The ARIA-MASK-air® approach

Funding Information: The authors thank Ms Véronique Pretschner for submitting the paper. MASK‐air has been supported by Charité Universitätsmedizin Berlin, EU grants (EU Structural and Development Funds Languedoc Roussillon and Region PACA; POLLAR: EIT Health; Twinning: EIP on AHA; Twinning DHE: H2020; Catalyse: Horizon Europe) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis, Stallergènes‐Greer and Uriach. None for the study. ® Publisher Copyright: © 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.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.publishersversionpublishe

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Asthma: From one disease to endotypes

International audienceThe meaning of the word “asthma” has evolved greatly from antiquity to the present. Once considered as a single entity, asthma is now recognized as a heterogeneous disease characterized by numerous and various phenotypes, that is, the observable characteristics. However, a study of these phenotypes alone does not offer insight into the underlying pathophysiology of the disease. Despite a similar clinical picture, distinct underlying aetiologies for asthma may confer divergent natural histories and treatment responses. There has been a recent impetus to decipher underlying asthma pathways or endotypes through molecular and omics techniques, due to the advent of precision medicine strategies for the treatment of asthma. This chapter describes the history of asthma and the evolution of the word “asthma” over time. It introduces the current epidemiology of asthma and describes childhood and adult asthma phenotypes and endotypes

Outdoor air pollution and asthma in a changing climate

International audienceThe purpose of the chapter is to summarize the recent research on the associations between long-term exposure to air pollution and asthma and allergies, both in adults and children, and to identify knowledge gaps for future research. The chapter also discusses the evidence of the impacts of climate change on air pollution as well as the possible interactions between air pollution, climate change, and allergens

Caractéristiques de la rhinite selon sa sévérité en population générale : la cohorte Constances

International audienceINTRODUCTION - Bien que la sévérité de la rhinite ait des impacts non-négligeables sur la qualité de vie des patients, aucune étude n’a décrit la rhinite suivant l’intensité de sa sévérité en population générale française. Notre objectif était de décrire les caractéristiques de la rhinite selon le score de sévérité construit sur la base de quatre de ses principaux symptômes parmi les adultes de l’étude épidémiologique en population générale Constances. METHODES - L’analyse est basée sur les réponses aux questions validées et standardisées sur la rhinite incluses dans le questionnaire de suivi annuel de 2014, adressé à 26737 participants et complété par 21507 (80%). Le score de sévérité de la rhinite a été construit comme décrit précédemment (Burte et al. JACI 2020) parmi les participants ayant déclaré des symptômes de rhinite dans les 12 derniers mois (n=8069). Ce score se base sur les réponses concernant la sévérité des symptômes de rhinorrhée, congestion, éternuements et prurit nasal. Pour chaque symptôme, les participants indiquaient l’intensité de la gêne dans leur vie quotidienne : 0 (absent), 1 (présent sans gêne) 2 (gêne sans affecter activités/sommeil) et 3 (affecte activités/ sommeil). Le score total est compris entre 0 et 12, un score élevé indique une sévérité importante. RESULTATS - 6611 participants ayant des données pour le score ont été inclus dans les analyses (âge moyen : 50 ans, 56% de femmes) : 72% déclaraient de la rhinite allergique (RA) et 28% de la rhinite non-allergique (RNA). Le score de sévérité était en moyenne de 5,2, avec une moyenne de 5,8 pour la RA et 3,6 pour la RNA (p<10-4). Les participants qui rapportaient un score plus élevé déclaraient plus d’asthme, de conjonctivite et d’eczéma au cours de leur vie, de traitement pour la rhinite dans les 12 derniers mois, et de rhinite persistante (p tendance<10-4). Les participants qui rapportaient un score plus élevé rapportaient un âge de début de la rhinite plus précoce (β=-0,043, p<10-4). Après stratification sur le statut allergique, ces résultats ne changeaient pas excepté pour la persistance qui n’augmentait pas selon la sévérité chez les RNA. CONCLUSION - Ce travail montre pour la première fois en population générale française que les caractéristiques de la rhinite différaient suivant le niveau du score de sévérité. Les résultats suggèrent que l’âge de début et les comorbidités pourraient être des déterminants de la sévérité de la rhinite

Prévalence et caractéristiques de la rhinite allergique et non-allergique chez l’adulte en France en population générale : la cohorte Constances

International audienceINTRODUCTION - La rhinite est l’une des affections médicales les plus courantes, caractérisée par une morbidité importante et un lourd fardeau financier. Si de nombreuses études en population générale ont été conduites pour estimer la prévalence de la rhinite allergique (RA), très peu ont porté sur la rhinite non-allergique (RNA). L’objectif de cette analyse était d’estimer la prévalence et de décrire les caractéristiques des RA et RNA chez l’adulte dans la cohorte Constances. METHODES - Parmi les 26 737 participants inclus jusqu’en décembre 2013, 21 507 (80%) ont complété le module rhinite du questionnaire de suivi annuel de 2014. La rhinite actuelle a été définie par les questions « Au cours de votre vie, avez-vous déjà eu des problèmes d’éternuement, nez qui coule ou nez bouché quand vous n’étiez pas enrhumé(e) et n’aviez pas la grippe ? » et « Avez-vous eu ces problèmes dans les 12 derniers mois ? ». La RA et la RNA ont été définies parmi les participants ayant déclaré une rhinite et par une réponse positive (RA) ou négative (RNA) à « Au cours de votre vie, avez-vous eu des allergies nasales, y compris le rhume des foins ? ». RESULTATS - 18 735 participants ont été inclus dans les analyses (âge moyen = 53 ans, 55,7% de femmes, 12,8% asthmatiques vie). Les prévalences brutes de la rhinite actuelle, de la RA et de la RNA actuelles étaient de 43,6%, 32,9% et 10,7% respectivement. Les caractéristiques des groupes RA et RNA actuelles sont présentées dans le tableau ci-joint. Les participants RA déclaraient en moyenne plus d’asthme, de conjonctivite et d’eczéma que les participants RNA. Les participants du groupe RA déclaraient également un âge de début plus précoce des symptômes. La majorité des participants RA déclaraient les pollens comme déclencheurs de leurs symptômes contre moins de 10% pour les participants RNA. CONCLUSIONS - Nous observons des caractéristiques différentes entre la RA et la RNA, qui sont cohérentes avec celles décrites dans la littérature et connues des cliniciens. En l’absence de données biologiques ou de tests cutanés, un questionnaire validé et standardisé semble adapté pour estimer et décrire les phénotypes allergiques et non-allergiques de la rhinite

The exposome in respiratory diseases: multiple preventable risk factors from early life to adulthood

International audienceThe increasing global burden of respiratory diseases over the last decades raises questions about the impact of environmental factors during industrialisation and urbanisation. Although the knowledge of environmental epidemiology is growing, it is still unclear what the most critical exposure windows are for respiratory health. In addition, the relationships between different environmental exposures can be complex. The exposome approach investigating all non-genetic factors on health has been developed in recent years but has been little applied in respiratory health to date. This journal club article reviews three recent publications investigating the effects of environmental exposures, considered separately or in an exposome approach with different exposure windows, on respiratory health outcomes. These three studies highlight targets for action in primary and secondary prevention. Two studies, using data from the INMA and RHINESSA cohorts, support the regulation and reduction of phthalates and air pollution, respectively. Moreover, the exposome approach conducted in the NutriNet-Santé cohort emphasises that risk reduction must involve a multi-interventional approach targeting both specific early-life risk factors and promotion of a healthy lifestyle in adulthood. These three articles also present research perspectives in environmental epidemiology

Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution

International audienceIntroduction: Although rhinitis is among the most common diseases worldwide, rhinitis prevalence in the general adult population is unclear and definitions differ widely. Objective: To summarize the literature on rhinitis prevalence in the general adult population and to assess: (1) the prevalence according to different rhinitis definitions overall and in different regions of the world, and (2) the evolution of rhinitis prevalence over time. Methods: We conducted an extensive literature review of publications including rhinitis prevalence using Pubmed and Scopus databases up to October 2020. We classified the definitions into three categories: unspecified rhinitis, allergic rhinitis (AR), and nonallergic rhinitis (NAR). Results: Among 5878 articles screened, 184 articles were included, presenting 156 different definitions of rhinitis. Rhinitis prevalence ranged from 1% to 63%. The overall median prevalences of unspecified rhinitis, AR and NAR were 29.4%, 18.1% and 12.0%, and they varied according to the geographical location. Rhinitis prevalence tended to increase over time. Conclusions: This review highlights the great heterogeneity of the definitions. The majority of studies had focused on AR, while only a few epidemiological data exist on NAR. We found geographical variability in rhinitis prevalence. Most of studies reported an increase of rhinitis prevalence over the last decades

Age of onset of rhinitis as a determinant of different rhinitis phenotypes

International audienceRhinitis is a heterogeneous disease. Age of onset of rhinitis as a determinant of the different phenotypes has not yet been explored.Our aim was to describe phenotypes of rhinitis accordi ng to age of onset in adults from Constances, a large French population-based cohort. The 2014 annual follow-up questionnaire included detailed and validated questions that have allowed us to define rhinitis and its different phenotypes. This questionnaire was sent to 26,737 adults and completed by 21,507. We included in this analysis 5,795 participants with current rhinitis, thus is who reported symptoms in the last 12 months, and informed about the age of onset. We categorized the age of onset of rhinitis as follows: < 16, [16-30[, [30-45[, [45-60[ and ≥ 60 years.The mean age of onset was 26.7 years, 24.3 years for allergie rhinitis (AR) and 34.5 years for non-allergie rhinitis (NAR). The later the age of onset, the number of participants reporting AR decreased while the number was quite constant for NAR. Self-reported triggers of symptoms varied depending on the age of onset (see Figure). Participants with a later age of onset, whether with AR or NAR, reported more persistent rhinitis and fewer severe symptoms. Beyond allergy, age of onset seems to be an essential characteristic of rhinitis. These findings may have epidemiological and clinical implications, especially given that the prevalence of rhinitis is high in the general population

Influence of asthma on ARIA classification of allergic rhinitis in the population-based cohort Constances

International audienceINTRODUCTION - Few population-based studies have described allergic rhinitis (AR) according to the Allergic Rhinitis and its Impact on Asthma (ARIA) classification. AIMS - To describe AR according to its severity and duration and taking asthma multimorbidity into account among adults from the population-based cohort Constances. METHODS - Cross-sectional analyses were performed using data from the 2014 annual follow-up questionnaire. AR was defined by sneezing, runny or blocked nose in the last 12 months and the report of nasal allergies. Following ARIA recommendations, rhinitis was considered according to its severity (mild or moderate-severe) and duration (intermittent or persistent). Asthma ever was self-reported on questionnaire. RESULTS - Among the 4675 participants with AR (57% women, mean age 50.2±12.7 years), 44% were classified as mild/intermittent, 16% mild/persistent, 25% moderate-severe/intermittent, and 15% moderate-severe/persistent. Within each of the four ARIA classes, compared to participants with rhinitis alone, participants with rhinitis and asthma had significantly more severe symptoms, more conjunctivitis, higher levels of eosinophils and more common treatments with intra-nasal corticosteroids and oral antihistamines co-medication (all p <0.05). CONCLUSION - This is a paradigm changing study as, for the first time we show how taking asthma status into account modify ARIA classification. Moreover, it was done in a large population-based study in adults. This study confirms that rhinitis alone and rhinitis and asthma represent two entirely different phenotypes. This new classification should be used for new guidelines