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allergic rhinitis archivos - Bilastina

covid and rinitis

How does allergic rhinitis impact the severity of COVID-19?: a case-control study

By | Selected articles

Ali Guvey

Eur Arch Otorhinolaryngol . 2021 May 1;1-5. doi: 10.1007/s00405-021-06836-z. Online ahead of print.

 

SARS-CoV-2, which leads to coronavirus disease (COVID-19), is an exceptionally infectious disease which symptoms include fever, cough, fatigue, and dyspnea, and sometimes can be fatal in people with risk factors. Initially, some allergic diseases, including asthma, were defined as risk factors and poor outcomes. The objective of this study was to evaluate how allergic rhinitis affects the severity of COVID-19.

This was a case-control study conducted at Sakarya Educational and Research Hospital, Toyota Hospital, and Yenikent State Hospital between March 18, 2020, and August 30, 2020. It included 125 randomly selected patients previously diagnosed with allergic rhinitis before being diagnosed with COVID-19; and a control group of 125 patients without allergic rhinitis and diagnosed with COVID-19.

Patients were assessed regarding symptoms, lifestyle (smoke), comorbidities, and length of hospitalization.

The two groups did not have statistical differences in asymptomatic patients, smokers, hospitalization status, and length.

Two patients from each group went to an intensive care unit, and three patients died: one patient with allergic rhinitis and two from the control group.

In conclusion, allergic rhinitis did not impact the severity of COVID-19. However, more studies are needed with patients with allergic rhinitis and COVID-19.

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Heterogeneity of the pharmacologic treatment of allergic rhinitis in Europe based on MIDAS and OTCims platforms

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Jean Bousquet

Clin Exp Allergy . 2021 Apr 20. doi: 10.1111/cea.13884. Online ahead of print.

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.

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B cells and upper airway disease: allergic rhinitis and chronic rhinosinusitis with nasal polyps evaluated

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Harsha H Kariyawasam & Louisa K James

Expert Rev Clin Immunol. 2021 Apr 1:1-15. doi: 10.1080/1744666X.2021.1905527. Epub ahead of print.

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.

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Systematic review of measures of disease severity in rhinitis

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Andraia R. Li, Kathy Zhang, Priyanka D. Reddy, Shaun A. Nguyen, Amar Miglani, Jacob Fried, Mariam I. Nguyen, Rodney J. Schlosser

Int Forum Allergy Rhinol. 2021 Mar 27. doi: 10.1002/alr.22794. Epub ahead of print.

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.

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Manifesto on united airways diseases (UAD): an Interasma (global asthma association – GAA) document

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Angelica Titiu, et al.

Received 21 Oct 2020, Accepted 17 Jan 2021, Accepted author version posted online: 25 Jan 2021, Published online: 05 Mar 2021

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.

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Health Disparities in Allergic and Immunologic Conditions in Racial and Ethnic Underserved Populations

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Carla M. Davis, et al.

J Allergy Clin Immunol . 2021 Mar 10;S0091-6749(21)00365-1. doi: 10.1016/j.jaci.2021.02.034. Online ahead of print.

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.

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Differences in gut microbiota between allergic rhinitis, atopic dermatitis, and skin urticaria: A pilot study

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Yu-Jih Su, Sheng-Dean Luo, Chung-Yuan, Ho-Chang Kuo

Medicine (Baltimore) . 2021 Mar 5;100(9):e25091. doi: 10.1097/MD.0000000000025091.

Allergic rhinitis and urticaria prevalence are increasing. The intestinal flora or microbiota may influence their pathogeneses. This study aimed to compare differences between the gut microbiota of people with atopic dermatitis, allergic rhinitis, and chronic urticaria.

The study included 19 participants with eczema, nine with urticaria, and 11 with allergic rhinitis. The microbiota was compared by examining participants’ fecal samples using 16S ribosomal ribonucleic acid amplicon sequencing and bioinformatics and statistical analysis.

All three groups of patients had similar clinical data. The microbiota was substantially different between participants with atopic dermatitis, allergic rhinitis, and chronic urticaria, demonstrating gut-skin and gut-nose axes. Bacteroidales species were found in skin allergies more than in allergic rhinitis. This may represent a link between gut flora and skin allergy because gut flora colonies differ significantly between them.

In conclusion, different conditions have heterogeneous microbiota. Bacteroidales species could represent a link between gut flora and skin allergy, with Bacteroids Plebeius DSM 17135 being significantly associated with urticaria. Ruminococcaceae is also associated with allergic diseases.

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The role of mobile health technologies in stratifying patients for AIT and its cessation. The ARIA-EAACI perspective

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Jean Bousquet, et al.

J Allergy Clin Immunol Pract . 2021 Mar 1;S2213-2198(21)00240-3. doi: 10.1016/j.jaip.2021.02.035. Online ahead of print.

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.

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Association of Serum Vitamin D and Immunoglobulin E Levels with Severity of Allergic Rhinitis

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Nukhbat U. Awan, Shahzada K. Sohail, Fatima Naumeri, Shahida Niazi, Khalid Cheema, Samina Qamar, Syeda Fatima Rizvi

Cureus. 2021 Jan 25;13(1): e12911. doi: 10.7759/cureus. 12911..

Allergic rhinitis symptoms include inflammation of the nasal mucosa and affect up to 30-40% of the population with an increasing prevalence. This study’s objective was to assess the relationship between the severity of allergic rhinitis and serum vitamin D and immunoglobulin E (IgE) levels.

This was a case-control study conducted between June and September 2020, which included a total of 224 participants divided into two groups. Group A included 112 participants with moderate to severe asthma symptoms, and group B (control) included 112 participants with mild asthma symptoms after treatment of allergic rhinitis. Both groups were compared by assessing the mean difference between serum IgE and serum vitamin D levels. The relationship was evaluated by logistic regression and odds ratio.

There were 106 female participants (47,3%), with a mean age of 26.78±8.92 years old in group A and 25.72±8.12 years in group B. Mean serum IgE levels were 383.69±154.86 IU/mL for group A and 373.03±106.83 IU/mL for group B (p=0.0001). Mean serum vitamin D levels were 16.24±6.7 ng/mL for group A and 26.92±35 ng/mL for group B (p=0.0001).

Participants with low vitamin D levels were 24 times more likely to develop moderate to severe allergic rhinitis disease. In conclusion, this study demonstrated that IgE levels are increased in moderate to severe allergic rhinitis compared to mild allergic rhinitis. The deficiency of vitamin D is related to increased severity of allergic rhinitis symptoms.

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Allergic rhinitis: impact on quality of life of adolescents

Allergic rhinitis: impact on quality of life of adolescents

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C S Rosario

Eur Ann Allergy Clin Immunol . 2020 Nov 12. doi: 10.23822/EurAnnACI.1764-1489.176. Online ahead of print.

One of the faster phases of human development is adolescence, with biological maturity anteceding psychosocial maturity. 15% of young people between 13 and 14 years old suffer from allergic rhinitis, double that of those with 6-7 years old. The prevalence of allergic rhinitis is higher in boys up to 10 years old. It reverses to girls having a higher prevalence during adolescence, and by adulthood, there are no differences in prevalence between genders.

Changes that occur in adolescence have health consequences over the life-course and impact the quality of life. Allergic rhinitis has a significant impact on the quality of life of adolescents and their parents: most antihistamines have sedating effects, school absences, and lower performance due to distraction, fatigue, and irritability. It also has a negative impact on the parents, who may become anxious, overprotective, and need to miss work.

Digital technology is the way to help an original approach to characterize allergic rhinitis signs and symptoms, as well as their connection with other allergic conditions. The treatment’s achievement lies in the partnership between teenagers with allergic rhinitis and mobile technology, letting them have more information available on the disease and its treatment.

In conclusion, there is some knowledge on challenges adolescents with asthma face, but some information lacks allergic rhinitis challenges.

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nasal allergen challenge in allergic rhinitis

Repetitive nasal allergen challenge in allergic rhinitis: Priming and Th2-type inflammation but no evidence of remodelling

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Nara Orban, Mikila R Jacobson, Kayhan T Nouri-Aria, Stephen R Durham, Aarif O Eifan

Clin Exp Allergy . 2020 Nov 3. doi: 10.1111/cea.13775. Online ahead of print.

Seasonal allergic rhinitis is characterized by local tissue eosinophilia and Th2-cytokines. Asthma is characterized by airway-remodeling and which conflicts with evidence for remodeling in allergic rhinitis. This study aimed to assess the relationship between allergic inflammation and features of remodeling in allergic rhinitis using a new human repetitive nasal allergen challenge.

This study included twelve patients with moderate-to-severe allergic rhinitis who underwent 5-alternate day challenges with diluent, followed after 4-weeks by 5-alternate day challenges with grass pollen extract. Nasal symptoms, Th1/Th2 cytokines in the nasal secretion, and blood were assessed. Nasal biopsies were taken one day after the first and fifth challenges with diluent and allergen. Sixteen healthy controls were challenged with diluent and allergen once. Epithelial and sub-mucosal inflammatory cells and remodeling markers were assessed by computed image analysis.

Allergic rhinitis symptoms increased after every allergen challenge compared to diluent (p<0.05), with evidence of both clinical and immunological priming. Nasal secretion tissue eosinophils and IL-5 increased significantly after nasal allergen challenge, compared to corresponding diluent challenges. Allergic rhinitis patients evidenced a correlation between submucosal mast cells and the early-phase clinical response and an association between epithelial eosinophils and IL-5 in nasal secretion. There were no differences after allergen challenge concerning epithelial integrity, reticular basement membrane thickness, glandular area, expression of markers of activation of airway-remodeling including α-SMA, HSP-47, extracellular matrix, angiogenesis, and lymphangiogenesis for allergic rhinitis compared to controls.

In conclusion, novel repetitive nasal allergen challenges in people with severe persistent allergic rhinitis yielded in tissue eosinophilia. They increased IL-5, but with no structural changes, which supports no relationship between Th2-inflammation and development of airway-remodeling in allergic rhinitis.

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EUFOREA treatment algorithm for allergic rhinitis

By | Artículos seleccionados, Selected articles

P W Hellings, et al.

Rhinology . 2020 Sep 29. doi: 10.4193/Rhin20.246. Online ahead of print.

Allergic rhinitis is the most common chronic inflammatory condition. It affects more than 100 million people living in Europe, with a significant impact on individuals, society, and health economies. Most times, patients prefer to self-manage the condition by visiting pharmacies rather than seeking medical advice due to the long wait for an appointment.

Other difficulties to an effective and appropriate allergic rhinitis treatment include the inability to recognize and diagnose it and adequately prescribe a treatment. Lately, there has been a shift into more patient-approach to allergic rhinitis management, focusing on personalized, predictive, preventative, and participatory strategies.

The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and global key opinion leaders have developed a treatment algorithm to facilitate allergic rhinitis treatment in real-life settings. This guide includes a checklist of what to do when assessing patients, including a list of symptoms suggestive of allergic rhinitis, questions on suspected asthma, and instructions on using the visual scales. It consists of five steps: diagnosis, patients classification, therapy definition, product selection, and treatment plan activation. Patient education is central at all stages and their participation in the decision-making process and goal-setting.

This algorithm is concise, simple to use, suitable for all stakeholders, including pharmacies, primary care physicians, ENT doctors, pulmonologists, allergologists, and pediatricians. It provides evidence-based and expert-endorsed recommendations for the management of allergic rhinitis. The full pocket guide is available on the EUFOREA website (www.euforea.eu).

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rinithis alercica aerosoles nasales

As-needed versus regular use of fluticasone furoate nasal spray in patients with moderate to severe, persistent, perennial allergic rhinitis: a randomized controlled trial

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Torpong Thongngarm, Chamard Wongsa, Phichayut Phinyo, Paraya Assanasen, Pongsakorn Tantilipikorn, Mongkhon Sompornrattanaphan

J Allergy Clin Immunol Pract . 2020 Oct 10;S2213-2198(20)31107-7. doi: 10.1016/j.jaip.2020.09.057. Online ahead of print.

Allergic rhinitis is one of the most common diseases globally, and its prevalence is up to 50 % in children and 40 % in adults. It has a high economic burden and impacts the quality of life of patients. Allergic rhinitis related to house-dust mites or common indoor allergens is denominated perennial allergic rhinitis. The regular use of intranasal corticosteroids is recommended for the treatment of perennial allergic rhinitis. Due to the lack of studies that evaluate the “as-needed” use of intranasal corticosteroids, this study aimed to compare the efficacy between the as-needed and regular use of these products moderate-to-severe perennial allergic rhinitis.

This randomized controlled trial included 103 participants for six weeks. Participants were assigned to fluticasone furoate nasal spray (27,5 mg), two sprays once daily for one week, followed by as-needed use for five weeks (FF-as-needed) or two sprays once daily for six weeks (FF-regular). The primary endpoint was a change in the total nasal symptom score (TNSS), and secondary endpoints included a change in nasal peak inspiratory flow (NPIF), rhinoconjunctivitis quality of life-36 questionnaire score (RCQ-36), and cumulative fluticasone furoate dose.

Participants were divided into FF-as-needed (n = 51) and FF-regular (n = 52). The mean change of TNSS between the two groups was not significant at six weeks; however, the FF-regular group tendency was to a greater improvement in TNSS. The NPIF mean change was greater in the FF-regular group. Both groups had similar improvements in RCQ-36. The mean cumulative FF dose in the as-needed group was half of the regular group.

In conclusion, perennial allergic rhinitis patients from both groups had similar improvements in TNSS and quality of life, with those from the as-needed group having half of the exposure to intranasal corticosteroids.

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Null association between serum 25-hydroxyvitamin D levels with allergic rhinitis, allergic sensitization and non-allergic rhinitis: A Mendelian randomization study

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Qi Feng, Klaus Bønelykke, Weronica Ek, Bo CHawes, Shuai Yuan, Ching Cheung, Gloria Li, Raymond Leung, Bernard Cheung

Clin Exp Allergy. 2020 Sep 18. doi: 10.1111/cea.13739. Online ahead of print.

Allergic rhinitis and allergic sensitization are the most common and prevalent allergic conditions in the world. It has been suggested that serum 25-hydroxyvitamin D might have a role in immunomodulation and, consequently, in allergic rhinitis and allergic sensitization. This study aimed to assess a causal association between 25-hydroxyvitamin D levels and risk of allergic rhinitis or allergic sensitization, using two-sample Mendelian randomization (MR) approach.

Instrumental variables identified seven single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D levels. The primary objective was allergic rhinitis, and the secondary objectives were allergic sensitization and non-allergic rhinitis. Two cohort studies provided the genome-wide association summary statistics of the outcomes. MR analysis with a random-effects inverse variance weighted method was performed as the primary analysis to estimate the overall effect size. Sensitivity analysis using the weighted median method and MR-Egger regression method was conducted. A subgroup analysis based on 25-hydroxyvitamin D synthesis-SNPs was also applied.

There wasn’t a causal association between serum 25-hydroxyvitamin D and risk of allergic rhinitis, and subgroup analysis also showed no relation between 25-hydroxyvitamin D synthesis-related SNPs and outcomes. The same results were obtained for sensitivity analysis.

In conclusion, this study did not find any evidence that supports a causal association between serum 25-hydroxyvitamin D levels and risk of allergic rhinitis, allergic sensitization, or non-allergic rhinitis in the European-ancestry population. This conclusion is against the use of vitamin D supplementation for the prevention of allergic diseases.

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para identificar personas con rinitis alérgica.

Can we identify allergic rhinitis from administrative data: A validation study

By | Artículos seleccionados, Selected articles

Katja Biering Leth-Møller, Tea Skaaby, Flemming Madsen, Janne Petersen

Pharmacoepidemiol Drug Saf. 2020 Sep 23. doi: 10.1002/pds.5120. Online ahead of print.

The prevalence of allergic rhinitis has been increasing, with more than one in five people being affected. The objective of this study was to evaluate the validity of 13 different Danish prescription algorithms and hospital data to identify people with allergic rhinitis.

This study included 10 653 Danish adults in two time periods. Investigators used a positive serum-specific IgE and self-reported nasal symptoms as the primary gold-standard of allergic rhinitis. The secondary gold standard of allergic rhinitis was self-reported physician diagnosis. They calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value, and corresponding 95 % confidence intervals for each register-based algorithm in the two periods.

All algorithms had a low sensitivity, irrespective of the definition of allergic rhinitis or period. The highest positive predictive values were achieved for algorithms that required antihistamines and intranasal corticosteroids, with a value of 0.69 (0.62 – 0.75) and a corresponding sensitivity of 0.10 (0.09 – 0.12) for the primary gold standard of allergic rhinitis.

In conclusion, due to the low use of prescription medication among those with allergic rhinitis, sensitivity was low (≤ 0.40) for all algorithms irrespectively of the definition of allergic rhinitis. Algorithms based on antihistamines and intranasal corticosteroids granted the highest PPVs. Nevertheless, PPVs were still moderate, due to low sensitivity, when applying a strict gold standard (sIgE and nasal symptoms). Studies using administrative data must consider how to reliably identify allergic rhinitis, for example, using different data sources, and how a potential misclassification will

impact their results.

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