Allergic rhinitis and its impact on asthma (ARIA) in Greece: Integrated care pathways for predictive medicine across the life cycle

© Athens Medical Society. Allergic rhinitis is a serious global health problem which affects approximately 10–20% of the European population. In 1999, during a workshop of WHO, the project Allergic Rhinitis and its Impact on Asthma (ARIA) was developed. Its objective was to propose a new classification of allergic rhinitis according to the severity and the duration of the symptoms, to promote the idea of multimorbidity of allergic rhinitis and asthma, and to create guidelines for global use, with the help of local stakeholders and experts from all the countries involved. The focus of ARIA during recent years has been the use of new technologies for individualized medical care and prevention. The MASK instrument uses smartphone technology to create care pathways for controlling rhinitis, for both multidisciplinary care teams and the patients themselves. Using a mobile app (Allergy Diary), a patient can assess symptoms, control and productivity using a visual analog scale, which is connected with a clinical decision support system. The information is sent to an interoperable tablet where healthcare professionals can be informed about the patient’s rhinitis management. As the European population is ageing, the novel approach of ARIA aims to provide active and healthy ageing in order to improve the quality of life of patients with allergic rhinitis. In Greece, ARIA has been implemented since the early 2000s. In 2017 a new ARIA implementation group was established, consisting of a large number of health care professionals from both Greece and Cyprus. The MASK Allergy Diary has been translated into Greek and is currently being used in clinical practice and research protocols with great enthusiasm. In order to rectify the lack of recent studies on the epidemiology of allergic rhinitis in Greece, MASK will be the instrument which, in combination with aerobiological studies, will form the basis for reporting allergic rhinitis activity around the country.status: publishe

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

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, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) 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.Peer reviewe