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

Article in press
Background: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. Objective: We sought to provide a targeted update of the ARIA guidelines. Methods: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. Results: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H-1-antihistamines, intranasal H-1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. Conclusions: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.
J. L. Brozek has received support for the development of systematic reviews in these guidelines from the ARIA Initiative. J. Bousquet has received personal fees from Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, Chiesi, GlaxoSmithKline, and Menarini. S. Bosnic-Anticevich is on the advisory board for TEVA; has consultant arrangements with MEDA and GlaxoSmithKline; has received grants from TEVA; has received payment for lectures from TEVA, GlaxoSmithKline, and AstraZeneca; has received payment for manuscript preparation from MEDA; and has received payment for development of educational presentations from GlaxoSmithKline. T. Casale is the executive vice president of the American Academy of Allergy, Asthma & Immunology. J. Correia de Sousa has board memberships with Boehringer Ingelheim and Novartis, has received payment for lectures from Boehringer Ingelheim, and has received payment for development of educational presentations from Boehringer Ingelheim. A. A. Cruz has board memberships with Novartis, Boehringer Ingelheim, AstraZeneca, MEDA Pharma, and GlaxoSmithKline; has consultant arrangements with Boehringer Ingelheim; has provided expert testimony for Boehringer Ingelheim; has received grants from GlaxoSmithKline; and has received payment for lectures from Eurofarma, Chiesi, MEDA Pharma, and Hypermarcas-Ache. C.A. Cuello-Garcia has consultant arrangements with and has received payment for manuscript preparation and travel support from the World Allergy Organization. P. Demoly has received consulting fees from ALK-Abello, Stallergenes Greer, Thermo Fisher Scientific, MEDA, Chiesi, and Ysslab and has received grants from AstraZeneca. M. Dykewicz has consultant arrangements with Alcon and Merck and is the Workgroup Char for the Rhinitis Practice Parameter Update of the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology ACAAI Joint Task Force on Practice Parameters. I. Etxeandia-Ikobaltzeta has received a consulting fee or honorarium from
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