New 'Allergic Rhinitis And Its Impact On Asthma' (ARIA) Guideline Urges Doctors To Make A Stronger Link Between Rhinitis And Asthma
ARIA chairman, Professor Jean Bousquet from Montpellier, France said: "People with rhinitis frequently develop asthma and people with asthma frequently develop rhinitis. In fact, it is possible to detect evidence of inflammation in the lungs of rhinitis patients even when they have no overt asthma symptoms. We therefore recommend that patients with persistent rhinitis should be evaluated for asthma and those with persistent asthma be assessed for rhinitis."
Both allergic rhinitis and asthma are systemic inflammatory conditions that affect the upper and lower airways, respectively. Allergic rhinitis worsens asthma, increases the risk of hospitalisation and leads to increased asthma exacerbations. The new ARIA guidelines report that up to 80% of people with asthma also have rhinitis. Professor Bousquet commented: "There has been a real need for a global document that highlights the interactions between the upper and lower airways in terms of diagnosis, epidemiology, common risk factors, management and prevention. I am pleased that this new update does exactly that."
The treatments recommended in the updated report are presented in a new, user-friendly algorithm. Intra-nasal corticosteroids are still considered first-line therapy in patients with moderate to severe disease and H1-antihistamines are important treatments for all patients. Leukotriene receptor antagonists (LTRAs) are important because they treat both rhinitis and asthma and sublingual immunotherapy is considered to be a safe and effective treatment.
Other updated sections in the guidelines include those on the use of complementary and alternative medicine; dealing with rhinitis during sports and exercise; and the link between rhinitis and asthma in preschool children.
First developed in 1999 following a World Health Organization (WHO) workshop, the ARIA guidelines were published as a state-of-the-art reference for GPs and hospital doctors to update their knowledge of allergic rhinitis and to highlight the impact of allergic rhinitis on asthma. The result was an evidence-based revision of the then current diagnosis and treatment practices plus a proposed stepwise approach to management.
This update, in collaboration with GA2LEN (the Global Allergy and Asthma Network, EU) and Allergen (Canada) has been in development since 2004 and was begun to keep pace with the large number of papers published since the guidelines were first developed.
The full update to the ARIA guidelines will be made available following a meeting in Rome on 20 June 2007. The evidence and recommendations for management guidelines will be assessed using a new grading system - GRADE (Grading of Recommendations Assessment, Development and Evaluation) - which combines efficacy of the intervention, burden and risks. It is expected that some of the recommendations offered by this ARIA update will differ from the original workshop report.
For further information from ARIA, please refer to http://www.whiar.org