Kuwait Medical Electronic Library

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

J Bousquet 1 2 3 4, E Melén 5 6, T Haahtela 7, G H Koppelman 8, A Togias 9, R Valenta 10, C A Akdis 11, W Czarlewski 12 13, M Rothenberg 14, A Valiulis 15 16, M Wickman 17, M Akdis 11, D Aguilar 18, A Bedbrook 13 19, C Bindslev-Jensen 20 21, S Bosnic-Anticevich 22 23 24, L P Boulet 25, C E Brightling 26, L Brussino 27 28, E Burte 4 29, M Bustamante 30 31 32, G W Canonica 33 34, L Cecchi 35, J C Celedon 36, C Chaves Loureiro 37, E Costa 38, A A Cruz 39, M Erhola 40, B Gemicioglu 41, W J Fokkens 42, J Garcia-Aymerich 30 31, S Guerra 43, J Heinrich 44, J C Ivancevich 45, T Keil 46 47 48, L Klimek 49 50, P Kuna 51, M Kupczyk 51, V Kvedariene 52 53, D E Larenas-Linnemann 54, N Lemonnier 55, K C Lodrup Carlsen 56, R Louis 57 58, M Makela 7, M Makris 59, M Maurer 1 2, I Momas 60 61, M Morais-Almeida 62, J Mullol 63 64, R N Naclerio 65, K Nadeau 66, R Nadif 4 29, M Niedoszytko 67, Y Okamoto 68 69, M Ollert 20 21 70, N G Papadopoulos 71, G Passalacqua 72, V Patella 73 74 75, R Pawankar 76, N Pham-Thi 77 78 79, O Pfaar 80, F S Regateiro 81 82 83, J Ring 84 85, P W Rouadi 86 87, B Samolinski 88, J Sastre 89, M Savouré 4 29 90, N Scichilone 91, M H Shamji 92 93, A Sheikh 94, V Siroux 95, B Sousa-Pinto 96 97, M Standl 98 99, J Sunyer 30 31 32 100, L Taborda-Barata 101 102, S Toppila-Salmi 7, M J Torres 103, I Tsiligianni 104 105, E Valovirta 106, O Vandenplas 107 108, M T Ventura 109 110, S Weiss 111, A Yorgancioglu 112, L Zhang 113, A H Abdul Latiff 114, W Aberer 115, I Agache 116, M Al-Ahmad 117, I Alobid 118 119, I J Ansotegui 120, S H Arshad 121 122, E Asayag 123, C Barbara 124, A Baharudin 125, L Battur 126, K S Bennoor 127, E C Berghea 128, K C Bergmann 1 2, D Bernstein 129, M Bewick 130, H Blain 131, M Bonini 132 133 134, F Braido 135 136, R Buhl 137, R S Bumbacea 138, A Bush 139, M Calderon 140, M Calvo-Gil 141, P Camargos 142, L Caraballo 143, V Cardona 144 145, W Carr 146, P Carreiro-Martins 147 148, T Casale 149, A M Cepeda Sarabia 150 151, R Chandrasekharan 152, D Charpin 153, Y Z Chen 154, I Cherrez-Ojeda 155 156, T Chivato 157, E Chkhartishvili 158, G Christoff 159, D K Chu 160, C Cingi 161, J Correia de Sousa 162, C Corrigan 163, A Custovic 164, G D'Amato 165, S Del Giacco 166, F De Blay 167 168, P Devillier 169, A Didier 170, M do Ceu Teixeira 171 172, D Dokic 173, H Douagui 174, M Doulaptsi 175, S Durham 176, M Dykewicz 177, T Eiwegger 178, Z A El-Sayed 179, R Emuzyte 180, A Fiocchi 181, N Fyhrquist 182, R M Gomez 183, M Gotua 184, M A Guzman 185, J Hagemann 49, S Hamamah 186, S Halken 187, D M G Halpin 188, M Hofmann 1 189, E Hossny 179, M Hrubiško 190, C Irani 191, Z Ispayeva 192, E Jares 193, T Jartti 194, E Jassem 195, K Julge 196, J Just 197, M Jutel 198 199, I Kaidashev 200, O Kalayci 201, A F Kalyoncu 202, P Kardas 203, B Kirenga 204, H Kraxner 205, I Kull 5 6, M Kulus 206, S La Grutta 207, S Lau 208, L Le Tuyet Thi 209, M Levin 210, B Lipworth 211, O Lourenço 212, B Mahboub 213, E Martinez-Infante 214, P Matricardi 215, N Miculinic 216, N Migueres 167, F Mihaltan 217, Y Mohammad 218 219, M Moniuszko 220, S Montefort 221, H Neffen 222, K Nekam 223, E Nunes 224, D Nyembue Tshipukane 225, R O'Hehir 226, I Ogulur 11, K Ohta 227, K Okubo 228, S Ouedraogo 229, H Olze 230 189, I Pali-Schöll 231, O Palomares 232, K Palosuo 233, C Panaitescu 234, P Panzner 235, H S Park 236, C Pitsios 237, D Plavec 238 239, T A Popov 240, F Puggioni 241, S Quirce 242, M Recto 243, M S Repka-Ramirez 244, C Robalo Cordeiro 37, N Roche 245 246, M Rodriguez-Gonzalez 247, J Romantowski 67, N Rosario Filho 248, M Rottem 249, H Sagara 250, F S Serpa 251, Z Sayah 252, S Scheire 253, P Schmid-Grendelmeier 254, J C Sisul 255, D Sole 256, M Soto-Martinez 257, M Sova 258, A Sperl 50, O Spranger 259, R Stelmach 260, C Suppli Ulrik 261 262, M Thomas 263, T To 264, A Todo-Bom 265, P V Tomazic 266, M Urrutia-Pereira 267, M Valentin-Rostan 268, E Van Ganse 269, M van Hage 270 271, T Vasankari 272 273, P Vichyanond 274, G Viegi 275, D Wallace 276, D Y Wang 277, S Williams 278, M Worm 279, P Yiallouros 237, O Yusuf 280, F Zaitoun 281, M Zernotti 282, M Zidarn 283 284, J Zuberbier 230 189, J A Fonseca 96 97, T Zuberbier 1 2, J M Anto 30 31 32

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Affiliations

1Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
2Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
3University Hospital Montpellier, Montpellier, France.
4Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
5Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
6Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
7Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
8Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
9Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.
10Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
11Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
12Medical Consulting Czarlewski, Levallois, France.
13MASK-air, Montpellier, France.
14Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
15Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.
16Medical Faculty of Vilnius University, Vilnius, Lithuania.
17Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden.
186AM Data Mining, Barcelona, Spain.
19ARIA, Montpellier, France.
20Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
21Odense Research Center for Anaphylaxis « ORCA », Odense, Denmark.
22Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
23Sydney Local Health District, Sydney, NSW, Australia.
24Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.
25Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
26Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK.
27Department of Medical Sciences, University of Torino, Torino, Italy.
28Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
29Université Paris-Saclay, UVSQ, UnivParis-Sud, Villejuif, France.
30Universitat Pompeu Fabra (UPF), Barcelona, Spain.
31ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
32CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
33Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
34Personalized medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
35SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
36Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
37Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
38UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
39Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
40Pirkanmaa Welfare district, Tampere, Finland.
41Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
42Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
43Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA.
44Ludwig Maximilians University Munich, University Hospital Munich - Instituteand Outpatient Clinic for Occupationa, Social and Environmental Medicine, Munich, Germany.
45Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
46Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
47Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
48State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany.
49Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
50Center for Rhinology and Allergology, Wiesbaden, Germany.
51Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
52Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
53Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
54Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
55Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, La Tronche, France.
56Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
57Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
58GIGA I3 Research Group, University of Liège, Liège, Belgium.
59Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
60Department of Public Health and Health Products, Paris Descartes University-Sorbonne Paris Cité, EA 4064, Paris, France.
61Paris Municipal Department of Social Action, Childhood, and Health, Paris, France.
62Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
63ENT Department, Rhinology Unit & Smell Clinic, Hospital Clínic, Barcelona, Spain.
64Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
65Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
66Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA.
67Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
68Chiba Rosai Hospital, Chiba, Japan.
69Chiba University Hospital, Chiba, Japan.
70Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
71Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
72Allergy and Respiratory Diseases, IRCCS Policlinico San Martino - University of Genoa, Genoa, Italy.
73Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.
74Agency of Health ASL, Salerno, Italy.
75Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
76Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
77Ecole Polytechnique de Palaiseau, Palaiseau, France.
78IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France.
79Université Paris Cité, Paris, France.
80Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
81Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
82Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
83Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
84Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
85Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland.
86Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
87Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait.
88Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
89Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
90French Environment and Energy Management Agency, Angers, France.
91PROMISE Department, University of Palermo, Palermo, Italy.
92National Heart and Lung Institute, Imperial College, London, UK.
93NIHR Imperial Biomedical Research Centre, London, UK.
94Usher Institute, The University of Edinburgh, Edinburgh, UK.
95INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France.
96MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
97CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
98Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
99German Center of Lung Research (DZL), Munich, Germany.
100IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
101Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
102UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
103Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain.
104International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.
105Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
106Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland.
107Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium.
108Université Catholique de Louvain, Yvoir, Belgium.
109Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
110Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
111Harvard Medical School and Channing Division of Network Medicine, Boston, USA.
112Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
113Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China.
114Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
115Department of Dermatology, Medical University of Graz, Graz, Austria.
116Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
117Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait.
118Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
119Centro Médico Teknon, Barcelona, Spain.
120Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
121Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
122David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.
123Argentine Society of Allergy and Immunopathology, Buenos Aires, Argentina.
124Portuguese National Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal.
125Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
126Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia.
127Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh.
128Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
129Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
130University of Central Lancashire Medical School, Preston, UK.
131Department of Geriatrics, Montpellier University Hospital, MUSE, Montpellier, France.
132Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy.
133Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy.
134National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
135Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.
136IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
137Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
138Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania.
139Imperial College and Royal Brompton Hospital, London, UK.
140Imperial College and National Heart and Lung Institute, London, UK.
141Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile.
142Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
143Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia.
144Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
145ARADyAL Research Network, Barcelona, Spain.
146Allergy & Asthma Associates of Southern California, A Medical Group, Southern California Research, Mission Viejo, California, USA.
147NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.
148Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
149Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA.
150Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia.
151SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Columbia.
152Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman.
153Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France.
154The Capital Institute of Pediatrics, Chaoyang district, Beijing, China.
155Universidad Espíritu Santo, Samborondón, Ecuador.
156Respiralab Research Group, Guayaquil, Guayas, Ecuador.
157School of Medicine, University CEU San Pablo, Madrid, Spain.
158David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia.
159Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria.
160Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
161Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
162School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.
163Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
164National Heart and Lung Institute, Imperial College London, London, UK.
165Division of Respiratory and Allergic Diseases, Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy.
166Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
167Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
168Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
169VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France.
170Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France.
171Dr Agostinho Neto University hospital, Praia, Cape Verde.
172Immunology, Faculty of Medicine, Cabo Verde University, Praia, Cape Verde.
173Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, Republic of Macedonia.
174Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria.
175Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
176Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
177Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
178The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada.
179Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
180Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
181Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
182Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
183School of Health Sciences, Catholic University of Salta, Salta, Argentina.
184Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia.
185Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile.
186Biology of Reproduction department, INSERM 1203, University hospital, Montpellier, France.
187Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
188University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK.
189Berlin Institute of Health, Berlin, Germany.
190Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia.
191Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon.
192Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan.
193Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina.
194EDEGO Research Unit, University of Oulu, Oulu, Finland.
195Department of Pneumology, Medical University of Gdańsk, Gdansk, Poland.
196Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia.
197Sorbonne université, Hôpital américain de Paris, Neuilly, France.
198Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
199ALL-MED Medical Research Institute, Wroclaw, Poland.
200Poltava State Medical University, Poltava, Ukraine.
201Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
202School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey.
203Department of Family Medicine, Medical University of Lodz, Lodz, Poland.
204Makerere University Lung Institute, Kampala, Uganda.
205Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
206Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland.
207Institute of Translational Pharmacology, National Research Council, Palermo, Italy.
208Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.
209University of Medicine and Pharmacy, Hochiminh City, Vietnam.
210Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa.
211Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK.
212Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
213Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE.
214Hospital San Luca, Oaxaca, Mexico.
215Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
216Croatian Pulmonary Society, Zagreb, Croatia.
217National Institute of Pneumology M Nasta, Bucharest, Romania.
218National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria.
219Syrian Private University, Damascus, Syria.
220Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland.
221Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
222Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina.
223Hungarian Allergy Association, Budapest, Hungary.
224Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
225ENT Department, University Hospital of Kinshasa, Kinshasa, Congo.
226Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
227Japan Anti-Tuberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan.
228Department of Otolaryngology, Nippon Medical School, Tokyo, Japan.
229Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
230Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
231Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria.
232Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
233Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland.
234OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania.
235Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
236Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
237Medical School, University of Cyprus, Nicosia, Cyprus.
238Srebrnjak Children's Hospital, Zagreb, Croatia.
239Medical Faculty, University JJ Strossmayer of Osijek, Osijek, Croatia.
240Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria.
241Personalized medicine Asthma & Allergy, Rozzano, IRCCS Humanitas Research Center, Milan, Italy.
242Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
243Division of Adult and Pediatric Allergy and Immunology, University of the Philippines- Philippines General Hospital, Manila, Philippines.
244Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay.
245Pneumologie, AP-HP Centre, Université de Paris Cité, Hôpital Cochin, Paris, France.
246UMR 1016, Institut Cochin, Paris, France.
247Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico.
248Department of Pediatrics, Federal University of Parana, Curitiba, Brazil.
249Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel.
250Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan.
251Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil.
252SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco.
253Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
254Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland.
255Allergy & Asthma, Clinica SISUL, FACAAI, SPAAI, Asuncion, Paraguay.
256Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
257Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica.
258Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic.
259Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria.
260Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
261Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
262Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
263University of Southampton, Southampton, UK.
264The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
265Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
266Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria.
267Universidade Federal dos Pampa, Uruguaiana, Brazil.
268Allergist, Montevideo, Uruguay.
269Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France.
270Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
271Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
272FILHA, Finnish Lung Health Association, Helsinki, Finland.
273Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
274Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand.
275Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
276College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
277Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
278International Primary Care Respiratory Group IPCRG, Aberdeen, UK.
279Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany.
280The Allergy and Asthma Institute, Islamabad, Pakistan.
281Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE.
282Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Villa Maria, Argentina.
283University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
284Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

17 February 2023

doi: 10.1111/all.15679

Abstract

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.

Keywords: IL-33; Toll-like receptors; asthma; multimorbidity; rhinitis.

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Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

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