July 2020

Allergic rhinitis is a chronic disease with a high prevalence with an impact on quality of life. The original Allergic Rhinitis and Its Impact on Asthma Guideline (ARIA) severity classification uses 4 items (sleep, daily activities/sport, work/school performance and troublesome symptoms) and defines allergic rhinitis as mild (no items affected) or moderate/severe (1 to 4 items affected). A validated modified three-level ARIA (mARIA) classification was proposed to discriminate allergic rhinitis severity between moderate (1 to 3 items affected) and severe (4 items affected).

The aim of this prospective, observational, cross-sectional study was to use the 4 original ARIA items to validate a three-level evaluation of allergic rhinitis control (ARIA-C): controlled, partially controlled and not controlled, by estimating control of symptoms, impairment in activities and respiratory function.

A total of 252 adult participants with moderate-to-severe allergic rhinitis were included using both mARIA severity criteria and a reflective total nasal symptom score (rTNSS) ≥ 8. They followed their routine treatments and were interviewed twice a month. Demographic, concomitant diseases, allergic sensitization, AR severity and impact on quality of life data were collected. Additionally, participants’ control was assessed with the validated Spanish version of the Rhinitis Control Assessment Test (RCAT).

At baseline, 20 % of the participants had their allergic rhinitis controlled with the ARIA-C. At follow-up, 30 % of them were controlled and 40 % partially controlled.

Disease control was evaluated and showed that the three categories of ARIA-C can effectively discriminate between controlled, partially controlled and not controlled allergic rhinitis. Its validation shows favorable and statistically significant results for test-retest reliability, convergent validity, discrimination among groups, and responsiveness to change.

These results suggest that the ARIA-C can be used to obtain a fast screening of patients with inadequate allergic rhinitis control, or to help their communication with specialists.

A mobile application (MASK-air®) has demonstrated usefulness in assessing patient behaviour in allergic rhinitis. This app measures general, nasal, ocular and asthma symptoms with a visual scale and daily medication intake.

The objective of this study was to validate the app for allergic rhinitis, comparing it to a written questionnaire for a month.

A total of 252 participants were randomly assigned to one of two groups: participants with allergic rhinitis who used the Spanish version of the app on a daily basis and participants with allergic rhinitis who were asked to use the questionnaire at days 1, 3, 7, 14, 21 and 28 and at a final visit one week later.

The usefulness of the allergic rhinitis app was evaluated at baseline and at the end using the Rhinitis Control Assessment Tool questionnaire. Other allergic rhinitis outcomes included treatment adherence, reflective total nasal symptom score, ocular symptom score, the modified ARIA severity classification, a quality-of-life questionnaire and daily visual analogue scales for nasal, conjunctival, asthma, and global for overall allergy symptoms, and the asthma control test for asthmatic patients at baseline and at end of study. Participants and specialists’ satisfaction with the app were evaluated using a Likert scale.

Most participants in the app group (90 %) had downloaded it to their smartphone and 92 % of them used it. Most users (88 %) reported being satisfied or very satisfied with the app, with 72% of the specialists reporting that their patients were satisfied.

At the end of the study, a relevant improvement on the Rhinitis Control Assessment Tool score was observed, but with no significant or clinically relevant difference between groups. Other outcomes were not different between study groups either.

This study demonstrated that the app contributed to the improvement of allergic rhinitis as effectively as the written questionnaire. It has shown that the MASK-air® app is practical ad useful.

Chronic rhinitis can be classified in allergic rhinitis and non-allergic rhinitis (NAR). Allergic rhinitis is an inflammatory disease of the nasal mucosa with symptoms such as nasal discharge, sneezing, nasal itching and congestion. It is characterized by eosinophilic inflammation as a result of IgE-sensitization to seasonal or perennial aeroallergens. NAR is a highly heterogeneous group that includes disorders characterized by either immunological or neurogenic inflammation (hormonal rhinitis, rhinitis of the elderly, gustatory rhinitis, drug-induced rhinitis and occupational rhinitis).

Local allergic rhinitis (LAR) is neither classical allergic rhinitis neither NAR. Its symptoms, duration, severity and complications are similar to those of allergic rhinitis and can affect adults and children. It is characterized by a localized nasal allergic response and the absence of systemic atopy since specific IgE antibodies are produced locally. A Th2 pattern of mucosal cell infiltration during natural exposure to aeroallergens and a positive nasal allergen provocation test (NAPT) response, with the release of inflammatory mediators such as mast cells, eosinophils, IgE, B cells, and T cells, are detected.

LAR is an underdiagnosed entity that affects a significant number of people with chronic rhinitis, mainly in Mediterranean countries. It is a chronic condition that tends to worsen and is associated with conjunctivitis and bronchial symptoms. Its diagnosis is a challenge and should be based on a detailed clinical history, the demonstration of a nasal allergic response to aeroallergens by NAPT in patients with negative skin prick test and non-detectable serum sIgE, and the exclusion of chronic rhinosinusitis with/without nasal polyps.

Oral antihistamines and intranasal corticosteroids, alone or in an intranasal formulation of fluticasone + azelastine in severe cases, are the two traditional bases of allergic rhinitis treatment. Clinical experience indicates that these drugs are similarly effective in LAR patients. Also, subcutaneous immunotherapy has shown to be effective and well tolerated in LAR. A correct early diagnosis through nasal allergen challenge enables the establishment of an etiologic treatment, improving quality of life and preventing the development of lower airway disease.