Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines

2010 Revision

Brożek, Jan L. MD, PhD
Bousquet, Jean MD, PhD
Baena-Cagnani, Carlos E. MD
Bonini, Sergio MD
Canonica, Walter G. MD
Casale, Thomas B. MD
van Wijk, Roy Gerth MD, PhD
Ohta, Ken MD, PhD
Zuberbier, Torsten MD
Schünemann, Holger J. MD, PhD, MSc

^aDepartment of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
^bService des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France
^cINSERM, CESP U1018, Respiratory and Environmental Epidemiology Team, Montpellier, France
^dWHO Collaborating Center for Rhinitis and Asthma, Montpellier, France
^eFaculty of Medicine, Catholic University of Córdoba, Córdoba, Argentina
^fInstitute of Neurobiology and Molecular Medicine—CNR, Rome, Italy
^gDepartment of Medicine, Second University of Naples, Naples, Italy
^hAllergy and Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy
ⁱDivision of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Neb
^jSection of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
^kDivision of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
^lDepartment of Dermatology and Allergy, Charité Universitätsmedizin, Berlin, Germany

Reprint requests: Holger J. Schünemann, MD, PhD, MSc, Chair, Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C10B, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. E-mail: [email protected]

J.B., S.B., G.W.C., R.GvW., H.J.S., and T.Z. are members of the Global Allergy and Asthma European Network supported by European Commission Framework Programme grant FOOD-CT-2004-506378.

Disclosure of potential conflict of interest: J. L. B. is a member of the GRADE working group; he is an editor of a clinical journal where various drugs are advertised, including those that are the subject of these guidelines; he received honoraria for speaking at conferences and travel reimbursement from GlaxoSmithKline and i3 Research and for expert panel participation from Boehringer Ingelheim. J. B. received fees and honoraria for lectures, expert panel participation and consultations from Allmiral, ALK, AstraZeneca, Chiesi Farmaceutici, Faes Pharma, GlaxoSmithKline, Meda, Merck Sharp and Dohme, Mundifarma, Novartis, Nycomed-Altana, Roche, Sanofi-Aventis, Stallergènes, Schering- Plough, Teva, UCB and Uriach. C. E. B-C. received fees for consultancy, speaker bureau participation, lectures and research grants from Abello, ALK, FAES (Spain), GlaxoSmithKline, Grünenthal (Venezuela), Lofarma (Italy), Merk Serono, MSD, Novartis, Phoenix (Argentina), Sanofi-Aventis, Schering-Plough, and Uriach (Spain). S. B. received consultancy fees and honoraria for editorial activity or participation in sponsored symposia from: ALK, Almirall, AstraZeneca, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novartis, Nycomed, Phadia, Schering-Plough, Sigma Tau and Stallergens. G. W. C. received fees and honoraria for lectures, expert panel participation and consultations and research support from A. Menarini, Alcon, Alk-Abellò, Almirall, Anallergo, AstraZeneca, Biofutura Pharma, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Lofarma, Merck Sharp & Dome, Novartis, Nycomed, Pfizer, Phadia, Schering Plough, SigmaTau, Stallergenes, UCB Pharma, Uriach and Valeas. T. C. declares no potential conflict of interest. R.GvW. received fees for lectures, expert panel participation and consultancy from Allergopharma, Allmiral, Alcon, Crucell, Hal, Merck Sharp & Dome, Novartis, Stallargènes and UCB. K. O. received fees and honoraria for lectures, expert panel participation and consultations from AstraZeneca, GlaxoSmithKline, Merck Banyu, Novartis, Schering Plough, Kyorin, Otsuka, and Taisho. H. J. S. is co-chair of the GRADE working group and he supports the implementation of the GRADE approach worldwide. From non-profit organizations he has accepted honoraria and consulting fees for activities in which his work with GRADE is relevant. In the past five years, H. J. S. received no personal payments for service from pharmaceutical for profit organizations. No financial support was received for the preparation of the evidence profiles or provided to the evidence synthesis team that HJS led as part of this work. T. Z. has received fees for consulting from Ansell, Bayer Schering, DST, Fujisawa, HAL, Henkel, Kryolan, Leti, Merck Sharp & Dohme, Novartis, Procter & Gamble, Sanofi-Aventis, Schering Plough, Stallergenes and UCB Pharma. None of the ARIA panel members have received any financial support for the work on these guidelines.

Received for publication April 12, 2010; revised June 7, 2010; accepted for publication June 10, 2010

Journal of Allergy & Clinical Immunology 126(3):p 466-476, September 2010.

Background

Allergic rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally.

Objective

To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of allergic rhinitis on the basis of current best evidence.

Methods

The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group.

Results

This article presents recommendations about the prevention of allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with allergic rhinitis as well as patients with both allergic rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals.

Conclusion

These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.