Bilastina

Allergic rhinitis is a prevalent chronic condition. There are different treatments across countries in Europe that depend on the cost and sales too. The objective of this study was to evaluate practices in Europe to implement the Good Practice of DG Santé (MASK-air). A secondary purpose included understanding the differences and propose improvement strategies.

This study consisted of analyzing a pharmaco-epidemiological database to evaluate prescribed allergic rhinitis treatment from 2016 to 2018 in the five principal markets in the EU (France, Germany, Italy, Poland, and Spain). To gather this information, the IQVIA platforms for prescribed medicines (MIDAS®—Meaningful Integration of Data, Analytics, and Services) and for OTC medicines (OTC International Market Tracking—OTCims) were used.

The analyses excluded intranasal decongestants as they are seldom prescribed for allergic rhinitis. France leads concerning the other countries in costs and Standard Units (SU). All other countries are similar in respect to SU. However, Poland’s costs are lower than the remaining. The use of medication is very different, though: in 2018, intranasal corticosteroid was the first treatment in Poland (70,0%), France (51,3%), Spain (51,1%), and Germany (50,3%). Systemic antihistamines were more sold in Italy (41,4%), followed by 30,1% of intranasal corticosteroids. In 2016 and 2017, the results were similar.

This study represents an excellent interest in assessing the differences in allergic rhinitis treatment in Europe and can be a start for future studies of treatment trends.

Allergic rhinitis and chronic rhinosinusitis with nasal polips (CRSwP) are upper airway immunological conditions with complex mechanisms of action. Airway local mucosal B cells are drivers for the conditions, with B cells migrating into the airway mucosa when there is an airway injury.

B-cells are very important in the defense, tissue surveillance, and immune modulation of the upper airways. Allergic rhinitis and CRSwP are two of the upper airway conditions that can be identified as expressing B-cells or dysregulating their function within T2-high mucosal inflammatory states. B cells can drive T2 inflammatory states via functional antibody production and also through interactions with commensal microbes and other recruited inflammatory cells such as Th2 cells and eosinophils, leading to immune amplification and dysregulation.

This review aimed to report the existing knowledge of the key role of B cells in allergic inflammatory upper airway disease and highlight the need for more focus on human B-cell-directed disease-context-specific upper airway studies.

The authors concluded that there is a lack of studies concerning the role of B-cell overexpression and dysfunction, especially those which relate sinonasal infection and mucosal inflammation. It is important to understand how respiratory inflammation, together with augmented or impaired B-cell function, increases and dysregulates immune signaling pathways in allergic rhinitis and CRSwP to develop novel B-cell disease-specific therapeutic interventions with molecular manipulation.

Rhinitis is an inflammation of the nasal mucosa with itching, sneezing, rhinorrhea, and congestion. It may be classified into allergic rhinitis and nonallergic rhinitis. The ARIA (allergic rhinitis and its impact on asthma) guidelines categorize allergic rhinitis upon intermittent or persistent timing of symptoms and mild, moderate or severe. The objective of this review was to assess if patient-reported outcome measures (PROMs) and clinical physiological measures vary, and which factors impact rhinitis.

A systematic search identified allergic rhinitis and nonallergic rhinitis that reported Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), total nasal symptom score (TNSS), or visual analog scale (VAS) scores, and physiologic measures (peak nasal inspiratory flow and nasal airflow). The relationship between PROMs, physiologic measures, and associated factors was statistically evaluated.

The review included 171 studies, which reflected 33843 patients. Patients with allergic rhinitis had more severe symptoms than nonallergic rhinitis ones. There was no significant correlation between PROMs and demographic factors, comorbidities, or physiologic measures. Statistical analysis identified a correlation between the worse quality of life and shorter disease duration.

In conclusion, patients with rhinitis have a more severe impact in their quality of life in the presence of allergy with variable impact upon specific symptom subdomains. PROMs did not show a correlation with demographic factors, comorbidities, or physiologic measures of nasal airflow.

The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members.

The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient’s health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient’s quality of life.

The Manifesto concludes that patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.

Health disparities negatively impact groups with greater social or economic obstacles in health based on race, ethnicity, religion, socioeconomic status, gender, age, disability, sexual orientation, and/or geographic location. The American Academy of Allergy, Asthma, and Immunology participated in a Commission to End Health Disparities 10 years ago. This study describes health disparities in allergy/immunology in racial and ethnic underserved populations and how they address people with allergic rhinitis and other allergic conditions.

Certain racial and ethnic populations are frequently not included in guidelines of care for patients with allergic rhinitis. Racial minorities show less allergic rhinitis prevalence, probable due to variability in self-reporting the disease: a 2017 report revealed that 5% of black children and 5% of Hispanic children had allergic rhinitis, compared to 9% of white children.

It is known that allergic rhinitis significantly impacts the quality of life and morbidity in underserved populations, and allergic rhinitis control was associated with fewer school absences.

Studies have shown that low-income and minority groups are less likely to receive allergen immunotherapy and have highlighted that additional burdens faced by these minorities can contribute to fewer resources needed to adhere to AIT schedules.

In conclusion, adherence could be improved when medical resources are provided to increase specialty care access in underserved communities. Observational and interventional studies are important for allergic rhinitis diagnosis, management, and outcomes for these underserved populations. A multi-level approach should also be addressed, involving patients, health providers, local agencies, professional societies, and national governmental agencies.

Allergic rhinitis treatment options include allergen immunotherapy (AIT). There are different guidelines and national practice parameters or care pathways for AIT. However, the decision to prescribe AIT should be personalized and based on the importance of the allergens and the persistence of the symptoms, even when using appropriate medications.

The practice of medicine has been revolutionized by digital transformation, including mHealth and artificial intelligence, where the patient is placed at the health system’s center. There are different biomarkers associated with mHealth and clinical decision support systems. However, there are two conditions that should be considered before any mHealth tool is used: comply with privacy regulations and validation. Of the few tools available for allergic rhinitis, evidence-based development was found for four Apps: MASK-air, AllergyMonitor, Polle, and Air Rater.

This review focuses on patient stratification for AIT, symptom medication scores for follow-up, clinical trials, and the European Academy of Allergy and Clinical Immunology (EAACI).

Patient stratification is required to:

–           Identify the best candidates for intervention through complex care management

–           Reduce the time and resources needed to match a patient to a care management programme

–           Optimize costs.

Symptom medication scores are needed to assess the efficacy of AIT, especially in clinical trials and observational studies.

The EAACI task force was created to evaluate the state of the art and the future potential of technology in the field of allergic rhinitis. This task force evaluated the design, user engagement, content, potential of inducing behavioural change, credibility, and privacy policies of mHealth products.

In conclusion, mHealth technology is a potential tool to aid AIT’s decision-making, increase adherence, monitor efficacy and safety, and identify responders to the treatment. However, these tools may also have their inconveniences, namely if they are improperly used or are not validated.