Skip to main content


We're creating a new version of this page. See preview

  • Review
  • Open Access

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

  • 1, 2, 3, 312Email author,
  • 4,
  • 5,
  • 2,
  • 6,
  • 7, 8,
  • 9,
  • 10,
  • 11,
  • 12,
  • 13,
  • 14,
  • 15,
  • 16,
  • 17,
  • 18, 19,
  • 20,
  • 18,
  • 13, 21, 22,
  • 23,
  • 24, 25, 26,
  • 27,
  • 28,
  • 29,
  • 30,
  • 31,
  • 32, 33,
  • 34,
  • 35,
  • 36,
  • 37,
  • 38,
  • 39,
  • 40,
  • 41, 42,
  • 43, 44,
  • 45,
  • 46,
  • 47, 48,
  • 49,
  • 50,
  • 51,
  • 52,
  • 53,
  • 54,
  • 55,
  • 56, 57, 58,
  • 59, 60,
  • 61,
  • 62, 63,
  • 64,
  • 65,
  • 7, 8,
  • 66,
  • 67,
  • 67,
  • 21, 22,
  • 3,
  • 68,
  • 69, 70, 71, 72,
  • 73,
  • 74, 75,
  • 76,
  • 77,
  • 15,
  • 78,
  • 79,
  • 80,
  • 81,
  • 82,
  • 83,
  • 84,
  • 49,
  • 85,
  • 86,
  • 87, 88,
  • 89,
  • 90,
  • 91,
  • 92,
  • 93,
  • 94,
  • 95,
  • 1,
  • 21,
  • 15,
  • 96,
  • 97, 98,
  • 50,
  • 99,
  • 100,
  • 3,
  • 101,
  • 102,
  • 101, 103,
  • 104,
  • 105,
  • 106, 107,
  • 108,
  • 109, 110,
  • 111,
  • 112, 113,
  • 114,
  • 115,
  • 13,
  • 116,
  • 117,
  • 118, 119,
  • 103,
  • 120,
  • 121,
  • 122,
  • 123,
  • 124,
  • 125,
  • 126, 127,
  • 128, 129,
  • 130,
  • 131,
  • 132,
  • 133,
  • 134,
  • 135,
  • 136,
  • 137,
  • 138,
  • 139,
  • 140,
  • 141,
  • 142, 143,
  • 144,
  • 10,
  • 56, 57, 58,
  • 145,
  • 146,
  • 147,
  • 148,
  • 149,
  • 150,
  • 151,
  • 152,
  • 153,
  • 154,
  • 155,
  • 156,
  • ^157,
  • 158,
  • 159,
  • 160,
  • 161,
  • 162,
  • 163,
  • 164, 165, 166,
  • 167,
  • 168,
  • 169,
  • 2, 87,
  • 170, 171,
  • 172,
  • 173,
  • 174,
  • 175,
  • 176,
  • 177,
  • 178,
  • 179,
  • 180,
  • 181,
  • 182,
  • 182,
  • 183,
  • 69, 70, 71, 72,
  • 184,
  • 185,
  • 186,
  • 187,
  • 62, 63,
  • 188,
  • 189,
  • 190,
  • 73,
  • 191,
  • 192,
  • 193,
  • 194,
  • 109, 195,
  • 196,
  • 197,
  • 198,
  • 199,
  • 200,
  • 201,
  • 202,
  • 203,
  • 204, 205,
  • 206,
  • 207,
  • 208,
  • 209,
  • 73,
  • 7,
  • 210,
  • 62, 63,
  • 78,
  • 211,
  • 212,
  • 213,
  • 214,
  • 215,
  • 216, 217,
  • 218,
  • 219,
  • 220, 221,
  • 222,
  • 223,
  • 224,
  • 3,
  • 225,
  • 226,
  • 227,
  • 190,
  • 24, 25, 26, 228,
  • 2, 218,
  • 229,
  • 230,
  • 231,
  • 232,
  • 1, 28, 29,
  • 233,
  • 234,
  • 235,
  • 20,
  • 236,
  • 237,
  • 238,
  • 15,
  • 239,
  • 24, 25, 26, 240,
  • 34, 241,
  • 242,
  • 243,
  • 244,
  • 245, 246,
  • 247,
  • 248,
  • 2,
  • 249,
  • 250,
  • 251, 252,
  • 253, 254,
  • 49,
  • 255,
  • 256,
  • 257,
  • 258,
  • 259,
  • 260,
  • 261,
  • 262,
  • 263,
  • 264,
  • 265,
  • 266,
  • 267,
  • 268,
  • 269,
  • 270,
  • 271, 272,
  • 273,
  • 274,
  • 109, 195,
  • 275,
  • 276,
  • 277,
  • 146,
  • 278,
  • 279,
  • 280,
  • 69, 70, 71, 72,
  • 281,
  • 53,
  • 197,
  • 282,
  • 132,
  • 283, 284,
  • 74, 75, 285,
  • 286,
  • 287,
  • 114,
  • 288, 289,
  • 290,
  • 291, 292,
  • 293,
  • 294,
  • 295,
  • 296,
  • 190,
  • 297,
  • 167,
  • 298,
  • 299,
  • 311,
  • 300,
  • 301,
  • 302,
  • 303,
  • 304,
  • 305, 306,
  • 307,
  • 308, 309,
  • 194 and
  • 310
Clinical and Translational Allergy20166:47

  • Received: 10 November 2016
  • Accepted: 5 December 2016
  • Published:


The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.


  • ARIA
  • Rhinitis
  • ICT
  • EIP on AHA
  • Mobile technology


The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999 (published in 2001) [1]. The goals were (1) to propose a new allergic rhinitis (AR) classification using persistence and severity of symptoms in order to more closely reflect patients’ needs, (2) to promote the concept of multi-morbidity in asthma and rhinitis as a key factor for patient management, (3) to develop guidelines with all stakeholders, (4) to include experts from developed and developing countries and (5) to initiate global implementation among health care professionals (HCPs) and patients.

Patients, clinicians and other HCPs are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice. Worldwide, patients, clinicians and other HCPs are faced with uncertainty about the relative merits and downsides of the many AR treatment options available. The first ARIA workshop report used the Shekelle evidence-based methodology [1, 2]. It was the first guideline in chronic disease to assess multi-morbid conditions (i.e. asthma and rhinitis in the same patient). In 2008, ARIA was updated using the same evidence-based system [3]. More transparent reporting of guidelines to facilitate understanding and acceptance was needed. In its 2010 Revision, ARIA was the first chronic respiratory disease guideline to adopt the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach, an advanced evidence evaluation methodology [47]. A new revision is pending.

ARIA has been disseminated and is implemented in over 70 countries around the world [8]. It is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves [9].

The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status in order to reduce health and social inequalities incurred by the disease.

AIRWAYS ICPs: the ARIA 2016 political agenda

In 2012, the European Commission launched the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA; DG Santé and DG CONNECT) to enhance EU competitiveness and tackle societal challenges through research and innovation [10]. The B3 Action Plan is devoted to the scaling up and replication of successful innovative integrated care models for chronic diseases amongst older patients.

Chronic respiratory diseases were selected to be the pilot for chronic diseases of the EIP on AHA Action Plan B3 (Integrated care pathways for airway diseases, AIRWAYS ICPs) [11, 12] with a life cycle approach [13]. Several effective plans exist in Europe for chronic respiratory diseases, but they are rarely deployed to other regions or countries.

AIRWAYS ICPs aims to launch a collaboration to develop practical multi-sectoral care pathways (i.e. ICPs) in European countries and regions to reduce chronic respiratory disease burden, mortality and multi-morbidity, while maintaining patients’ quality-of-life (QOL) [11, 14]. AIRWAYS-ICPs proposes a feasible, achievable and manageable project (from science to guidelines and policies) using existing networks. It brings together key stakeholders including end users, public authorities, industry partners, involved in the innovation cycle, from research to adoption, as well as those engaged in standardisation and regulation. The Action Plan of AIRWAYS ICPs has been devised [11], implemented [14] and scaled up [15].

AIRWAYS ICPs is a GARD (WHO Global Alliance against Chronic Respiratory Diseases) [16] research demonstration project. Its deployment beyond Europe is carried out via GARD.

One AIRWAYS-ICPs activity is the development of multi-sectoral care pathways for rhinitis and asthma and their multi-morbidities, implementing emerging technologies for predictive medicine across the patient life cycle [13].

From guidelines to integrated care pathways: MACVIA-ARIA Sentinel NetworK (MASK)

Best practice, guideline and care pathways

A good or best practice is a technique, method, process, activity, incentive, or reward believed to be more effective than any other technique, method, process, etc. when applied to a particular condition or circumstance. A best practice can be adopted as a standard process or be used as a guideline (U.S. Dept. of Veterans Affairs [17]).

A guideline is a statement to determine a course of action. It aims to streamline particular processes according to a set routine or sound practice. By definition, following a guideline is never mandatory. Guidelines are not binding and are not enforced (U.S. Dept. of Veterans Affairs [17]).

Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (Institute of Medicine, 1990). These clinical practice guidelines define the role of specific diagnostic and treatment modalities. The statements include recommendations based on evidence intended to help HCPs and providers in their practice [18].

The Integrated Care Pathway (ICP) concept was initiated in 1985 by Zander and Bower [19]. ICPs are structured multi-disciplinary care plans detailing key steps of patient care for a given clinical problem [20]. They promote the translation of guidelines into local protocols and their subsequent application to clinical practice. An ICP forms all or part of the clinical record, documents the care given, and facilitates the evaluation of outcomes for continuous quality improvement [21]. They can help empower patients and their carers (health and social). ICPs differ from clinical practice guidelines as they are utilized by a multi-disciplinary team, and focus on the quality and co-ordination of care. ICPs need to have a mechanism for recording variations/deviations from planned care. Like guidelines, an ICP is a guide to treatment, and clinicians are free to exercise their own professional judgment as appropriate. However, any alteration to the practice identified within this ICP must be noted as a variance [22]. Variance analysis is a critical part of developing and using ICPs [23]. The resulting analysis can be used to amend the ICP itself if, for the majority of patients, the practice is different to the pathway (Table 1).
Table 1

Definition of guidelines, practice protocols and ICPs.

Adapted from



Clinical practice guidelines

Care pathway


Specific clinical circumstances

Treatment and/or prevention

The quality and co-ordination of care


Systematically developed statements to help practitioners and patients make decisions about appropriate health care

A suggested course of treatment and/or treatment service for a specific diagnosis, functional deficit or problem area

Structured, multi-disciplinary plans of care


Makes specific recommendations on health care and links these to research evidence

Highlights major therapeutic or preventive interventions

Identifies choices of different courses or paths of treatment

Supports the implementation of clinical guidelines and protocols


Provides a summary and appraisal of the best available research evidence or expert consensus

Highlights the strength of the evidence underlying each recommendation

Describes barriers and facilitators for each recommendation

Provides a logical flow of interventions. Provides detailed recommendations that build on those made in SPCs guidelines

Provides detailed guidance for each stage in the management of a patient and key performance indicators


Clinicians, patients and third parties (all stakeholders involved)

Specific to clinicians

A multidisciplinary clinical team


(1) Appraisal of literature (research evidence or expert consensus)

(2) Summary of recommendations

(3) An outline of how guidelines should be implemented and how adherence monitored

List of major therapeutic or preventive interventions

Goals: When interventions should be achieved

Options for different choices of treatment and/or prevention

(1) Timeline

(2) Categories of care/intervention

(3) Intermediate and long term outcome criteria

(4) A variance record

Multisectoral care pathways for rhinitis and asthma using ICT

A large number of AR patients do not consult physicians because they think their AR symptoms are ‘normal’ and/or trivial. However, AR negatively impacts social life, school and work productivity [3]. Many AR patients use over the counter (OTC) drugs [24] and only a fraction have had a medical consultation. The vast majority of patients who visit GPs or specialists have moderate/severe rhinitis [2529]. Thus, ICPs should consider a multi-disciplinary approach as proposed by AIRWAYS ICPs (Fig. 1).
Fig. 1
Fig. 1

Multi-sectoral care pathway for allergic rhinitis (from Bousquet et al. [9])

The variations/deviations of the ARIA recommendations from planned care have been assessed and several unmet needs identified. Disease severity is associated with several health outcomes, including quality of life [2529], and should be considered in ICPs. The duration of rhinitis (intermittent/severe-persistent) is an important indicator of asthma multi-morbidity (in some but not all studies) [30], duration of AR treatment and efficacy of treatment in AR [27]. Most patients receive combinations of oral antihistamines and intra-nasal corticosteroids (INS) [3133] which are not evaluated in guidelines using an appropriate methodology.

Simple approach to assess control in allergic rhinitis

In asthma, the management strategy is based on disease control, current treatment and future risk (exacerbations, lung function decline) [3436]. In AR, the switch from symptom severity to disease control to guide treatment decisions has been led by ARIA and is now expanding to include MACVIA (a reference site of the EIP on AHA, EU [37]) to form an Action Plan (MACVIA-ARIA). New developments which have facilitated this process include (1) the introduction of the visual analogue scale (VAS) as the common validated language of AR control, (2) categorization of AR control using VAS score cut-offs, (3) incorporation of this VAS into simple interactive apps for both patients (ARIA Allergy Diary) and HCPs (ARIA Allergy Diary Companion) [9, 38] and (4) the integration of all this knowledge into ICPs deployed by the EIP on AHA [9].

The VAS represents a simple way of measuring control. It has been used in many diseases, including AR. VAS scores appear to be similar in different countries, for patients with moderate–severe intermittent or persistent rhinitis [39, 40]. An advantage of the VAS is that it can be used in all age groups, including preschool children (guardian evaluation) [41] and the elderly [42, 43]. Furthermore, it can be used in a wide variety of languages [39, 40, 42, 4448]. VAS scores vary with ARIA AR classification in many languages [28, 44, 49, 50]. A VAS score of 50/100 mm suggests moderate–severe AR [32, 51, 52], although in some studies this cut-off was >60 mm [45]. The VAS has been used to define severe chronic upper airway disease (SCUAD [53]). The minimal clinically important difference (MCID) during treatment was found to be 2.3/10 cm in the French population [54] and may be generalized to other countries, but future studies may refine this cut-off score. VAS score changes appear to encompass both symptoms and disease-specific QOL [54, 55].

As is the case for asthma, the best control of AR should be achieved as early as possible in order to (1) improve patient satisfaction and concordance with treatment and (2) reduce the AR burden including symptoms, reduced QoL, and school and work presenteeism/absenteeism. Untreated AR can impair driving ability and put patients at risk [56]. The ultimate goal of AR control is to reduce the direct and indirect costs incurred by AR [5760].

The variability in approaches to achieve disease control is challenging, and necessitates careful monitoring as well as the step up/step down of individualized therapeutic regimens over time. However, the challenges of managing AR are increased by the fact that patients do not often recognise their AR symptoms or confuse them with those of asthma or other multimorbidities such as rhinosinusitis [61]. Therefore, it is important for patients, caregivers or HCPs to be able to use an AR symptom scoring system that is simple to use and rapidly responsive to change.

The aim is to encourage effective cross communication and achieve rapid and sustained disease control. MACVIA-ARIA has produced a simple VAS-based algorithm called the ARIA Clinical Decision Support System (CDSS) using a VAS score to guide treatment decisions in a step-up/step-down approach. This CDSS provides an individualized approach to AR pharmacotherapy (depending on medication availability and resources) [62]. This approach holds the potential for optimal AR control while minimizing side effects and costs.

MASK (MACVIA-ARIA Sentinel NetworK): rhinitis and asthma

MASK-rhinitis and asthma is a simple ICT tool used to implement ICPs for AR and asthma by means of a common language (for patients and HCPs) and a CDSS. Disease control is assessed by VAS, incorporated into apps for patients (ARIA Allergy Diary) and HCPs (ARIA Allergy Diary Companion), with the utility to assess patient QoL (weekly EQ-5D) [63, 64] and school/work productivity (weekly WPAI-AS and daily VAS) [25, 65, 66].

MASK-rhinitis and asthma will (1) allow patients and caregivers to screen for AR and asthma, and track their AR control (2) guide pharmacists in the prescription of OTC medications and referral of patients to physicians when appropriate, (3) allow primary care physicians to prescribe appropriate AR treatment, assess patients’ AR control and direct follow-ups in accordance with the CDSS and (4) encourage referral to specialists and outpatient clinics, if there is failure to gain AR control at the primary care level.

MASK-rhinitis and asthma will be important for establishing care pathways across the life cycle. It will stratify patients with severe uncontrolled disease and achieve better results in prevention and intervention trials guided by the use of an individualised and predictive medicine approach.

The MASK tools: the ARIA Allergy Diary and ARIA Allergy Diary Companion apps

The ARIA Allergy Diary is freely available in 15 EU countries, Australia, Mexico and Switzerland and in 15 languages (translated and back-translated, culturally adapted and legally compliant). It will also be deployed in Brazil, Canada and the USA. The companion app will be available in Autumn 2016.

A pilot study was completed in AR during the pollen season to assess the relevance of the ARIA Allergy Diary app. It showed the importance of the tool to stratify patients, assess their work productivity and improve quality of life (EQ-5D) (Bousquet et al., submitted). Studies in asthma are planned for the autumn and winter.


ARIA Allergy Diary users fill in simple questionnaires on asthma, rhinitis and the impact of the disease (globally, on work and school, on daily activities and on sleep) upon registration (Table 2). The pilot study in around 5000 users (9% over 60 years of age) indicates that these questions are easily answered and can help to stratify patients with rhinitis.
Table 2

Baseline questionnaire

Q1: I have rhinitis: yes/no

Q2: I have asthma: yes/no

Q3: My symptoms (tick)

 Runny nose

 Itchy nose


 Congestion (blocked nose)

 Red eyes

 Itchy eyes

 Watery eyes

Q4: How they affect me: my symptoms (tick)

 Affect my sleep

 Restrict my daily activities

 Restrict my participation in school or work

 Are troublesome

Q5: Medications

Q6: Are you currently receiving immunotherapy (a small dose of the thing you are allergic to, usually taken as an injection or placed under your tongue)? yes/no

 If YES to Q6 (Q7 and Q8)

Q7: What allergy is this?

 Grass pollen

 Parietaria pollen

 Birch pollen

 Other pollen

 Dust mite


 Cypress tree pollen

 Don’t know

 Add allergy

Q8: How do you receive your treatment?


 Tablet under the tongue

 Drops under the tongue

 Spray under the tongue


Moreover, two specific questionnaires are applied every week to assess disease impact on patients’ QoL (EQ-5D) [63, 64] and productivity at work (WPAI-AS) [25, 65, 66].

Treatments received

A list of all treatments available for asthma, conjunctivitis and rhinitis is included in the ARIA Allergy Diary, and users select the treatment(s) they are taking. Multiple treatments may be selected, and users can update the information when (or if) their treatment changes (Fig. 2). The list has been customized for all 20 countries in which the ARIA Allergy Diary is available, using data from IMS Health. Information on allergen specific immunotherapy is also requested on the day of first use. A questionnaire on biologics for asthma is under development.
Fig. 2
Fig. 2

Screens on medications

Daily visual analogue scales

Geolocalized users assess their daily symptom control using the touchscreen functionality on their smart phone to click on 5 consecutive VASs (global symptoms due to allergic diseases, rhinitis, conjunctivitis, asthma and work productivity) (Fig. 3). These scales have been validated for AR and asthma criteria [6771] and for work productivity (Bousquet et al., in preparation).
Fig. 3
Fig. 3

Screens on daily visual analogue scales


Besides the asthma VAS, a test to measure pulmonary function is being developed. It is expected to be added to the ARIA Allergy Diary by the end of 2016.

Clinical decision support system

The MASK CDSS is incorporated into an app for HCPs (i.e. ARIA Allergy Diary Companion). This is essentially an algorithm to aid clinicians to select pharmacotherapy for patients with AR and to stratify their disease severity [62]. It uses a simple step-up/step-down individualized approach to AR pharmacotherapy and may hold the potential for optimal control of symptoms, while minimizing side effects and costs. However, its use varies depending on the availability of medications in the different countries and on resources. A CDSS for asthma is also being developed.


The terms of use have been translated into all languages and customized according to the country’s legislation. They allow the use of anonymous data for research and commercial purposes. The app has a CE registration as a medical device class 1.

Patient empowerment

The validation of the ARIA Allergy Diary has already been accomplished (manuscript in preparation). With the help of patient organisations (EFA: European Federation of Allergy and Airways Diseases Patients’ Associations), it will be evaluated and improved by the patients themselves.

New concepts in allergic multimorbidity embedded in ARIA

The term allergic multimorbidity is more appropriate than comorbidity since the primary allergic disease is poorly known [72].

Stratification of severe allergic and/or asthma patients

Despite the major advances in understanding allergic diseases or asthma, treatments are not effective in all patients. From a clinical perspective, implementing knowledge-based decisions on what therapeutics to use for which patients and, if relevant, in which combinations, is extremely challenging. The aspiration to provide more effective therapeutic interventions tailored to the individual remains unfulfilled because of the variable response of individuals to such interventions. Patient stratification aims at grouping patients into disease sub-groups, where the specific pathological processes involved are better defined (clinical/molecular phenotypes).

Long-term birth cohort studies are essential for understanding the life course, early predictors, risk and protective factors of allergic diseases (including asthma and rhinitis) and the complex interplay between genes and environment (including life style and socio-economic determinants) [73]. MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No.: 261357; 2010–2015) attempted to better understand the complex links of allergic diseases at the clinical and mechanistic levels [7476].

MeDALL identified a rare but severe allergy phenotype: polysensitized-multimorbid phenotype. Although multimorbidity is not always associated with allergy, studies in MeDALL [77] on children, in the PARIS cohort at 2 years of age [78], in EGEA on adults [79, 80] (Siroux, in preparation) and patient cohorts in subjects with peanut allergy [81] all show that subjects who are polysensitized and multimorbid have a very high frequency of allergic symptoms, persistent symptoms over time, more severe asthma symptoms than other phenotypes and higher total and specific IgE levels.

Taken altogether, these results indicate that asthmatic patients cannot be managed appropriately without assessing rhinitis multimorbidity and also reinforce the importance of nasal problems (rhinitis and/or rhinosinusitis) in many uncontrolled asthmatic patients [8284].

Allergic multimorbidity in old age adults

Asthma and rhinitis often start in early age and persist in most, but not all, subjects. The expected epidemic wave of asthma and rhinitis in older adults is an insufficiently recognized problem. In Europe, over 20% of adults suffer from AR and over 5% from asthma. These patients are now reaching the age of 65 years and a new health problem in older adults will be to understand, detect and manage these patients. Asthma and rhinitis in older adults have specific symptoms and treatment needs, which are different from those in younger adults. These patients also suffer from multi-morbididy with high rates of poly-pharmacy reported. Integrated Care Pathways (ICPs) for rhinitis and asthma should cover the entire life cycle.

The scaling up strategy

The EIP on AHA has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory diseases action plan of the EIP on AHA [15].

There is an urgent need for scaling up strategies in order to (1) avoid fragmentation, (2) improve health care delivery across Europe, (3) speed up the implementation of good practices using existing cost-effective success stories and (4) meet the EIP on AHA objectives [10].

Reference Site Collaborate Network (RSCN) of the EIP on AHA

The RSCN brings together all EIP on AHA Reference Sites, and Candidate Reference Sites, across Europe into a single forum. The aim is to promote cooperation and develop and promote areas of innovative good practice and solutions, which contribute to improved health and care outcomes for citizens across Europe. The hope is to develop sustainable economic growth and create jobs. Members of 13 EIP on AHA Reference Sites (2013) have agreed on the AIRWAYS ICPs concept and are co-authors of the paper published in Clinical Translational Allergy [15]. A meeting of all EIP on AHA Reference Sites was co-organised by the Région LR, North England [85] and the EIP on AHA Reference Site Collaborative Network to scale up AIRWAYS ICPs in all Reference Sites (October 21, 2014). 74 EIP on AHA Reference Sites have now been approved by the EU (2016). A Twinning project has also been approved by the EIP on AHA to deploy MASK in 13 Reference Sites in order to compare allergic rhinitis diagnoses by allergists in adults and older people to study phenotypes, treatments and care pathways of rhinitis.


ARIA has evolved from a rigorously developed guideline to a mobile technology-based implementation strategy in order to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status with the aim to reduce health and social inequalities incurred by this very common disease globally.



integrated care pathways for airway diseases


allergic rhinitis


Allergic Rhinitis and its Impact on Asthma


Clinical Decision Support System


chronic obstructive pulmonary disease


Directorate General


European Academy of Allergy and Clinical Immunology

EIP on AHA: 

European Innovation Partnership on Active and Healthy Ageing


European Union


Framework Programme (EU)


Global Allergy and Asthma European Network (FP6)


WHO Global Alliance against Chronic Respiratory Diseases


Grading of Recommendation, Assessment, Development and Evaluation


health care professional


integrated care pathway


International Primary Care Respiratory Group


Contre les Maladies Chroniques pour un Vieillissement Actif (fighting chronic diseases for active and healthy ageing)


MACVIA-ARIA Sentinel NetworK


Mechanisms of the Development of ALLergy (EU FP7)


Ministry of Health


non-communicable disease


National Health Service


randomized controlled trial


Rhinoconjunctivitis Quality of Life Questionnaire


Reference Site Collaborative Network


severe chronic upper airway disease


visual analogue scale


World Health Organization


Authors’ contributions

All authors are participating to the ARIA and AIRWAYS ICPs projects globally. All authors participated in «ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle» . All authors read and approved the final manuscript.


Member of the dissemination of MASK in 20 countries: J. Bousquet, P. Hellings, A. Bedbrook, C. Bachert, K.C. Bergmann, M. Bewick, C. Bindslev-Jensen, S. Bosnic-Anticevitch, D. Caimmi, P.A.M. Camargos, G.W. Canonica, T. Casale, N.H. Chavannes, A.A. Cruz, G. De Carlo, R. Dahl, P. Demoly, P. Devillier, J. Fonseca, W.J. Fokkens, T. Haahtela, J. Just, L. Klimek, P. Kuna, D. Larenas-Linnemann, M. Morais-Almeida, J. Mullol, R. Murray, R. Naclerio, R.E. O’Hehir, N.G. Papadopoulos, P. Potter, D. Ryan, B. Samolinski, H.J. Schunemann, A. Sheikh, F.E.R. Simons, P.V. Tomazic, A. Valiulis, E. Valovirta, M. Wickman, A. Yorgancioglu, T. Zuberbier, S. Arnavielle, G. De Vries, G. Dray, M. van Eerd.

Twinning of MASK in Reference Sites of the European Innovation Partnership on Active and Healthy Ageing: J. Bousquet, A. Bedbrook, M. Bewick, C. Bindslev-Jensen, C. Bucca, D. Caimmi, N.H. Chavannes, P. Demoly, J. Fonseca, N.A. Guldemond, M. Illario, P. Kuna, M. Morais-Almeida, J. Mullol, R. Murray, C. Stellato, A. Todo-Bom, M.T. Ventura, I. Young, A. Yorgancioglu, S. Arnavielle, E. Ellers, J. Farrell, R. Gerth van Wick, Z. Gutter, G. Iaccarino, M. Olive-Elias.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Obtained from all authors.

Ethics approval and consent to participate

Review, none needed.


European Innovation Partnership on Active and Healthy Ageing Reference Site MACVIA-France, EU Structural and Development Fund Languedoc-Roussillon, ARIA.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

Montpellier University Hospital, Montpellier, France
MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
Transylvania University Brasov, Brasov, Romania
Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
iQ4U Consultants Ltd, London, UK
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
University Pneumology Unit-AOU Molinette, Hospital City of Health and Science of Torino, Turin, Italy
Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
ProAR – Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil
GARD Executive Committee, Salvador, Bahia, Brazil
EFA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
EPAR U707 INSERM, Paris, France
EPAR UMR-S UPMC, Paris VI, Paris, France
Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles, Saint-Quentin, France
Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal
Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
Institute of Health Policy and Management IBMG, Erasmus University, Rotterdam, The Netherlands
Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
Allergology Department, Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand-Trousseau (APHP), Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe EPAR, 75013 Paris, France
Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
Center for Rhinology and Allergology, Wiesbaden, Germany
Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, Mexico City, Mexico
Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
ENT Department, Hospital Clinic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Catalonia, Spain
MedScript Ltd, Dundalk, County Louth, Ireland
Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
Department of Immunology, Monash University, Melbourne, VIC, Australia
Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children’s Hospital, University of Manchester, Manchester, UK
Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital “P&A Kyriakou”, University of Athens, Athens, Greece
Department of Pediatrics, Nippon Medical School, Tokyo, Japan
Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
Woodbrook Medical Centre, Loughborough, UK
Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Department of ENT, Medical University of Graz, Graz, Austria
Clinic of Children’s Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Public Health Institute, Vilnius University, Vilnius, Lithuania
European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland
Allergy Clinic, Terveystalo, Turku, Finland
Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Queen’s University, Belfast, Northern Ireland, UK
Department of Pulmonology, Celal Bayar University, Manisa, Turkey
Department of Dermatology, Medical University of Graz, Graz, Austria
Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
IMIM (Hospital del Mar Research Institute), Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Universitat Pompeu Fabra (UPF), Barcelona, Spain
Kyomed, Montpellier, France
Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Department of Pediatric Pulmonology and Allergy, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
Regionie Puglia, Bari, Italy
Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
Geriatric Unit, Department of Internal Medicine (DIBIMIS), University of Palermo, Palermo, Italy
Department of Medicine, University of Cape Town, Cape Town, South Africa
Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, Linköping University, 58185 Linköping, Sweden
Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
Department of Geriatrics, Montpellier University Hospital, Montpellier, France
EA 2991, Euromov, University Montpellier, Montpellier, France
Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca’Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Pediatric Department, University of Verona Hospital, Verona, Italy
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
La Rochelle, France
Montreal, QC, Canada
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
Royal Brompton Hospital NHS, Imperial College London, London, UK
Centro Medico Docente La Trinidad, Caracas, Venezuela
National Heart and Lung Institute, Imperial College London, London, UK
Montpellier, Région Languedoc Roussillon, France
S. Allergologia, S. Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain
CEDOC, Respiratory Research Group, Nova Medical School, Campo dos Martires da Patria, Lisbon, Portugal
Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
Regional Ministry of Health of Andalusia, Seville, Spain
Department of Paediatrics, Oslo University Hospital, Oslo, Norway
University of Oslo, Oslo, Norway
Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia
SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Cartagena, Colombia
Gérontopôle de Toulouse, 31059 Toulouse, France
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
School of Medicine, University CEU San Pablo, Madrid, Spain
Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
Pulmonolory Research Institute FMBA, Moscow, Russia
GARD Executive Committee, Moscow, Russia
Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
ICVS/3B’s-PT Government Associate Laboratory, Life and Health Sciences, Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
Department of Medicine, Nova Southeastern University, Davie, FL, USA
EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
Department of Pediatric, Imperial College London, London, UK
The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Munich, Germany
AQuAS, Barcelona, Spain
EUREGHA, European Regional and Local Health Association, Brussels, Belgium
Allergology and Immunology Discipline, “Luliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
Peercode DV, Amsterdam, The Netherlands
Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
Service de Physiologie Respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
University Clinic of Pulmology and Allergy, Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
Ecole des Mines, Alès, France
Medical Faculty, Vilnius University, Vilnius, Lithuania
Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
Guy’s and St Thomas’ NHS Trust, Kings College London, London, UK
Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA
Computing Science Department, Umeå University, Umeå, Sweden
Four Computing Oy, Halikko, Finland
Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children’s Research Hospital Holy See, Rome, Italy
Education for Health, Warwick, UK
Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
Athens Chest Hospital, Athens, Greece
National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
Center of Tuberculosis and Lung Diseases, Latvian Association of Allergists, Riga, Latvia
Faculty of the Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
National eHealth Centre, University Hospital Olomouc, Olomouc, Czech Republic
Immunology and Allergy Division Clinical Hospital, University of Chile, Santiago, Chile
Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
Vienna Challenge Chamber, Vienna, Austria
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
Université Paris-Sud, Le Kremlin Bicêtre, France
Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
Inserm UMR_S999, Le Kremlin Bicêtre, France
School of Psychology, Plymouth University, Plymouth, UK
Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
Libra Foundation, Buenos Aires, Argentina
Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK
MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
Medical Commission, Montpellier University Hospital, Montpellier, France
Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, South Korea
Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
Ukrainian Medical Stomatological Academy, Poltava, Ukraine
Laboratory of Molecular Immunology, National Research Center, Institute of Immunology, Federal Medicobiological Agency, Moscow, Russia
Pediatric Allergy and Asthma Unit, School of Medicine, Hacettepe University, Ankara, Turkey
Immunology and Allergy Division, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey
First Department of Family Medicine, Medical University of Lodz, Lodz, Poland
Department of Medicine, McMaster University, Health Sciences Centre 3V47, 1280 Main Street West, Hamilton, ON, Canada
Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
GARD, Geneva, Switzerland
Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Department of Immunology, Rheumatology and Allergy and HARC, Medical University of Lodz, Lodz, Poland
Children’s Hospital, University of Helsinki, Helsinki, Finland
Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
VIB Inflammation Research Center, Ghent University, Ghent, Belgium
Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
University of Medicine and Pharmacy, Hochiminh City, Vietnam
Divisions of Allergy and Immunology, Department of Internal Medicine and Pediatrics, University of Tennessee College of Medicine, Germantown, TN, USA
Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
Service de Pneumologie, UMR INSERM, UMR1087 and CNR 6291, l’institut du Thorax, University of Nantes, Nantes, France
Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
Biomax Informatics AG, Munich, Germany
Department of Respiratory Medicine, University of Bratislava, Bratislava, Slovakia
Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
Kronikgune, Basque Region, Spain
Laboratory of Behavioral Immunology Research, Division of Clinical Immunology and Allergy, The University of Mississippi Medical Center, Jackson, MS, USA
Tobacco Control Research Centre, Iranian Anti Tobacco Association, Tehran, Iran
Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
Allergy and Asthma Medical Group and Research Center, San Diego, CA, USA
Department of Physiology, CHRU, PhyMedExp, INSERM U1046, CNRS UMR 9214, University Montpellier, Montpellier, France
Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
Croatian Pulmonary Society, Zagreb, Croatia
National Institute of Pneumology M. Nasta, Bucharest, Romania
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Serbian Association for Asthma and COPD, Belgrade, Serbia
Caisse d’assurance retraite et de la santé au travail du Languedoc-Roussillon (CARSAT-LR), Montpellier, France
National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
Department of Public Health and Health Products, EA 4064, Paris Descartes University-Sorbonne Paris Cité, Paris, France
Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
Scientific Centre of Children’s Health Under the Russian Academy of Medical Sciences, Moscow, Russia
Hospital de Niños Orlando Alassia, Santa Fe, Argentina
Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
Neumología y Alergología Infantil, Hospital La Fe, Valencia, Spain
Department of Internal Medicine, Centro Hospitalar Sao Joao, Porto, Portugal
ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, Vienna, Austria
Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
University of Southern Denmark, Kolding, Denmark
Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal
Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Conseil Général de l’Economie, Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
Société de Pneumologie de Langue Française, Espace francophone de Pneumologie, Paris, France
Département de pédiatrie, CHU de Grenoble, Grenoble, France
Children’s Hospital Srebrnjak, Zagreb, Croatia
School of Medicine, University J.J. Strossmayer, Osijek, Croatia
Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
Clinic of Allergy and Asthma, Medical University Sofia, Sofia, Bulgaria
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Laboratory of Medical Allergology, Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
Academic Centre of Primary Care, University of Aberdeen, Aberdeen, Scotland, UK
Research in Real-Life, Cambridge, UK
LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany
Department of Medicine, Christian Albrechts University, Airway Research Center North, German Center for Lung Research (DZL), Kiel, Germany
NHS Foundation Trust, University Hospitals of Southampton, Southampton, UK
Centre of Pneumology, Coimbra University Hospital, Coimbra, Portugal
Polibienestar Research Institute, University of Valencia, Valencia, Spain
Department of Geriatrics, Getafe University Hospital, Madrid, Spain
Association Asthme et Allergie, Paris, France
Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain
Allergy Unit, Complesso Integrato Columbus, Rome, Italy
Serviço de Imunoalergologia, Hospital da Luz, Lisbon, Portugal
Hospital de Clinicas, University of Parana, Curitiba, Brazil
Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
Faculty of Medicine, Autononous University of Madrid, Madrid, Spain
The Royal National TNE Hospital, University College London, London, UK
DIBIMIS, University of Palermo, Palermo, Italy
Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
Otolaryngology and Head and Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
Child Health, Queen’s University, Belfast, Northern Ireland, UK
Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
Sociedad Paraguaya de Alergia Asma e Inmunologıa, Asunción, Paraguay
Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
European Union Geriatric Medicine Society (EUGMS), Helsinki, Finland
Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
Pneumology and Allergy Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
PELyon, Lyon, France
HESPER 7425, Health Services and Performance Resarch, Université Claude Bernard Lyon, Villeurbanne, France
University Hospital, Stockholm, Sweden
Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
Philippines Society of Allergy, Asthma and Immunology, Manila, Philippines
Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S. Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy
Regional Agency for Health and Social Care, Reggio Emilia, Italy
Finnish Lung Association (FILHA), Helsinki, Finland
Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
CNR Institute of Biomedicine and Molecular Immunology “A. Monroy”, Palermo, Italy
Sotiria Hospital, Athens, Greece
Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
Asthma UK, Mansell Street, London, UK
Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
IPCRG, Aberdeen, Scotland, UK
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
Department of Research, Olmsted Medical Center, Rochester, MN, USA
Medical School, University of Cyprus, Nicosia, Cyprus
The Allergy and Asthma Institute, Lahore, Pakistan
Social Sciences, University of Southampton, Southampton, UK
Department of Paediatrics and Child Health, Red Cross Children’s Hospital, University of Cape Town, Cape Town, South Africa
MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
Universidad Católica de Córdoba, Córdoba, Argentina
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China
Beijing Institute of Otolaryngology, Beijing, China
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
Northern Health Alliance, Newcastle, UK
CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France


  1. Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147–334.PubMedView ArticleGoogle Scholar
  2. Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing guidelines. BMJ. 1999;318(7183):593–6.PubMedPubMed CentralView ArticleGoogle Scholar
  3. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.PubMedView ArticleGoogle Scholar
  4. Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64(5):669–77.PubMedView ArticleGoogle Scholar
  5. Brozek JL, Baena-Cagnani CE, Bonini S, Canonica GW, Rasi G, van Wijk RG, et al. Methodology for development of the Allergic Rhinitis and its Impact on Asthma guideline 2008 update. Allergy. 2008;63(1):38–46.PubMedView ArticleGoogle Scholar
  6. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76.PubMedView ArticleGoogle Scholar
  7. Padjas A, Kehar R, Aleem S, Mejza F, Bousquet J, Schunemann HJ, et al. Methodological rigor and reporting of clinical practice guidelines in patients with allergic rhinitis: QuGAR study. J Allergy Clin Immunol. 2014;133(3):777–783.e4.PubMedView ArticleGoogle Scholar
  8. Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al. Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130(5):1049–62.PubMedView ArticleGoogle Scholar
  9. Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, et al. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy. 2015;70(11):1372–92.PubMedView ArticleGoogle Scholar
  10. Bousquet J, Michel J, Standberg T, Crooks G, Iakovidis I, Gomez M. The European Innovation Partnership on Active and Healthy Ageing: the European Geriatric Medicine introduces the EIP on AHA Column. Eur Geriatr Med. 2014;5(6):361–2.View ArticleGoogle Scholar
  11. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44(2):304–23.PubMedView ArticleGoogle Scholar
  12. Bousquet J, Barbara C, Bateman E, Bel E, Bewick M, Chavannes N, et al. AIRWAYS ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation. Eur Respir J. 2016;47(4):1028–33. doi: 10.1183/13993003.01856-2015.PubMedView ArticleGoogle Scholar
  13. Bousquet J, Anto JM, Berkouk K, Gergen P, Antunes JP, Auge P, et al. Developmental determinants in non-communicable chronic diseases and ageing. Thorax. 2015;70(6):595–7.PubMedPubMed CentralView ArticleGoogle Scholar
  14. Bousquet J, Barbara C, Bateman E, Bel E, Bewick M, Chavannes NH, et al. AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation. Eur Respir J. 2016;47(4):1028–33.PubMedView ArticleGoogle Scholar
  15. Bousquet J, Farrell J, Crooks G, Hellings P, Bel E, Bewick M, et al. Scaling up strategies of the Chronic Respiratory Disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3—Area 5). Clin Transl Allergy. 2016;6:29. doi:10.1186/s13601-016-0116-9.PubMedPubMed CentralView ArticleGoogle Scholar
  16. Bousquet J, Dahl R, Khaltaev N. Global alliance against chronic respiratory diseases. Allergy. 2007;62(3):216–23.PubMedView ArticleGoogle Scholar
  17. TRM Glossary. One-VA technical reference model v14.10. US Department of Veteran Affairs. http://www.vagov/trm/TRMGlossaryPageasp. 2014.
  18. National Center for Complementary and Alternative Medicine (NCCAM). National Institutes of Health. Clinical practice guidelines. 2014.
  19. Zander K. Historical development of outcomes-based care delivery. Crit Care Nurs Clin N Am. 1998;10(1):1–11.Google Scholar
  20. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133–7.PubMedPubMed CentralView ArticleGoogle Scholar
  21. Overill S. A practical guide to care pathways. J Integr Care. 1998;2:93–8.Google Scholar
  22. Integrated Care Pathways users in Scotland (ICPUS). A workbook for people starting to develop integrated care pathways.
  23. How to produce and evaluate an integrated care pathway (ICP): information for staff. Great Ormond Street Hospital for Children. 2010.
  24. ARIA in the pharmacy: management of allergic rhinitis symptoms in the pharmacy. Allergic rhinitis and its impact on asthma. Allergy. 2004;59(4):373–87.Google Scholar
  25. Bousquet J, Neukirch F, Bousquet PJ, Gehano P, Klossek JM, Le Gal M, et al. Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol. 2006;117(1):158–62.PubMedView ArticleGoogle Scholar
  26. Bousquet J, Annesi-Maesano I, Carat F, Leger D, Rugina M, Pribil C, et al. Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group. Clin Exp Allergy. 2005;35(6):728–32.PubMedView ArticleGoogle Scholar
  27. Bousquet PJ, Devillier P, Tadmouri A, Mesbah K, Demoly P, Bousquet J. Clinical relevance of cluster analysis in phenotyping allergic rhinitis in a real-life study. Int Arch Allergy Immunol. 2015;166(3):231–40.PubMedView ArticleGoogle Scholar
  28. del Cuvillo A, Montoro J, Bartra J, Valero A, Ferrer M, Jauregui I, et al. Validation of ARIA duration and severity classifications in Spanish allergic rhinitis patients—the ADRIAL cohort study. Rhinology. 2010;48(2):201–5.PubMedGoogle Scholar
  29. Jauregui I, Davila I, Sastre J, Bartra J, del Cuvillo A, Ferrer M, et al. Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: the PEDRIAL study. Pediatr Allergy Immunol. 2011;22(4):388–92.PubMedView ArticleGoogle Scholar
  30. Cruz AA, Popov T, Pawankar R, Annesi-Maesano I, Fokkens W, Kemp J, et al. Common characteristics of upper and lower airways in rhinitis and asthma: ARIA update, in collaboration with GA(2)LEN. Allergy. 2007;62(Suppl 84):1–41.PubMedView ArticleGoogle Scholar
  31. Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62(Suppl 85):17–25.PubMedView ArticleGoogle Scholar
  32. Bousquet PJ, Demoly P, Devillier P, Mesbah K, Bousquet J. Impact of allergic rhinitis symptoms on quality of life in primary care. Int Arch Allergy Immunol. 2013;160(4):393–400.PubMedView ArticleGoogle Scholar
  33. Price D, Scadding G, Ryan D, Bachert C, Canonica GW, Mullol J, et al. The hidden burden of adult allergic rhinitis: UK healthcare resource utilisation survey. Clin Transl Allergy. 2015;5:39.PubMedPubMed CentralView ArticleGoogle Scholar
  34. Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;120(5 Suppl):S94–138.Google Scholar
  35. O’Byrne PM, Reddel HK, Eriksson G, Ostlund O, Peterson S, Sears MR, et al. Measuring asthma control: a comparison of three classification systems. Eur Respir J. 2010;36(2):269–76.PubMedView ArticleGoogle Scholar
  36. Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46(3):622–39. doi:10.1183/13993003.00853-2015.PubMedPubMed CentralView ArticleGoogle Scholar
  37. Bousquet J, Bourquin C, Augé P, Domy P, Bringer J, Camuzat T, et al. MACVIA-LR Reference Site of the European Innovation Partnership on Active and Healthy Ageing. Eur Geriatr Med. 2014;5(6):406–15.View ArticleGoogle Scholar
  38. Bourret R, Bousquet J, Mercier J, Camuzat T, Bedbrook A, Demoly P, et al. MASK rhinitis, a single tool for integrated care pathways in allergic rhinitis. World Hosp Health Serv. 2015;51(3):36–9.PubMedGoogle Scholar
  39. Bousquet J, Bachert C, Canonica GW, Mullol J, Van Cauwenberge P, Bindslev Jensen C, et al. Efficacy of desloratadine in intermittent allergic rhinitis: a GALEN study. Allergy. 2009;64:1516–23.PubMedView ArticleGoogle Scholar
  40. Bousquet J, Bachert C, Canonica GW, Mullol J, Van Cauwenberge P, Jensen CB, et al. Efficacy of desloratadine in persistent allergic rhinitis—a GA(2)LEN study. Int Arch Allergy Immunol. 2010;153(4):395–402.PubMedView ArticleGoogle Scholar
  41. Morais-Almeida M, Santos N, Pereira AM, Branco-Ferreira M, Nunes C, Bousquet J, et al. Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study. Allergy. 2013;68(10):1278–88.PubMedView ArticleGoogle Scholar
  42. Morais-Almeida M, Pite H, Pereira AM, Todo-Bom A, Nunes C, Bousquet J, et al. Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal. Allergy. 2013;68(9):1150–7.PubMedGoogle Scholar
  43. Klimek L, Bachert C, Mosges R, Munzel U, Price D, Virchow JC, et al. Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: results from a noninterventional study. Allergy Asthma Proc. 2015;36(1):40–7.PubMedView ArticleGoogle Scholar
  44. Ohta K, Bousquet PJ, Aizawa H, Akiyama K, Adachi M, Ichinose M, et al. Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan. Allergy. 2011;66(10):1287–95.PubMedView ArticleGoogle Scholar
  45. Larenas-Linnemann D, Dinger H, Shah-Hosseini K, Michels A, Mosges R. Over diagnosis of persistent allergic rhinitis in perennial allergic rhinitis patients: a nationwide study in Mexico. Am J Rhinol Allergy. 2013;27(6):495–501.PubMedView ArticleGoogle Scholar
  46. Shao J, Cui YX, Zheng YF, Peng HF, Zheng ZL, Chen JY, et al. Efficacy and safety of sublingual immunotherapy in children aged 3–13 years with allergic rhinitis. Am J Rhinol Allergy. 2014;28(2):131–9.PubMedView ArticleGoogle Scholar
  47. Wei H, Zhang Y, Shi L, Zhang J, Xia Y, Zang J, et al. Higher dosage of HIFU treatment may lead to higher and longer efficacy for moderate to severe perennial allergic rhinitis. Int J Med Sci. 2013;10(13):1914–20.PubMedPubMed CentralView ArticleGoogle Scholar
  48. Tatar EC, Surenoglu UA, Saylam G, Isik E, Ozdek A, Korkmaz H. Is there any correlation between the results of skin-prick test and the severity of symptoms in allergic rhinitis? Am J Rhinol Allergy. 2012;26(1):e37–9.PubMedPubMed CentralView ArticleGoogle Scholar
  49. Bousquet PJ, Bousquet-Rouanet L, Co Minh HB, Urbinelli R, Allaert FA, Demoly P. ARIA (Allergic Rhinitis and Its Impact on Asthma) classification of allergic rhinitis severity in clinical practice in France. Int Arch Allergy Immunol. 2007;143(3):163–9.PubMedView ArticleGoogle Scholar
  50. Rouve S, Didier A, Demoly P, Jankowsky R, Klossek JM, Anessi-Maesano I. Numeric score and visual analog scale in assessing seasonal allergic rhinitis severity. Rhinology. 2010;48(3):285–91.PubMedGoogle Scholar
  51. Baiardini I, Braido F, Brandi S, Tarantini F, Bonini S, Bousquet PJ, et al. The impact of GINA suggested drugs for the treatment of asthma on health-related quality of life: a GA(2)LEN review. Allergy. 2008;63(8):1015–30.PubMedView ArticleGoogle Scholar
  52. Yamamoto H, Yamada T, Sakashita M, Kubo S, Susuki D, Tokunaga T, et al. Efficacy of prophylactic treatment with montelukast and montelukast plus add-on loratadine for seasonal allergic rhinitis. Allergy Asthma Proc. 2012;33(2):e17–22.PubMedView ArticleGoogle Scholar
  53. Bousquet PJ, Bachert C, Canonica GW, Casale TB, Mullol J, Klossek JM, et al. Uncontrolled allergic rhinitis during treatment and its impact on quality of life: a cluster randomized trial. J Allergy Clin Immunol. 2010;126(3):666–668.e1-5.PubMedView ArticleGoogle Scholar
  54. Demoly P, Bousquet PJ, Mesbah K, Bousquet J, Devillier P. Visual analogue scale in patients treated for allergic rhinitis: an observational prospective study in primary care: asthma and rhinitis. Clin Exp Allergy. 2013;43(8):881–8.PubMedView ArticleGoogle Scholar
  55. Bousquet PJ, Combescure C, Klossek JM, Daures JP, Bousquet J. Change in visual analog scale score in a pragmatic randomized cluster trial of allergic rhinitis. J Allergy Clin Immunol. 2009;123(6):1349–54.PubMedView ArticleGoogle Scholar
  56. Vuurman EF, Vuurman LL, Lutgens I, Kremer B. Allergic rhinitis is a risk factor for traffic safety. Allergy. 2014;69(7):906–12.PubMedView ArticleGoogle Scholar
  57. Hellgren J, Cervin A, Nordling S, Bergman A, Cardell LO. Allergic rhinitis and the common cold–high cost to society. Allergy. 2010;65(6):776–83.PubMedView ArticleGoogle Scholar
  58. Zuberbier T, Lotvall J, Simoens S, Subramanian SV, Church MK. Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review. Allergy. 2014;69(10):1275–9.PubMedView ArticleGoogle Scholar
  59. Lamb CE, Ratner PH, Johnson CE, Ambegaonkar AJ, Joshi AV, Day D, et al. Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective. Curr Med Res Opin. 2006;22(6):1203–10.PubMedView ArticleGoogle Scholar
  60. Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007;120(2):381–7.PubMedView ArticleGoogle Scholar
  61. Nolte H, Nepper-Christensen S, Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respir Med. 2006;100(2):354–62.PubMedView ArticleGoogle Scholar
  62. Bousquet J, Schunemann HJ, Hellings PW, Arnavielhe S, Bachert C, Bedbrook A, et al. MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis. J Allergy Clin Immunol. 2016;138(2):367–374.e2. doi:10.1016/j.jaci.2016.03.025.
  63. Konig HH, Bernert S, Angermeyer MC, Matschinger H, Martinez M, Vilagut G, et al. Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care. 2009;47(2):255–61.PubMedView ArticleGoogle Scholar
  64. Smith AF, Pitt AD, Rodruiguez AE, Alio JL, Marti N, Teus M, et al. The economic and quality of life impact of seasonal allergic conjunctivitis in a Spanish setting. Ophthalmic Epidemiol. 2005;12(4):233–42.PubMedView ArticleGoogle Scholar
  65. Blanc PD, Trupin L, Eisner M, Earnest G, Katz PP, Israel L, et al. The work impact of asthma and rhinitis: findings from a population-based survey. J Clin Epidemiol. 2001;54(6):610–8.PubMedView ArticleGoogle Scholar
  66. Bousquet J, Bodez T, Gehano P, Klossek JM, Liard F, Neukirch F, et al. Implementation of guidelines for allergic rhinitis in specialist practices. A randomized pragmatic controlled trial. Int Arch Allergy Immunol. 2009;150(1):75–82.PubMedView ArticleGoogle Scholar
  67. Ohta K, Jean Bousquet P, Akiyama K, Adachi M, Ichinose M, Ebisawa M, et al. Visual analog scale as a predictor of GINA-defined asthma control. The SACRA study in Japan. J Asthma. 2013;50(5):514–21.PubMedView ArticleGoogle Scholar
  68. Hojo M, Ohta K, Iikura M, Mizutani T, Hirashima J, Sugiyama H. Clinical usefulness of a guideline-based screening tool for the diagnosis of allergic rhinitis in asthmatics: the Self Assessment of Allergic Rhinitis and Asthma questionnaire. Respirology. 2013;18(6):1016–21.PubMedView ArticleGoogle Scholar
  69. Sullivan PW, Smith KL, Ghushchyan VH, Globe DR, Lin SL, Globe G. Asthma in USA: its impact on health-related quality of life. J Asthma. 2013;50(8):891–9.PubMedView ArticleGoogle Scholar
  70. van der Leeuw S, van der Molen T, Dekhuijzen PN, Fonseca JA, van Gemert FA, Gerth van Wijk R, et al. The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts. NPJ Prim Care Respir Med. 2015;25:14107.PubMedPubMed CentralGoogle Scholar
  71. Ciprandi G, Schiavetti I, Sorbello V, Ricciardolo FL. Perception of asthma symptoms as assessed on the visual analog scale in subjects with asthma: a real-life study. Respir Care. 2016;61(1):23–9.PubMedView ArticleGoogle Scholar
  72. Belgrave DC, Buchan I, Bishop C, Lowe L, Simpson A, Custovic A. Trajectories of lung function during childhood. Am J Respir Crit Care Med. 2014;189(9):1101–9.PubMedPubMed CentralView ArticleGoogle Scholar
  73. Bousquet J, Anto J, Sunyer J, Nieuwenhuijsen M, Vrijheid M, Keil T, et al. Pooling birth cohorts in allergy and asthma: European Union-funded initiatives—a MeDALL, CHICOS, ENRIECO, and GA(2)LEN joint paper. Int Arch Allergy Immunol. 2013;161(1):1–10.PubMedView ArticleGoogle Scholar
  74. Anto JM, Pinart M, Akdis M, Auffray C, Bachert C, Basagana X, et al. Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: a Mechanisms of the Development of Allergy (MeDALL) seminar. J Allergy Clin Immunol. 2012;129(4):943–954.e4.PubMedView ArticleGoogle Scholar
  75. Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, et al. MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy. 2011;66(5):596–604.PubMedView ArticleGoogle Scholar
  76. Bousquet J, Anto JM, Akdis M, Auffray C, Keil T, Momas I, et al. Paving the way of systems biology and precision medicine in allergic diseases: the MeDALL success story. Allergy. 2016;71(11):1513–25. doi:10.1111/all.12880.PubMedView ArticleGoogle Scholar
  77. Ballardini N, Bergstrom A, Wahlgren CF, van Hage M, Hallner E, Kull I, et al. IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence. Allergy. 2016;71(3):342–9.PubMedView ArticleGoogle Scholar
  78. Gabet S, Just J, Couderc R, Bousquet J, Seta N, Momas I. Early polysensitisation is associated to allergic multimorbidity in PARIS birth cohort infants. Pediatr Allergy Immunol. 2016;27(8):831–37. doi:10.1111/pai.12622.PubMedView ArticleGoogle Scholar
  79. Burte E, Bousquet J, Varraso R, Gormand F, Just J, Matran R, et al. Characterization of rhinitis according to the asthma status in adults using an unsupervised approach in the EGEA study. PLoS ONE. 2015;10(8):e0136191.PubMedPubMed CentralView ArticleGoogle Scholar
  80. Siroux V, Lupinek C, Resch Y, Curin M, Just J, Keil T, et al. Specific IgE and IgG measured by the MeDALL allergen-chip depend on allergen and route of exposure: the EGEA study. J Allergy Clin Immunol. 2016. doi:10.1016/j.jaci.2016.05.023.Google Scholar
  81. Just J, Elegbede CF, Deschildre A, Bousquet J, Moneret-Vautrin DA, Crepet A, et al. Three peanut allergic/sensitized phenotypes with gender difference. Clin Exp Allergy. 2016;46(12):1596–1604. doi:10.1111/cea.12791.PubMedView ArticleGoogle Scholar
  82. Bresciani M, Paradis L, Des Roches A, Vernhet H, Vachier I, Godard P, et al. Rhinosinusitis in severe asthma. J Allergy Clin Immunol. 2001;107(1):73–80.PubMedView ArticleGoogle Scholar
  83. ten Brinke A, Grootendorst DC, Schmidt JT, De Bruine FT, van Buchem MA, Sterk PJ, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol. 2002;109(4):621–6.PubMedView ArticleGoogle Scholar
  84. ten Brinke A, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, et al. Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J. 2005;26(5):812–8.PubMedView ArticleGoogle Scholar
  85. Wilson N, Bewick M, Dziworski W. Maintaining health despite chronic illness in the elderly: a multi-disciplinary study visit to the north of England region. Eur Geriatr Med. 2015;6(4):396–400.View ArticleGoogle Scholar


© The Author(s) 2016