rolland C., Roller-Wirnsberger R., Roman Rodriguez M., Romano A., Romantowski J., Rombaux P., Romualdez J., Rosado-Pinto J., Rosario N., Rosenwasser L., Rossi O., Rottem M., Rouadi P.W., Rovina N., Rozman Sinur I., Ruiz M., Ruiz Segura L.T., Ryan D., Sagara H., Sakai D., Sakurai D., Saleh W., Salimaki J., Samitas K., Samolinski B., Sanchez Coronel M.G., Sanchez-Borges M., Sanchez-Lopez J., Sansonna M., Sarafoleanu C., Sarquis Serpa F., Sastre J., Savi E., Savonyte A., Sawaf B., Scadding G.K., Scheire S., Schmid-Grendelmeier P., Schuhl J.F., Schunemann H., Schvalbova M., Schwarze J., Scichilone N., Senna G., Sepulveda C., Serrano E., Shamai S., Shields M., Shishkov V., Siafakas N., Simeonov A., Simons E.F., Sisul J.C., Sitkauskiene B., Skrindo I., Soklic Kosak T., Sole D., Sondermann M., Sooronbaev T., Soto-Martinez M., Soto-Quiros M., Pinto B.S., Sova M., Soyka M., Specjalski K., Sperl A., Spranger O., Stamataki S., Stefanaki L., Stellato C., Stelmach R., Strandberg T., Stute P., Subramaniam A., Suppli Ulrik C., Sutherland M., Sylvestre S., Syrigou A., Taborda Barata L., Takovska N., Tan R., Tan F., Tan V., Tang I.P., Taniguchi M., Tannert L., Tantilipikorn P., Tattersall J., Tesi F., Thieme U., Thijs C., Thomas M., To T., Todo-Bom A.M., Togias A., Tomazic P.-V., Tomic-Spiric V., Toppila-Salmi S., Torres Jaen M.-J., Toskala E., Triggiani M., Triller N., Triller K., Tsiligianni I., Uberti M., Ulmeanu R., Urbancic J., Urrutia Pereira M., Vachova M., Valdes F., Valenta R., Valentin Rostan M., Valero A., Valiulis A., Vallianatou M., Valovirta E., Van Eerd M., Van Ganse E., van Hage M., Vandenplas O., Vasankari T., Vassileva D., Velasco Munoz C., Ventura M.T., Vera-Munoz C., Viart F., Vicheva D., Vichyanond P., Vidgren P., Viegi G., Vogelmeier C., Von Hertzen L., Vontetsianos T., Vourdas D., Tran Thien Quan V., Wagenmann M., Walker S., Wallace D., De Wang Y., Waserman S., Wehner K., Wickman M., Williams S., Williams D., Wilson N., Wong G., Woo K., Wozniak L., Wright J., Wroczynski P., Xepapadaki P., Yakovliev P., Yamaguchi M., Yan K., Yap Y.Y., Yassin M., Yawn B., Yiallouros P., Yorgancioglu A., Yoshihara S., Young I., Yusuf O.B., Zaidi A., Zaitoun F., Zalud P., Zar H., Zedda M.T., Zernotti M.E., Zhang L., Zhong N., and Zidarn M.

Subjects
MAPK/ERK pathway, ARIA group, Allergy, [SDV]Life Sciences [q-bio], NF-KAPPA-B, debelost, Review, Pharmacology, Resveratrol, PROTECTS, chemistry.chemical_compound, 0302 clinical medicine, RESPIRATORY SYNDROME CORONAVIRUS, ENDOPLASMIC-RETICULUM STRESS, Medicine and Health Sciences, Immunology and Allergy, Medicine, OXIDATIVE STRESS, COVID-19, Foods, Insulin resistance, Nrf2, Nutrients, Obesity, TRPA1, 2. Zero hunger, 0303 health sciences, RESPIRATORY, INSULIN-RESISTANCE, Muscle cell proliferation, SULFORAPHANE, 3. Good health, [SDV] Life Sciences [q-bio], 030220 oncology & carcinogenesis, SIGNALING PATHWAY, Signal transduction, Life Sciences & Biomedicine, Pulmonary and Respiratory Medicine, NRF2 ACTIVATORS, MUSCLE-CELL PROLIFERATION, Immunology, 610 Medicine & health, Lung injury, Settore MED/10 - Malattie Dell'Apparato Respiratorio, ACUTE LUNG INJURY, 03 medical and health sciences, COVID-19, Foods, Insulin resistance, Nrf2, Nutrients, Obesity, TRPA1, udc:616.9, odpornost proti inzulinu, SULFORAPHANE PROTECTS, Transcription factor, PI3K/AKT/mTOR pathway, 030304 developmental biology, Science & Technology, business.industry, SARS-CoV-2, food, medicine.disease, chemistry, hranila, SYNDROME CORONAVIRUS, business, hrana, GREEN TEA
Abstract

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.

Published
2020

34. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper

Author

Tari Haahtela, Sandra Nora González Díaz, Martti Anton Antila, Marek L. Kowalski, Nelson Augusto Rosário Filho, Didier G. Ebo, Lanny J. Rosenwasser, Victoria Cardona, Eleonora Savi, Wen Chin Chiang, Jean Bousquet, Luciana Kase Tanno, Torsten Zuberbier, Roy Gerth van Wijk, Oliver Pfaar, Luis Caraballo, Ignacio J. Ansotegui, Olga Patricia Monge Ortega, Giovanni Melioli, Antonino Romano, Marta Ferrer Puga, Bernard Yu-Hor Thong, Pascal Demoly, Gianenrico Senna, Alexei Gonzalez-Estrada, Erika Jensen-Jarolim, Olga Sánchez, Motohiro Ebisawa, Ruby Pawankar, R. Maximiliano Gómez, Giovanni Passalacqua, Giorgio Walter Canonica, Lawrence M. DuBuske, Mimi L.K. Tang, David A. Fischer, Robert A. Wood, Lars K. Poulsen, Rudolf Valenta, Enrico Scala, Harald Renz, Ayse Fusun Kalpaklioglu, Juan Carlos Sisul, Dennis K. Ledford, Mario Sanchez Borges, Elisa Villa, Edgardo Jares, John Oppenheimer, Mario Morais Almeida, Hospital Quirónsalud Bizkaia [Bilbao], Humanitas University [Milan] (Hunimed), University of Cartagena, Sagamihara National Hospital, University of Genoa (UNIGE), Antwerp University Hospital [Edegem] (UZA), Vall d'Hebron University Hospital [Barcelona], University of Veterinary Medicine [Vienna] (Vetmeduni), University of Helsinki, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM), European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Universitat Autònoma de Barcelona (UAB), Sorbonne Université - UFR Sciences de la vie (UFR 927 ), Sorbonne Université (SU), Universidad Autonoma de Nuevo Leon [Mexique] (UANL), Mayo Clinic [Jacksonville], University of São Paulo (USP), Medical University of Łódź (MUL), University of South Florida [Tampa] (USF), Philipps Universität Marburg, Nippon Medical School [Tokyo, Japon], Medizinische Universität Wien = Medical University of Vienna, Sechenov First Moscow State Medical University, R Valenta has received research grants from Viravaxx, Vienna, Austria, and serves as a consultant for this company., HUS Inflammation Center, Department of Dermatology, Allergology and Venereology, Internal Medicine, KKÜ, and Kırıkkale Üniversitesi

Subjects
Allergy, AAAAI, American Academy of Allergy Asthma and Immunology, LIPID TRANSFER PROTEIN, kUA/L, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays, SKIN-TESTS, IVD, in vitro diagnostic tool, Mab, Monoclonal Antibody, CCD, Cross-reactive Carbohydrate Determinants, ACAAI, American College of Allergy Asthma and Immunology, HYPERSENSITIVITY REACTIONS, Allergic sensitization, 0302 clinical medicine, Allergen, DBPCFC, Double-Blind Placebo-Controlled Food Challenge, W/v, weight /volume, NSAIDs, Non-Steroidal Anti-Inflammatory Drugs, EAACI, European Academy of Allergy and Immunology, 3. Good health, PPT, Prick-Prick Test, RAST, Radio Allergo Sorbent Test, IMMUNOGLOBULIN-E LEVELS, In vitro tests, IgE, Testes Cutâneos, Pulmonary and Respiratory Medicine, Allergen immunotherapy, H2, Histamine 2 receptor, NMBAs, NeuroMuscular Blocking Agents, AU/mL, Allergenic Units milliLiter, FACS, Fluorescence-Activated Cell Sorting, Hypersensitivity/diagnosis, Immunology, CDER, Center for Drug Evaluation and Research (USA), w/v, weight /volume, Article, Diagnostic strategies, 03 medical and health sciences, ENZYME PRODUCING PLANT, Food allergy, IN-VITRO DIAGNOSIS, Serologic Tests, H1, Histamine 1 receptor, ENPP-3, EctoNucleotide Pyrophosphatase/Phosphodiesterase 3, PPA, Positive Percent Agreement, IDT, Intradermal Test, medicine.disease, ISAC, Immuno-Solid phase Allergen Chip, BAU/mL, Biologic Allergenic Units milliLiter, Basophil activation, HPO, Horseradish Peroxidase, 030228 respiratory system, Human medicine, LAMP-3, Lysosomal-Associated Membrane Protein, lcsh:RC581-607, Imunoglobulina E, [SDV]Life Sciences [q-bio], BASOPHIL ACTIVATION TEST, ELISA, Enzyme Linked Immuno Sorbent Analysis, medicine.disease_cause, FOOD ALLERGY, FcεRI, High affinity IgE receptor, CBA, Cytometric Bead Array, EMEA, European MEdicine Agencies, CL, Chemiluminescence, Immunology and Allergy, 030223 otorhinolaryngology, FEIA, Fluorescent Enzyme Immunoassays, Sensitization, IgE, immunoglobulin E, MBAD, Molecule Based Allergy Diagnostics, ABA, Allergen Bead Array, Ku/l, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays, NPA, Negative Percent Agreement, COMPONENT-RESOLVED DIAGNOSIS, CaFE, Calibrated Fluorescence Enhancement, Hipersensibilidade/diagnóstico, medicine.anatomical_structure, BAT, Basophil Activation Test, lcsh:Immunologic diseases. Allergy, pNPP, p-Nitrophenylphosphate, MRGPRX2, Mas-related G protein receptor 2, Skin tests, mAb, Monoclonal Antibody, SCAR, severe cutaneous adverse drug reactions, Testes Sorológicos, NEUROMUSCULAR BLOCKING-AGENTS, IUIS, International Union of Immunological Societies, sIgE, specific IgE, FDA, Food and Drug Administration (U.S. Department of Health and Human Services), medicine, EIA, Enzyme Immune Assay, AEC, Allergen Exposure Chambers, Skin Tests, Anti-IgE, Antibody against IgE, AP, Alkaline Phosphatase, business.industry, Pnpp, p -Nitrophenylphosphate, SPT, Skin prick test, Cross-reactive carbohydrate determinants, Immunoglobulin E, AIT, allergen immunotherapy, Sige, specific IgE, NIH, National Institutes of Health (USA), 3121 General medicine, internal medicine and other clinical medicine, business
Abstract

Tang, Mimi/0000-0002-3839-5293; Romano, Antonino/0000-0001-9742-9898; Zuberbier, Torsten/0000-0002-1466-8875; Thong, Bernard/0000-0002-6338-8482; EBO, Didier/0000-0003-0672-7529; Scala, Enrico/0000-0002-9391-9168; Monge Ortega, Olga Patricia/0000-0002-6195-417X WOS:000523267300003 PubMed: 32128023 Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen. WAO Board of Directors The authors wish to thank the allergy societies from the membership of the World Allergy Organization who provided critical review of the draft and the WAO Board of Directors for supporting this work.

Published
2020

35. Pediatric asthma comorbidities: Global impact and unmet needs

Author

Elham Hossny, MD, PhD, Yuichi Adachi, MD, PhD, Eleni Anastasiou, MD, Héctor Badellino, MD, PhD, Adnan Custovic, PhD, Rasha El-Owaidy, MD, PhD, Zeinab A. El-Sayed, MD, PhD, Ivana Filipovic, MD, PhD, R. Maximiliano Gomez, MD, PhD, Ömer Kalayci, MD, Peter Le Souëf, FRACP, MD, Michael Miligkos, MD, PhD, Mário Morais-Almeida, MD, PhD, Antonio Nieto, MD, PhD, Wanda Phipatanakul, MD, Ghada Shousha, MD, PhD, Alvaro Teijeiro, MD, PhD, Jiu-Yao Wang, MD, DPhil, Gary W.K. Wong, MD, FRCPC, FHKAM, Paraskevi Xepapadaki, MD, PhD, Su Boon Yong, MD, PhD, and Nikolaos G. Papadopoulos, MD, PhD

Subjects
Asthma, Children, Comorbid conditions, Asthma control, Obesity, Upper airway, Immunologic diseases. Allergy, RC581-607
Abstract

Real-world data on the range and impact of comorbid health conditions that affect pediatric asthma are scant, especially from developing countries. Lack of data hinders effective diagnosis, treatment, and overall management of these complex cases. We, hereby, describe the common pediatric asthma comorbid conditions in terms of evidence for association, potential mechanisms of impact on asthma control, and treatment benefit. Obesity, upper airway allergies, dysfunctional breathing, multiple sensitizations, depressive disorders, food allergy, and gastro-esophageal reflux are common associations with difficult-to-treat asthma. On the other hand, asthma symptoms and/or management may negatively impact the well-being of children through drug adverse effects, worsening of anaphylaxis symptoms, and disturbing mental health.Awareness of these ailments may be crucial for designing the optimum care for each asthmatic child individually and may ultimately improve the quality of life of patients and their families. A multidisciplinary team of physicians is required to identify and manage such comorbidities aiming to mitigate the over-use of asthma pharmacotherapy. Asthma research should target relevant real-world difficulties encountered at clinical practice and focus on interventions that would mitigate the impact of such comorbidities. Finally, policymakers and global healthcare organizations are urged to recognize pediatric asthma control as a healthcare priority and allocate resources for research and clinical interventions. In other words, global asthma control needs support by compassionate scientific partnership.

Published
2024
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36. Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee

Author

Paul J. Turner, MD, PhD, Ignacio J. Ansotegui, MD, PhD, Dianne E. Campbell, MD, PhD, Victoria Cardona, MD, PhD, Stuart Carr, MD, Adnan Custovic, MD, PhD, Stephen Durham, MD, Motohiro Ebisawa, MD, PhD, Mario Geller, MD, Alexei Gonzalez-Estrada, MD, Paul A. Greenberger, MD, Elham Hossny, MD, PhD, Carla Irani, MD, Agnes S.Y. Leung, MD, Michael E. Levin, MD, PhD, Antonella Muraro, MD, John J. Oppenheimer, MD, José Antonio Ortega Martell, MD, Guillaume Pouessel, MD, Manuel J. Rial, MD, PhD, Gianenrico Senna, MD, PhD, Luciana K. Tanno, MD, PhD, Dana V. Wallace, MD, Margitta Worm, MD, PhD, and Mário Morais-Almeida, MD, PhD

Subjects
Adverse events, Allergen immunotherapy, Anaphylaxis, Clinical trials, Safety reporting, Immunologic diseases. Allergy, RC581-607
Abstract

There is a lack of consensus over the description and severity assignment of allergic adverse reactions to immunotherapy, although there seems to be a consensus at least in terms of using the World Allergy Organization (WAO) grading systems to describe local adverse events for Sublingual Immunotherapy (SLIT) and Systemic Allergic Reactions (SARs) to Subcutaneous Immunotherapy (SCIT) amongst the major national/regional allergy societies. In this manuscript, we propose a modification of the previous WAO Grading system for SARs, which aligns with the newly-proposed Consortium for Food Allergy Research (CoFAR) Grading Scale for Systemic Allergic Reactions in Food Allergy (version 3.0). We hope this can facilitate a unified grading system appropriate to SARs due to allergen immunotherapy, independent of allergen and route of administration, and across clinical and research practice.

Published
2024
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37. Growth and mouth breathers

Author

Gustavo Falbo Wandalsen, Dirceu Solé, and Mario Morais-Almeida

Subjects
Sleep Wake Disorders, Pediatrics, medicine.medical_specialty, Adenoides, Mouth breather, Mouth breathing, Growth, Short stature, Allergic rhinitis, Muscle hypertrophy, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Hypersensitivity, medicine, Humans, Adenoid hypertrophy, 030212 general & internal medicine, Respiratory system, Child, Growth Disorders, Hipersensibilidade, Rhinitis, Data source, Sleep disorder, business.industry, lcsh:RJ1-570, lcsh:Pediatrics, Mouth Breathing, medicine.disease, Adenoids, Pediatrics, Perinatology and Child Health, Failure to thrive, Tonsillar hypertrophy, Nasal Obstruction, medicine.symptom, business
Abstract

Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers. Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: “mouth breathing”, “adenotonsilar hypertrophy”, “allergic rhinitis”, “sleep disturbance” AND “growth impairment”, “growth hormone”, “failure to thrive”, “short stature”, or “failure to thrive”. Data summary: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). Conclusions: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner. Resumo: Objetivo: Avaliar a relação entre respiração oral e distúrbios do crescimento entre crianças e adolescentes. Fonte de dados: Busca na base de dados do MEDLINE, nos últimos 10 anos, com o emprego dos seguintes termos: “mouth breathing” ou “adenotonsilar hypertrophy”, ou “allergic rhinitis” ou sleep disturbance” AND “growth impairment” ou “growth hormone” ou ''failure to thrive” ou “short stature” ou ‘failure to thrive”. Síntese dos dados: Foram identificados 247 artigos, que após a leitura dos títulos foram reduzidos a 45, cujos resumos foram lidos e desses 20 foram considerados de importância e integraram a revisão. Além desses, referências por eles citadas e livros-texto específicos sobre respiração oral considerados importantes foram incluídos. A hipertrofia de tonsilas palatinas e/ou faríngeas, associada ou não à rinite alérgica, assim como a rinite alérgica mal controlada, é a principal causa de respiração oral na criança. Distúrbios respiratórios do sono são frequentes entre esses pacientes. Vários estudos associam a respiração oral à redução do crescimento, bem como à redução de liberação de hormônio do crescimento, que são restabelecidos após o tratamento efetivo da respiração oral (clínico e/ou cirúrgico). Conclusões: A respiração oral deve ser cogitada como possível causa de retardo de crescimento em crianças e cabe ao pediatra a tarefa de investigar esses pacientes de forma mais abrangente. Keywords: Allergic rhinitis, Adenoid hypertrophy, Tonsillar hypertrophy, Mouth breather, Growth, Palavras-chave: Rinite alérgica, Hipertrofia de adenoide, Hipertrofia de amígdala, Respirador oral, Crescimento

Published
2019

38. Still Fighting for Breath: a patient survey of the challenges and impact of severe asthma

Author

Robin Gore, Christian Domingo Ribas, Paraskevi Katsaounou, Lorena Garcia Conde, Francesco Menzella, Matthias Gasser, Mario Morais-Almeida, Ismail Kasujee, Michael E. Hyland, Mikaela Odemyr, O. Spranger, and Claus Kroegel

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Severe asthma, MEDLINE, lcsh:Medicine, Disease, 03 medical and health sciences, 0302 clinical medicine, medicine, In patient, 030212 general & internal medicine, Author Correction, Asma, Asthma, business.industry, lcsh:R, Severe persistent asthma, Original Articles, medicine.disease, Disease control, 3. Good health, respiratory tract diseases, 030228 respiratory system, Emergency medicine, Patient survey, business
Abstract

We conducted a large global survey, Still Fighting for Breath, in patients with severe persistent asthma, 10 years after the Fighting for Breath survey to assess the impact of disease on patients' lives and to determine if control and management have changed in recent years. Data were collected from 1333 adults (aged >18 years) and caregivers of children (aged 6–17 years) with severe persistent asthma from nine countries through an online survey conducted in 2016 by GfK. A decade after the first survey, our results showed that the impact of severe asthma has not changed significantly and a high proportion of patients with severe asthma remain inadequately controlled. A large discrepancy was observed between the proportion of patients who perceived their asthma to be well controlled (42%) and the proportion of patients who reported to be well controlled as per the Global Initiative for Asthma (GINA) assessment (6%). Although most patients perceived their asthma to be controlled, many experienced frequent symptoms that affected their daily lives. Thus, there is a need for improved management (support and strategies) of patients with severe persistent asthma and improved coordination of efforts that would enable these patients to achieve better disease control., There is a need for improved management of patients with severe persistent asthma to achieve better disease control http://ow.ly/rv5K30mQdGG

Published
2018

39. A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

Author

John Oppenheimer, Ignacio J. Ansotegui, Mario Morais Almeida, Enrico Scala, Lindo Cox, Michael Levin, Jonathan A. Bernstein, Torsten Zuberbier, Ruby Pawankar, Luciana Kase Tanno, Peter Schmid-Grendelmeier, Nelson Augusto Rosário Filho, Giovanni Melioli, Marianne van Hage, Giorgio Walter Canonica, Thilo Jakob, Rudolf Valenta, Bryan Martin, Juan Carlos Sisul, Carlos Nunes, Philip W. Rouadi, Pedro Giavina Bianchi, Jean Bousquet, Mimi L.K. Tang, José Antonio Ortega Martell, Harald Renz, Lars K. Poulsen, Luis Caraballo, Giovanni Passalacqua, Eleonora Savi, Hugh A. Sampson, Paolo Maria Matricardi, Sandra Nora González Díaz, Alessia Ruiba, Pascal Demoly, Gianenrico Senna, Gary W.K. Wong, Olga Luengo, Victoria Cardona, Riccardo Asero, Jörg Kleine-Tebbe, Motohiro Ebisawa, Mario Sanchez Borges, Olga Patricia Monge Ortega, Erika Jensen-Jarolim, Elisa Villa, Fatima Ferreira, Anahí Yáñez, R. Maximiliano Gómez, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Sorbonne Université (SU), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Universidade de São Paulo (USP), R Valenta discloses research grants from Viravaxx, Vienna, Austria and serves as a consultant for this company. E Jensen-Jarolim discloses she is a shareholder and inventor on EP 2894478, with Biomedical International R + D GmbH Vienna, has received a grant and lecture honoraria from Bencard GmbH Germany, has received lecture honoraria from Sanofi GmbH, Roxall, Meda, and Novartis, and is a joint Editor-in-Chief of this journal. All other authors have declared they have no competing interests related to this work., and The authors extend their appreciation to Naomi Ruff, PhD, for her contribution as editor of the document. The World Allergy Organization thanks Thermo Fisher Scientific for supporting this project, in part, by a medical educational grant. The supporter did not participate in document development.

Subjects
lcsh:Immunologic diseases. Allergy, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergen immunotherapy, Allergy, Specific immunoglobulin E, Immunology, Molecular allergy, Article, 03 medical and health sciences, 0302 clinical medicine, Clinical history, Food allergy, Diagnosis, medicine, Immunology and Allergy, Medical physics, [SDV.IMM.ALL]Life Sciences [q-bio]/Immunology/Allergology, 030223 otorhinolaryngology, Routine care, Cross reactivity, Panallergen, Specific IgE, PAMD@, business.industry, medicine.disease, 3. Good health, Specific IgE, 030228 respiratory system, PAMD@, lcsh:RC581-607, business, Relevant information
Abstract

Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@.PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies. Keywords: Diagnosis, Molecular allergy, Cross reactivity, Panallergen, Specific IgE, PAMD@

Published
2020

40. Unanswered questions on the use of biologics in pediatric asthma

Author

Antonio Nieto, MD, PhD, Zeinab A. El-Sayed, MD, PhD, René Maximiliano Gómez, PhD, Elham Hossny, MD, PhD, Wang Jiu-Yao, MD, DPhil, Ömer Kalayci, MD, Mário Morais-Almeida, Wanda Phipatanakul, MD, Paulo Marcio Pitrez, MD, César Fireth Pozo Beltrán, MD, Paraskevi Xepapadaki, MD, and Nikolaos G. Papadopoulos, MD, PhD

Subjects
Severe childhood asthma, Biologics, Omalizumab, Mepolizumab, Benralizumab, Dupilumab, Immunologic diseases. Allergy, RC581-607
Abstract

The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease.Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers.For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.

Published
2023
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41. Living with severe asthma year 2016

Author

Cristian Domingo Ribas, Mikaela Odemyr, Robin Gore, Ismail Kasujee, Matthias Gasser, Francesco Menzella, Claus Kroegel, Paraskevi Katsaounou, Lorena Garcia Conde, Mario Morais Almeida, and Michael E. Hyland

Subjects
Pediatrics, medicine.medical_specialty, Health professionals, business.industry, Everyday activities, Severe asthma, Severe persistent asthma, Gina guidelines, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Asthma control, medicine, 030212 general & internal medicine, Psychological aspects, Allergists, business
Abstract

Objective: To assess the impact of severe asthma on daily life (asthma control, activity, psychological aspects, treatment). Methods: Data were collected from 1333 adults and children (through caregivers) with severe persistent asthma in 9 countries through an online survey done by GfK on behalf of Novartis in 2016 (Table 1a). Results: Severe asthmatics were diagnosed by respiratory physicians (42%), general practitioners (30%), allergists (21%) and paediatricians (6%). On average, adults were diagnosed 15 years ago, adolescents 7 years and pediatrics 3 years ago. As per patients’ knowledge, 47% were non-allergic. A large discrepancy was seen between real-life control according to GINA guidelines (6%) and self-estimated control (42%). In the previous year, 73% of patients experienced exacerbations that required treatment from a healthcare professional (emergency room, ambulance, physician at home); 34% had ≥2 exacerbations (13%, three; 7%, four; 3%, five; 11%, more than 5). On an average, 20 days of OCS use was reported in the last 6 months. The impact on psychology and activities is shown in Table 1b. Conclusions: Although asthma control is GINA’s main goal, severe asthmatics are uncontrolled with poor quality of life as reflected in their psychological profile and everyday activities. There is a strong disconnect between perceived and actual asthma control. More action is needed to help severe asthmatics achieve control and live normal unrestricted lives.

Published
2017

42. Utility of biomarkers in the diagnosis and monitoring of asthmatic children

Author

Paraskevi Xepapadaki, MD, PhD, Yuichi Adachi, César Fireth Pozo Beltrán, MD, Zeinab A. El-Sayed, MD, PhD, René Maximiliano Gómez, PhD, Elham Hossny, MD, PhD, Ivana Filipovic, MD, Peter Le Souef, MD, Mário Morais-Almeida, MD, PhD, Michael Miligkos, MD, Antonio Nieto, MD, PhD, Wanda Phipatanakul, MD, Paulo M. Pitrez, MD, Jiu-Yao Wang, MD, Gary W.K. Wong, MD, and Nikolaos G. Papadopoulos, MD, PhD

Subjects
Asthma, Children, Pediatric asthma, Non-invasive biomarkers, Immunologic diseases. Allergy, RC581-607
Abstract

Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited.In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and “omic” approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all “well-known” and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers’ use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.

Published
2023
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43. Estudo da Variação Intradiária das Concentrações de Pólen de Gramíneas na Atmosfera de Portugal Continental

Author

Elsa Caeiro, Lopes, M. L., Gaspar, A., Todo-Bom, A., Oliveira, J. F., Nunes, C., Mario Morais-Almeida, Trindade, Costa, and Brandao, R. M.

Subjects
grasses, pollen, Portuguese Aerobiological Network, outdoor environment, meteorology, plant ecology
Abstract

Introdução: O pólen da família das Poaceae (gramíneas) é uma das principais fontes de aeroalergénios no mundo, particularmente na Europa Mediterrânica. Representa, por isso, um importante factor de risco de asma, rinite e/ou conjuntivite alérgica e constitui a principal causa de polinose em Portugal. Objectivo: Analisar a variação intradiária das concentrações de pólen de gramíneas na atmosfera das 5 estações de monitorização continentais da Rede Portuguesa de Aerobiologia (RPA): Porto, Coimbra, Lisboa, Évora e Portimão. Métodos: Neste estudo utilizaram -se os dados diários e horários das monitorizações de pólen de gramíneas das cinco estações de monitorização continentais da RPA, ao longo de 7 anos (2002 -2008). Resultados: Entre as localidades encontraram -se diferenças significativas, em termos de Estudo da variação intradiária das concentrações de pólen de gramíneas na atmosfera de Portugal Continental O pólen atmosférico de gramíneas constitui a principal causa de rinite, asma, conjuntivite e eczema nos indivíduos alérgicos ao pólen na área Mediterrânica1,2, nomeadamente em Portugal3,4. Dado que o pólen, particularmente o pólen de gramíneas, é um factor de risco para as doenças alérgicas respiratórias exercendo um impacto negativo sobre a qualidade de vida dos indivíduos sensibilizados, é de particular interesse, quer dos profissionais de saúde, quer do doente conhecer a sua distribuição intradiária, ou seja a variação horária das concentrações de pólen de gramíneas ao longo do dia, de modo a adequar de forma mais eficaz medidas de evicção e de intervenção terapêutica. curvas horárias. O pólen encontrou -se presente na atmosfera durante 24 horas em todas as localidades, e os valores das concentrações horárias variaram ao longo do dia e de ano para ano. As concentrações mais baixas registaram -se entre as 22 e as 6 horas e as mais elevadas, entre as 7 e as 21 horas, as quais em Évora ultrapassaram os 30 grãos de pólen/m3/hora. Em geral, registaram -se 2 picos de concentrações máximas, um de manhã (9 -10 horas) ou à tarde (12 -13 horas) e outro no final da tarde / início da noite (19 -20 horas). Conclusões: O ritmo diurno difere muito de local para local. Cada localidade tem o seu próprio padrão de variação das concentrações horárias do pólen atmosférico de gramíneas que se pode dever, quer às diferentes espécies presentes, quer às diferentes condições ambientais. O risco de exposição variou de localidade para localidade e ao longo do dia, sendo o Porto a localidade onde este é menor, enquanto Évora apresenta o maior risco.

Published
2013

44. Aerobiologia do pólen de Olea europaea L. em Portugal Continental

Author

Caeiro, E., R. Ferro, Brandao, R. M., Trindade, Costa, Lopes, M.L., Gaspar, A., Nunes, C., Todo-Bom, A., Oliveira, J.F., and Mario Morais-Almeida

Subjects
aerobiology, olea, pollen, Portuguese Aerobiological Network, portugal
Abstract

Introdução: O pólen de oliveira (Olea europaea L.) constitui uma das fontes de aeroalergenos mais importantes na Europa Mediterrânica e em Portugal. Objectivos: Analisar a aerobiologia do pólen de Olea em Portugal Continental. Métodos: No estudo utilizaram-se os dados horários e diários das monitorizações de pólen de Olea efetuadas entre 2002 e 2012 de cinco estações de monitorização continentais da Rede Portuguesa de Aerobiologia - RPA: Porto, Coimbra, Lisboa, Évora e Portimão. Resultados: O pólen de Olea encontra-se bem representado no espectro polínico da atmosfera de Portugal: 4% Porto, 14% Coimbra, 12% Lisboa, 9% Évora e 36% Portimão. Entre as localidades encontraram-se diferenças estatisticamente significativas (p 200 grãos de pólen/ m3. Detectou-se a presença de pólen na atmosfera ao longo de todo o dia, em que as concentrações horárias foram homogéneas no Norte, Porto, e heterogéneas nas restantes localidades, onde as mais elevadas registaram-se durante as horas de sol. Conclusões: A aerobiologia do pólen de Olea diferiu entre as localidades devido ao diferente grau de abundância desta árvore nas localidades e proximidades, e às diferentes condições ambientais. O grau de exposição e risco variou de ano para ano, de região para região, sendo maior nas regiões do Sul do País.

Published
2012

45. The Portuguese aerobiology network

Author

I. Câmara, Caeiro, E., Lopes, M.L., Gaspar, A., Todo-Bom, A., Nunes, C., Câmara, Rita, Brandao, R.M., Mario Morais-Almeida, and Oliveira, J.F.

Subjects
aerobiology, Portuguese Aerobiological Network, portugal
Abstract

The Portuguse Aerobiology NetworkBackground: Aeropalynological monitoringing is an aiding factor to respiratory disease knowledge

Published
2011

46. Asthma management with breath-triggered inhalers: innovation through design

Author

Mário Morais-Almeida, Helena Pité, João Cardoso, Rui Costa, Carlos Robalo Cordeiro, Eurico Silva, Ana Todo-Bom, Cláudia Vicente, and José Agostinho Marques

Subjects
Asthma, Breath-triggered-inhalers, Control, Inhalers, Innovation, K-haler, Diseases of the respiratory system, RC705-779
Abstract

Abstract Background Asthma affects the lives of hundred million people around the World. Despite notable progresses in disease management, asthma control remains largely insufficient worldwide, influencing patients’ wellbeing and quality of life. Poor patient handling of inhaling devices has been identified as a major persistent problem that significantly reduces inhaled drugs’ efficacy and is associated with poor adherence to treatment, impairing clinical results such as asthma control and increasing disease-related costs. We herein review key research and development (R&D) innovation in inhaler devices, highlighting major real-world critical errors in the handling and inhalation technique with current devices and considering potential solutions. Furthermore, we discuss current evidence regarding breath-triggered inhalers (BTI). Main body The two most common significant problems with inhalers are coordinating actuation and inhalation with pressurized metered-dose inhalers (pMDIs), and the need to inhale forcibly with a dry powder inhaler. BTI R&D plans were designed to overcome these problems. Its newest device k-haler® has several other important features, generating a less forceful aerosol plume than previous pMDIs, with efficient drug delivery and lung deposition, even in patients with low inspiratory flow. The local and systemic bioavailability of fluticasone propionate and formoterol (FP/FORM) administered via k-haler® has been shown to be therapeutically equivalent when administered via the previous FP/FORM pMDI. This device requires very few steps and has been considered easy to use (even at first attempt) and preferred by the patients in a randomized crossover study. In our country, FP/FORM k-haler is available without additional costs compared to FP/FORM pMDI. All devices continue to require education and regular checking of the correct inhalation technique. Conclusion BTI R&D can bring advantage over current available inhalers, avoiding the two most common identified critical errors in inhalation technique. K-haler® BTI is currently available, without an increased cost, and approved for adolescents and adults with asthma in whom treatment with inhaled combined therapy with long-acting beta2-agonists and corticosteroids is indicated. Its attractive and practical design to facilitate its use has been awarded. K-haler® represents added value through innovation to fulfill actual asthma patient needs, thus with potential relevant impact in asthma management and effective control.

Published
2020
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47. Prevalence, Presentation and Outcomes of Silent Hypoxemia in COVID-19

Author

Amélia Ribeiro, Mauro Mendonça, Cláudia Sabina Sousa, Miguel Trigueiro Barbosa, and Mário Morais-Almeida

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701, Diseases of the respiratory system, RC705-779
Abstract

Dyspnea is reported in a minority of patients affected by coronavirus disease 2019 (COVID-19). Even patients with pneumonia can present hypoxemia without any respiratory distress, a phenomenon known as “silent” or “happy hypoxemia”. During the current pandemic there were only a few studies conducted on this subject and these were quite heterogeneous. Therefore, the prevalence of “silent hypoxemia” varied substantially. While studies did not show a clear tendency of “silent hypoxemia” to poorer outcomes compared to hypoxemia presenting with dyspnea, several showed that patients with “silent hypoxemia” are not protected from poor outcomes either. There is a need for a uniform definition of “silent hypoxemia”, in order to better guide clinicians and investigators. More studies are needed to shed light on the mechanisms of “silent hypoxemia”, as well as its presentation and influence in the disease's progression and outcomes, so as to better assist physicians in the care of COVID-19 patients.

Published
2022
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48. Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK‐air®

Author

Bernardo Sousa‐Pinto, Patrik Eklund, Oliver Pfaar, Ludger Klimek, Torsten Zuberbier, Wienczyslawa Czarlewski, Annabelle Bédard, Carsten Bindslev‐Jensen, Anna Bedbrook, Sinthia Bosnic‐Anticevich, Luisa Brussino, Victoria Cardona, Alvaro A. Cruz, Govert deVries, Philippe Devillier, Wytske J. Fokkens, José Miguel Fuentes‐Pérez, Bilun Gemicioğlu, Tari Haahtela, Yunen Rocío Huerta‐Villalobos, Juan Carlos Ivancevich, Inger Kull, Piotr Kuna, Violeta Kvedariene, Désirée E. Larenas Linnemann, Daniel Laune, Michael Makris, Erik Melén, Mário Morais‐Almeida, Ralph Mösges, Joaquim Mullol, Robyn E. O'Hehir, Nikolaos G. Papadopoulos, Ana Margarida Pereira, Emmanuel P. Prokopakis, Fotis Psarros, Frederico S. Regateiro, Sietze Reitsma, Boleslaw Samolinski, Nicola Scichilone, Jane daSilva, Cristiana Stellato, Ana Todo‐Bom, Peter Valentin Tomazic, Sanna Toppila Salmi, Antonio Valero, Arunas Valiulis, Erkka Valovirta, Michiel vanEerd, Maria Teresa Ventura, Arzu Yorgancioglu, Xavier Basagaña, Josep M. Antó, Jean Bousquet, and João Almeida Fonseca

Subjects
allergic rhinitis, mobile health, reliability, responsiveness, visual analog scales, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Background MASK‐air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods Daily monitoring VAS data were assessed in MASK‐air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol‐5 Dimensions (EQ‐5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI‐AS) Questionnaire (work and activity impairment scores). Intra‐rater reliability was assessed in users providing multiple daily VASs within the same day. Test–retest reliability was tested in clinically stable users, as defined by the EQ‐5D VAS, CARAT, or “VAS Work” (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ‐5D‐VAS or “VAS Work” indicating clinical change. Results A total of 17,780 MASK‐air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate–high (Spearman correlation coefficient range: 0.437–0.716). Intra‐rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test–retest reliability ICCs ranged between 0.604 and 0.878—“VAS Work” and “VAS asthma” presented the highest ICCs. Moderate/large responsiveness effect sizes were observed—the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion In MASK‐air®, daily monitoring VASs have high intra‐rater reliability and moderate–high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.

Published
2021
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49. Erratum to 'IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper' [World Allergy Organ J 13/2 (2020) 100080]

Author

Ignacio J. Ansotegui, Giovanni Melioli, Giorgio Walter Canonica, Luis Caraballo, Elisa Villa, Motohiro Ebisawa, Giovanni Passalacqua, Eleonora Savi, Didier Ebo, R.Maximiliano Gómez, Olga Luengo Sánchez, John J. Oppenheimer, Erika Jensen-Jarolim, David A. Fischer, Tari Haahtela, Martti Antila, Jean J. Bousquet, Victoria Cardona, Wen Chin Chiang, Pascal M. Demoly, Lawrence M. DuBuske, Marta Ferrer Puga, Roy Gerth van Wijk, Sandra Nora González Díaz, Alexei Gonzalez-Estrada, Edgardo Jares, Ayse Füsun Kalpaklioğlu, Luciana Kase Tanno, Marek L. Kowalski, Dennis K. Ledford, Olga Patricia Monge Ortega, Mário Morais-Almeida, Oliver Pfaar, Lars K. Poulsen, Ruby Pawankar, Harald E. Renz, Antonino G. Romano, Nelson A. Rosário Filho, Lanny Rosenwasser, Mario A. Sánchez Borges, Enrico Scala, Gian-Enrico Senna, Juan Carlos Sisul, Mimi L.K. Tang, Bernard Yu-Hor Thong, Rudolf Valenta, Robert A. Wood, and Torsten Zuberbier

Subjects
Immunologic diseases. Allergy, RC581-607
Published
2021
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50. Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

Author

Jonathan Grigg, Heather J Zar, David Price, Andrew Bentley, Aziz Sheikh, Michael Miligkos, Giuseppe De Carlo, Peter N Le Souëf, Tim Felton, Graham Roberts, Jose A Castro-Rodriguez, Stephen Turner, Alexander G Mathioudakis, Gioulinta S Alimani, Georgios A Mathioudakis, Effie Papageorgiou, Nikolaos G Papadopoulos, Apostolos Beloukas, Ioanna Tsiligianni, Despo Ierodiakonou, Tuomas Jartti, A Deschildre, Wojciech Feleszko, Matteo Bonini, Clare Murray, Adnan Custovic, Mário Morais-Almeida, Wanda Phipatanakul, Mika J Mäkelä, Gunilla Hedlin, Robert F Lemanske, Paraskevi Xepapadaki, James E Gern, Cristina Boccabella, Francine Monique Ducharme, Omer Kalayci, Antonio Nieto Garcia, Ioana Octavia Agache, Leonard Bacharier, Timothy Craig, Zuzana Diamant, Elham M Hossny, Alan Kaplan, Paolo Matricardi, Marina Mitrogiorgou, Karthik Nagaraju, Helena Pité, Paulo M C Pitrez, Petr Pohunek, Susanne Vijverberg, Tonya A Winders, and Gary WK Wong

Subjects
Medicine
Abstract

Introduction Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted.Methods and analysis Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence.Ethics and dissemination Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank.PROSPERO registration numbers CRD42020132990, CRD42020171624.

Published
2021
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