Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. the role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.This classification is now validated. the diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. the statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. in the future, the GRADE approach will be used, but is not yet available.Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. in the 2008 Update, these links have been confirmed.The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.Univ Hosp, Montpellier, FranceHop Arnaud Villeneuve, INSERM, Univ Hosp Montpellier, U657, Montpellier, FranceGARD ARIA, Geneva, SwitzerlandUniv Fed Bahia, Sch Med, BR-41170290 Salvador, BA, BrazilMcMaster Univ, AllerGen NCE, Hamilton, ON L8S 4L8, CanadaUniv Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, NetherlandsNIAID, Bethesda, MD 20892 USACharite, Allergy Ctr Charite, D-13353 Berlin, GermanyWAO, Cordoba, ArgentinaCatholic Univ Cordoba, Cordoba, ArgentinaUniv Genoa, Allergy & Resp Dis Clin, Genoa, ItalyRadboud Univ Nijmegen, Med Ctr, NL-6525 ED Nijmegen, NetherlandsTransylvania Univ, Brasov, RomaniaUniv Hosp Ghent, UZG, Ghent, BelgiumUniv Tennessee, Ctr Hlth Sci, Memphis, TN 38163 USAUniv Naples 2, INMM CNR, Rome, ItalyHop Laval, Inst Cardiol & Pneumol, Quebec City, PQ, CanadaUniv Laval, Quebec City, PQ, CanadaUniv Nimes Hosp, F-30006 Nimes, FranceUniv Fed Minas Gerais, Univ Hosp, Sch Med, Belo Horizonte, MG, BrazilUniv Oslo, Rikshosp, Norwegian Sch Sport Sci, Fac Med, N-0027 Oslo, NorwayCapital Inst Pediat, Asthma Clin & Educ Ctr, Natl Cooperat Grp Pediat Res Asthma, Beijing, Peoples R ChinaUniv Manchester, Manchester, Lancs, EnglandAarhus Univ Hosp, DK-8000 Aarhus, DenmarkCtr Hosp Univ Beni Messous, Algiers, AlgeriaUniv London Imperial Coll Sci Technol & Med, London, EnglandErasmus MC, Rotterdam, NetherlandsPediat Allergy & Asthma Unit, Ankara, TurkeyGeo Washington Univ, Sch Med, Washington, DC USAInst Asthma & Allergy, Chevy Chase, MD USASeoul Natl Univ Hosp, Seoul 110744, South KoreaMed Univ Lodz, Barlicki Univ Hosp, Lodz, PolandUniv Med & Pharm, Thanh Pho Ho Chi Minh, VietnamUniv Montreal, Montreal, PQ, CanadaFirst Affiliated Hosp, Guangzhou Med Sch, Guangzhou Inst Resp Dis, Guangzhou, Peoples R ChinaUniv S Florida, Coll Med, Tampa, FL 33620 USAChildrens Hosp, Maputo, MozambiqueUniv Calif San Diego, Allergy & Asthma Med Grp & Res Ctr, San Diego, CA 92103 USATishreen Univ Sch Med, Latakia, SyriaHosp Clin IDIBAPS, Barcelona, Catalonia, SpainUniv Chicago, Chicago, IL 60637 USAAlfred Hosp, Melbourne, Vic, AustraliaMonash Univ, Melbourne, Vic 3004, AustraliaTeikyo Univ, Sch Med, Tokyo 173, JapanCtr Hosp Univ Pediat Charles de Gaulle, Ouagadougou, Burkina FasoEFA European Federat Allergy & Airways Dis Patien, Brussels, BelgiumUniv Athens, Allergy Res Ctr, Athens, GreeceUniv Genoa, Genoa, ItalyNippon Med Sch, Bunkyo Ku, Tokyo 113, JapanMed Univ Sofia, Clin Allergy & Asthma, Sofia, BulgariaLeiden Univ, Med Ctr, Leiden, NetherlandsHosp Dona Estefania, Lisbon, PortugalUCL, Royal Natl TNE Hosp London, London, EnglandUniv Manitoba, Winnipeg, MB R3T 2N2, CanadaHelsinki Univ Hosp, Helsinki, FinlandFinnish Inst Occupat Hlth, Helsinki, FinlandTurku Allergy Ctr, Turku, FinlandUniv Ghent, B-9000 Ghent, BelgiumNatl Univ Singapore, Yong Loo Lin Sch Med, Singapore 117548, SingaporeKarolinska Inst, Sachs Childrens Hosp, Stockholm, SwedenKarolinska Inst, Inst Environm Med, S-10401 Stockholm, SwedenUniv Minnesota, Olmsted Med Ctr, Rochester, MN USACelal Bayar Univ, Sch Med, Manisa, TurkeyAllergy & Asthma Inst, Islamabad, PakistanUniv Cape Town, Sch Child & Adolescent Hlth, Red Cross Childrens Hosp, ZA-7925 Cape Town, South AfricaINSERM, EPAR U707, F-75654 Paris 13, FranceUPMC, EPAR, UMR S, Paris, FranceUniv Cape Town, Fac Hlth Sci, ZA-7925 Cape Town, South AfricaUniv Tunis, Tunisian Soc Resp Dis, Pan African Thorac Soc, Tunis, TunisiaUniv Ghana, Coll Hlth Sci, Noguchi Mem Inst Med Res, Legon, Accra, GhanaHop Malbaie, Quebec City, PQ, CanadaUniv London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, London, EnglandUniv Wisconsin, Sch Med & Publ Hlth, Dept Med, Madison, WI USAUniv British Columbia, Vancouver, BC V5Z 1M9, CanadaPulmonol Res Inst, Moscow, RussiaRussian Resp Soc, Moscow, RussiaMed Coll Georgia, Augusta, GA 30912 USAVilnius State Univ, Fac Med, Vilnius, LithuaniaUniv Washington, Sch Med, Seattle, WA 98195 USAUniv Paris Sud, Hop Antoine Beclere, Clamart, FranceUniv Dundee, Tayside Ctr Gen Practice, Dundee, ScotlandMcMaster Univ, Hamilton, ON, CanadaUniv Calif San Diego, Sch Med, San Diego, CA 92103 USAUniv Poitiers, Poitiers, FranceHosp Med Sur, Mexico City, DF, MexicoHop Sacre Coeur Montreal, Montreal, PQ, CanadaUniv Mississippi, Jackson, MS 39216 USAUniversidade Federal de São Paulo, São Paulo, BrazilHosp Hospitaller Bros Buda, Budapest, HungaryGerman Red Cross Hosp Berlin, Berlin, GermanyJagiellonian Univ, Sch Med, Krakow, PolandChiba Univ, Chiba, JapanGroote Schuur Hosp, ZA-7925 Cape Town, South AfricaUniv Cape Town, Lung Inst, ZA-7700 Rondebosch, South AfricaUniv Aberdeen, Aberdeen, ScotlandUniv Nevada, Sch Med, Reno, NV 89557 USACatholic Univ Louvain, Univ Hosp Mt Godinne, Yvoir, BelgiumCNR, Inst Clin Physiol, I-56100 Pisa, ItalyUniv N Carolina, Sch Pharm, Chapel Hill, NC 27515 USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc