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allergic rhinitis

The effect of face mask usage on the allergic rhinitis symptoms in patients with pollen allergy during the covid-19 pandemic

By Artículos seleccionados, Selected articles

Mengi E, Kara CO, Alptürk U, Topuz B

Am J Otolaryngol . 2021 Sep 10;43(1):103206. doi: 10.1016/j.amjoto.2021.103206. Online ahead of print.

Allergic rhinitis is an inflammation of the nasal mucosa mediated by IgE. It is characterized by nasal discharge, nasal obstruction, nasal itching, and sneezing. Allergic rhinitis prevalence has been increasing worldwide and it is believed that it affects up to 40% of the population. The objective of this study was to assess the use of face masks on allergic rhinitis symptomatology in people allergic to pollen and who were using face masks during the COVID-19 pandemic.

A total of 50 participants answered over the telephone a 15-item questionnaire which was developed by a team of allergic rhinitis experts. Participants were selected from those who had had allergy tests between 2013 and 2019.

The mean age of the participants was 34.34±9.41 years old and 60% were female. The number of participants who defined their nasal symptoms as severe-moderate in the pre-pandemic was higher (46 participants) than the number of participants with severe-moderate symptoms during the pandemic (28 participants). Patients who used mask had a statistically significant decrease in nasal and ocular symptoms (p<0,001), in sneezing (p=0,029) and nasal discharge (p=0,039).

In conclusion, the use of face mask reduced allergic rhinitis symptoms in people with pollen allergy, which supports the use of face masks for people with allergic rhinitis.

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Allergic rhinitis and COVID-19: friends or foes?

By Artículos seleccionados, Selected articles

F Gani

Eur Ann Allergy Clin Immunol . 2021 Sep 10. doi: 10.23822/EurAnnACI.1764-1489.234. Online ahead of print.

Allergic rhinitis is a usual condition that affects around 40% of the world population. During the COVID-19 pandemic, there was an increase in observational studies on the effect of asthma and chronic obstructive pulmonary disease and the risk of developing COVID-19. Still, there were no studies on allergic rhinitis and COVID-19.

This review aimed at assessing the risk of patients with allergic rhinitis developing worse COVID-19 outcomes. It also evaluated if COVID-19 can influence allergic rhinitis symptoms and influence the psychological conditions of pediatric and adult patients with allergic rhinitis.

The authors performed a comprehensive review of the literature. It included a set of different keywords, such as allergic rhinitis, rhinitis, allergy, atopy, COVID-19, and SARS-CoV-2.

From the articles selected, allergic rhinitis patients, appear to be protected from COVID-19 infection. However, there is not enough data on the influence of allergic rhinitis and the severity of COVID-19 disease; there is some information that being an allergic rhinitis patient does not increase the risk of a poor prognosis SARS-CoV-2 infection. The authors suggest that patients with allergic rhinitis follow their treatment accordingly, especially while the COVID-19 pandemic persists.

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Advances and highlights in allergic rhinitis

By Artículos seleccionados, Selected articles

Yuan Zhang, Feng Lan, Luo Zhang

Allergy . 2021 Aug 11. doi: 10.1111/all.15044. Online ahead of print.

Allergic rhinitis incidence has been growing in the past years, representing a medical and economic burden worldwide. This review describes the main findings with regards to allergic rhinitis for the past two years, including risk factors for the growing prevalence of allergic rhinitis, its strategy for the diagnosis, immunological mechanisms underlying the condition, and therapies used during the COVID-19 pandemic. It also aims at describing future perspectives.

Some of the most critical risk factors for allergic rhinitis are environmental exposures, climate changes, and lifestyle. There is an essential need to understand the connection between environmental exposures and health to design risk profiles instead of using single predictors and help eliminate adverse health outcomes in these conditions.

A newly defined allergic rhinitis phenotype, dual allergic rhinitis, includes perennial and seasonal related nasal symptoms but is more connected to seasonal allergic allergens. This indicates that it is crucial to assess inflammation at the local sites.

The authors suggest a combination of precise diagnosis in local sites and territories and traditional diagnostic methods to improve the precision medicine-based approach to managing allergic rhinitis.

In conclusion, further understanding of changes in cell profiles after treatment is needed. Apart from the usual treatments for allergic rhinitis during the current pandemic, social distancing, washing hands, and disinfection are also great aids in managing patients with allergic rhinitis.

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Meta-analyses of the efficacy of pharmacotherapies and sublingual allergy immunotherapy tablets for allergic rhinitis in adults and children

By Artículos seleccionados, Selected articles

Eli O. Meltzer, Dana Wallace, Howard S. Friedman, Prakash Navaratnam, Erin P. Scott, Hendrik Nolte

Rhinology . 2021 Aug 31. doi: 10.4193/Rhin21.054. Online ahead of print.

Allergic rhinitis impacts the quality of life of people who suffer from it, such as sleep impairment and reduction in work and school productivity. Current treatment options for seasonal and perennial allergic rhinitis include pharmacotherapy and immunotherapy. These meta-analysis aimed to assess the efficacy of pharmacotherapies and sublingual immunotherapy tablets (SLIT) versus placebo on people with nasal symptoms associated with both types of allergic rhinitis.

A systematic search identified randomized, double-blind, placebo-controlled trials with these comparisons. The primary outcome was the mean numerical difference in total nasal symptom score (TNSS) between active treatment and placebo at the end of the assessment timeline. A meta-analysis estimated the mean difference for each group of medication weighted by the inverse of the trial variance.

Most pharmacotherapy trials did not allow rescue symptom-relieving medicines but were allowed in sublingual immunotherapy tablets. The following table includes total nasal symptom scores for children and adults with allergic rhinitis.


Seasonal allergic rhinitis TNSS mean numerical difference (95%CI) vs. placebo

Perennial allergic rhinitis TNSS mean numerical difference (95%CI) vs. placebo

Intranasal corticosteroids 1.38 (1.18-1.58) 0.82 (0.66-0.97)
Combination intranasal antihistamines+corticosteroids 1.34 (1.15-1.54)
Intranasal antihistamines 0.72 (0.56-0.89)
Oral antihistamine 0.62 (0.35-0.90) 0.27 (0.11-0.42)
SLIT tablets 0.57 (0.41-0.73) 0.65 (0.42-0.88)
Montelukast 0.48 (0,36-0,60)


In conclusion, all treatments significantly improved nasal symptoms when compared with placebo. SLIT-tablets improved TNSS, even using rescue symptom-relieving pharmacotherapy. However, since trials have considerable heterogeneity, it is difficult to compare treatment effects among treatment classes.

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Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis

By Artículos seleccionados, Selected articles

J. Rodrigues, F. Franco-Pego, B. Sousa-Pinto, J. Bousquet, K. Raemdonck, R. Va

Rhinology. 2021 Aug 1;59(4):360-373. doi: 10.4193/Rhin21.087.

More than 400 million people suffer from allergic rhinitis worldwide. In Europe, its prevalence is around 25%, higher in urban areas. Although allergic rhinitis is not a life-threatening condition, it affects health and well-being (disruption of sleeping patterns, cognitive and performance impairment, decreased quality of life, and work/school performance). It may also be associated with a higher risk for psychiatric diseases, such as depression and anxiety.

This systematic review and meta-analysis aimed to quantify the relationship between allergic rhinitis and depression and anxiety.

An electronic search for observational studies that evaluated the relationship between allergic rhinitis and depression and anxiety was conducted. The association was quantified by random-effects meta-analysis, with an estimation of the pooled odds ratio.

Twenty-four studies were included (23 evaluated depression and 11 anxiety). Of these, 12 have odds ratio values from multivariable regression models and were included.

Allergic rhinitis was associated with higher odds of depression and anxiety.

In conclusion, allergic rhinitis seems to be related to a high risk of depression and anxiety; however, more studies are needed.

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One hundred and ten years of Allergen Immunotherapy: A journey from empiric observation to evidence

By Artículos seleccionados, Selected articles

Oliver Pfaar, Jean Bousquet, Stephen R. Durham, Jörg Kleine-Tebbe, Mark Larche, Graham C Roberts, Mohamed H Shamji, Roy Gerth Van Wijk

Allergy . 2021 Jul 27. doi: 10.1111/all.15023. Online ahead of print.

It was back in 1911 that Noon has first described the favorable effects of subcutaneous injections with grass pollen extract on himself. Since then, allergen immunotherapy (AIT) has evolved as the most important treatment for allergic patients. AIT constitutes the only disease-modifying treatment available, with consistent efficacy and safety. Worldwide regulatory authorities recognize AIT, which products are subject to thorough assessments before a market authorization is granted.

The disease-modifying effects of AIT are associated with immune modulation of the innate and adaptive immune responses. The recent advances in understanding

the mechanisms supporting AIT will enable the identification of immune monitoring biomarkers as well as biomarkers of efficacy and tolerance. Additionally, this knowledge will be helpful for the development of new therapeutic targets that can be used in conjunction with immunotherapy to shorten treatment duration and improve patient compliance and efficacy.

Recent regulations of allergen products by authorities have positively integrated scientific progress in modern allergology and clinical advances. Definitions of homologous allergen groups based on biological and molecular relationships, manufacturing, and quality aspects have been combined with a framework for the clinical development of allergen products.

Also, a list of in vivo diagnostic and AIT-products is still to be market authorized, including pollen, dust mites, pets, and venoms.

The delivery of cost-effective modern health care is exciting for allergic diseases. Novel solutions – based on mobile health devices- are required to support authorities, and they should promote change of health and care towards integrated care with organizational health literacy.

International guidelines describe and acknowledge the use of AIT.

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Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

By Artículos seleccionados, Selected articles

M C Sánchez-Hernández, M. T. Dordal, A. M. Navarro, I. Dávila, B. Fernández-Parra, C. Colás, C. Rondón, A. del Cuvillo, F. Vega, J. Montoro, M. Lluch-Bernal, V. Matheu, P. Campo, M. L. González, R. González-Pérez, A. Izquierdo-Domínguez, A. Puiggros, M. Velasco, A. Fernández-Palacín, A. Valero, SEAIC Rhinoconjunctivitis Committee 2014-2018

Eur Ann Allergy Clin Immunol. 2021 Jul 27. doi: 10.23822/EurAnnACI.1764-1489.231. Versión digital previa a la impresión.

Allergic conjunctivitis is a reaction of the conjunctiva of the eye due to IgE hypersensitivity. It is commonly associated with other allergic conditions, such as eczema, food allergy, but especially allergic rhinitis and asthma. Still, the relation between allergic conjunctivitis and allergic rhinitis and asthma needs to be understood.

This study aimed to classify allergic conjunctivitis in a patient population and evaluate the relationship between allergic conjunctivitis and asthma, using the Consensus Document for Allergic Conjunctivitis (DECA).

A total of 2914 participants of all ages who participated in the “Alergológica 2015” study were included. They were then divided into two age groups ≤14 and >14 years old. Of these, 965 participants were diagnosed with allergic conjunctivitis, classified by severe (1,8%), moderate (46,4%) or mild (51,8%), and as intermittent (51,6%) or persistent (48,4%). Allergic conjunctivitis was mainly associated with allergic rhinitis (88,4%), asthma (38,2%), food allergy (8,3%), and atopic dermatitis (3,5%). The duration and severity of allergic conjunctivitis were significantly related to allergic rhinitis for both age groups and asthma in adults.

In conclusion, the new DECA classification showed a direct relationship between allergic conjunctivitis, allergic rhinitis, and asthma, which suggests that it should be considered in the hypothesis of the one airway concept.

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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

By Selected articles

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

By Selected articles

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

By Selected articles

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

By Selected articles

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

By Selected articles

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

By Selected articles

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

By Selected articles

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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