Open Access Highly Accessed Review

Assessment of disease control in allergic rhinitis

Pascal Demoly1*, Moises A Calderon2, Thomas Casale3, Glenis Scadding4, Isabella Annesi-Maesano5, Jean-Jacques Braun6, Bertrand Delaisi7, Thierry Haddad8, Olivier Malard9, Florence Trébuchon10 and Elie Serrano11

Author Affiliations

1 Allergy Division, Pulmonary Department, INSERM U657-EA2415, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France

2 Section of Allergy and Clinical Immunology, Imperial College London-NHLI, Royal Brompton Hospital, London, UK

3 Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, NE, USA

4 Rhinology Department, Royal National Throat, Nose and Ear Institute, London, UK

5 INSERM U707 and Faculté de Médecine Pierre et Marie Curie, Paris, France

6 Hôpital de Hautepierre and Nouvel Hôpital Civil, Strasbourg, France

7 Hôpital Robert Debré, Paris, France

8 Hôpital Tenon, Paris, France

9 Centre Hospitalier Universitaire de Nantes, Nantes, France

10 Private office, St Clement de Rivière, France

11 Hôpital Larrey, Toulouse, France

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Clinical and Translational Allergy 2013, 3:7  doi:10.1186/2045-7022-3-7

Published: 18 February 2013

Abstract

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has had a significant impact, by raising awareness of allergic rhinitis (AR) and improving the diagnosis and treatment of AR sufferers. ARIA classifies the severity of AR as "mild" or "moderate/severe" on the basis of "yes"/"no" answers to four questions. This two-point classification has been criticized as providing little guidance on patient management; patients with "mild" AR are unlikely to consult a physician, whereas the group of patients with "moderate/severe" seen by specialists is heterogeneous. These perceived shortcomings have prompted attempts to improve the ARIA classification or, by analogy with the Global Initiative for Asthma (GINA), adopt approaches based on "disease control" in AR. Even though "disease severity", "disease control" and "responsiveness to treatment" are different (albeit related) metrics, they are not mutually exclusive. Currently, there is no single, accepted definition, but we propose that "disease control" in AR can combine (i) measurements of the severity and/or frequency of daily or nocturnal symptoms, (ii) impairments in social, physical, professional and educational activities, (iii) respiratory function monitoring and (iv) exacerbations (e.g. unscheduled medical consultations and rescue medication use). Although control-based classifications have a number of limitations (e.g. their dependence on treatment compliance and the patient's psychological status), these instruments could be used as an adjunct to the ARIA severity classification and regional practice parameters. Here, we assess the strengths and weaknesses of the current two-level ARIA classification, analyze published proposals for its modification and review the literature on instruments that measure AR control. We conclude that there is a need for research in which severity is compared with control in terms of their effects on patient management.

Keywords:
Allergic rhinitis; Disease control; Disease severity; Classification; Questionnaire; ARIA; GINA