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Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 Update (In Collaboration with the World Health Organization, GA2LEN* and Allergen**)

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Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 Update (In Collaboration with the World Health Organization, GA2LEN* and Allergen**) Allergy 2008: 63 (Suppl. 86): 8–160 Ó 2008 The Authors Journal compilation Ó 2008 Blackwell Munksgaard ALLERGY Review article Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN* and AllerGen**) J. Bousquet1, N. Khaltaev2, A. A. Cruz3, J. Denburg4, W. J. Fokkens5, A. Togias6, T. Zuberbier7, C. E. Baena-Cagnani8, G. W. Canonica9, C. van Weel10, I. Agache11, N. At-Khaled12, C. Bachert13, M. S. Blaiss14, S. Bonini15, L.-P. Boulet16, P.-J. Bousquet17, P. Camargos18, K.-H. Carlsen19, Y. Chen20, A. Custovic21, R. Dahl22, P. Demoly23, H. Douagui24, S. R. Durham25, R. Gerth van Wijk26, O. Kalayci27, M. A. Kaliner28, Y.-Y. Kim29, M. L. Kowalski30, P. Kuna31,L.T.T.Le32, C. Lemiere33,J.Li34, R. F. Lockey35, S. Mavale-Manuel 36, E. O. Meltzer37, Y. Mohammad38, J. Mullol39, R. Naclerio40,R.E.OÕHehir41, K. Ohta42, S. Ouedraogo43, S. Palkonen44, N. Papadopoulos45, G. Passalacqua46, R. Pawankar47, T. A. Popov48, K. F. Rabe49, J. Rosado-Pinto50, G. K. Scadding51, F. E. R. Simons52, E. Toskala53, E. Valovirta54,P.van Cauwenberge55, D.-Y. Wang56, M. Wickman57,B.P.Yawn58, A. Yorgancioglu59, O. M. Yusuf60, H. Zar61 Review Group: I. Annesi-Maesano62, E. D. Bateman63, A. Ben Kheder64, D. A. Boakye65, J. Bouchard66, P. Burney67, W. W. Busse68, M. Chan-Yeung69, N. H. Chavannes70, A. Chuchalin71, W. K. Dolen72, R. Emuzyte73, L. Grouse74, M. Humbert75, C. Jackson76, S. L. Johnston77, P. K. Keith78, J. P. Kemp79, J.-M. Klossek80, D. Larenas-Linnemann81, B. Lipworth82, J.-L. Malo83, G. D. Marshall84, C. Naspitz85, K. Nekam86, B. Niggemann87, E. Nizankowska-Mogilnicka88, Y. Okamoto89, M. P. Orru90, P. Potter91, D. Price92, S. W. Stoloff93, O. Vandenplas94, G. Viegi95, D. Williams96 1University Hospital and INSERM, Hpital Arnaud de Villeneuve, Montpellier, France; 2GARD/ARIA Coordinator, Geneva, Switzerland; 3Federal University of Bahia School of Medicine, Brazil; 4AllerGen NCE, McMaster University, Canada; 5Academic Medical Center, Amsterdam, The Netherlands; 6National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA; 7Allergy Centre Charit, Charit – Universittsmedizin Berlin, Berlin, Germany; 8World Allergy Organization (WAO) and Catholic University of Cordoba, Argentina; 9Allergy & Respiratory Diseases Clinic, University of Genova, Genova, Italy; 10Radboud University Medical Centre, Nijmegen, The Netherlands; 11Transylvania University, Brasov, Romania; 12The International Union Against Tuberculosis and Lung Diseases; 13UZG, University Hospital Ghent, Ghent, Belgium; 14University of Tennessee Health Science Center, Memphis, TN, USA; 15Second University of Naples, INMM-CNR, Rome, Italy; 16Institut de cardiologie et de pneumologie de lÕHpital Laval and Universit Laval, Quebec, Canada; 17University Hospital, Nmes, France; 18Medical School, University Hospital, Federal University of Minas Gerais, Brazil; 19Voksentoppen, Rikshospitalet, Faculty of Medicine, University of Oslo, Norwegian School of Sport Science, Oslo, Norway; 20National Cooperative Group of Pediatric Research on Asthma, Asthma Clinic and Education Center of the Capital Institute of Pediatrics, Peking, China; 21University of Manchester, Manchester, UK; 22Aarhus University Hospital, Aarhus, Denmark; 23University Hospital of Montpellier – Inserm U657, Hpital Arnaud de Villeneuve, Montpellier, France; 24Centre Hospitalo-Universitaire de Bni-Messous, Algiers, Algeria; 25Imperial College London, London, UK; 26Erasmus MC, Rotterdam, The Netherlands; 27Pediatric Allergy and Asthma Unit, Hacettepe, Ankara, Turkey; 28Geo Washington Univ School of Medicine, Washington, DC and Institute for Asthma and Allergy, Chevy Chase, MD, USA; 29Seoul National University Hospital, Seoul, Korea; 30Medical University of Lodz, Lodz, Poland; 31Barlicki University Hospital, Medical University of Lodz, Lodz, Poland; 32University of Medicine and Pharmacy, Hochiminh City, Vietnam; 33University of Montreal, Montreal, Canada; 34Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical School, China; 35Joy McCann Culverhouse, University of South Florida College of Medicine, FL, USA; 36ChildrenÕs Hospital, Maputo, Mozambique; 37Allergy & Asthma Medical Group & Research Center, University of California, San Diego, CA, USA; 38Tishreen University School of Medicine, Lattakia, Syria; 39Hospital Clinic – IDIBAPS, Barcelona, Catalonia, Spain; 40Professor and Chief of OHNS, University of Chicago, Chicago, IL, USA; 41Alfred Hospital and Monash University, Melbourne, Australia; 42Teikyo University School of Medicine, Tokyo, Japan; 43Centre Hospitalier Universitaire Pdiatrique Charles de Gaulle, Ouagadougou, Burkina Faso, West Africa; 44EFA European Federation of Allergy and Airways Diseases PatientsÕ Associations, Brussels, Belgium; 45Allergy Research Center, University of Athens, Athens, Greece; 46University of Genoa, Genoa, Italy; 47Nippon Medical School, Bunkyo-ku, Tokyo, Japan; 48Clinic of Allergy and Asthma, Medical University Sofia, Sofia, Bulgaria; 49Leiden University Medical Center, Leiden, The Netherlands; 50Hospital Dona Estef¼nia, Lisboa, Portugal; 51Royal National TNE Hospital London, University College London, London, UK; 52University of Manitoba, Manitoba, Canada; 53Helsinki University Hospital and Finnish Institute of Occupational Health, Haartmanink, Helsinki, Finland; 54Turku Allergy Center, Turku, Finland; 55Ghent University, Ghent, Belgium; 56Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 57SachÕs ChildrenÕs Hospital, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 58Olmsted Medical Center, University of Minnesota, Rochester, MN, USA; 59Celal Bayar University, Medical School, Manisa, Turkey; 60The Allergy & Asthma Institute, Islamabad, Pakistan; 61School of Child and Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa; 62EPAR U707 INSERM and EPAR UMR-S UPMC, Paris VI, France; 63Health Sciences Faculty, University of Cape Town, Cape Town, South Africa; 64Pan African Thoracic Society, Tunisian Society of Respiratory Diseases, University of Tunis, Tunis, Tunisia; 65Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; 66Hpital de La Malbaie, Quebec, Canada; 67National Heart & Lung Institute at Imperial College, London, UK; 68George R. and Elaine Love Professor, Chair, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; 69University of British Columbia, Vancouver, Canada; 70Leiden University Medical Center, Leiden, The Netherlands; 71Pulmonology Research Institute and Russian Respiratory Society, Moscow, Russia; 72Medical College of Georgia, Augusta, GA, USA; 73Vilnius University Faculty of Medicine, Lithuania; 74University of Washington School of Medicine, WA, USA; 75Hpital Antoine-Bclre, Universit Paris-Sud, Clamart, France; 76Tayside Centre For General Practice, University of Dundee, Dundee, UK; 77National Heart and Lung Institute, Imperial College London, London, UK; 78McMaster University, Hamilton, Ontario, Canada; 79University of California School of Medicine, San Diego, CA, USA; 80University of Poitiers, France; 81Hospital Mdica Sur, Mexicocity, Mexico; 82University of Dundee, Dundee, UK; 83Universit de Montral et Hpital du Sacr-Coeur de Montral, Canada; 84University of Mississippi, Jackson, MS, USA; 85Federal University of S¼o 8 ARIA: 2008 Update Paulo, S¼o Paulo, Brazil; 86Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary; 87German Red Cross Hospital Berlin, Berlin, Germany; 88Jagiellonian University School of Medicine, Krakow, Poland; 89Chiba University, Chiba, Japan; 90Pharmacist, Italy; 91Groote Schuur Hospital and the University of Cape Town Lung Institute, South Africa; 92University of Aberdeen, Aberdeen, UK; 93University of Nevada School of Medicine, Reno, NV, USA; 94University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium; 95CNR Institute of Clinical Physiology, Pisa, Italy; 96School of Pharmacy, University of North Carolina, NC, USA Key words: ARIA; asthma; guideline; management; rhinitis. J. Bousquet, University Hospital and INSERM, Hpital Arnaud de Villeneuve, Montpellier, France *Global Allergy and Asthma European Network (GA2LEN), supported by the Sixth EU Framework Program for research, contract no. FOOD-CT-2004-506378. **AllerGen NCE Inc., joint initiative of the Natural Science and Engineering Research Council, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council and Industry Canada. countries, all ethnic groups and of all ages suffer from 1. Introduction allergic rhinitis. It affects social life, sleep, school and work. Allergic rhinitis is a symptomatic disorder of the nose The economic impact of allergic rhinitis is often underes- induced after allergen exposure by an immunoglobulin E timated because the disease does not induce elevated direct (IgE)-mediated inflammation of the membranes lining the costs. However, the indirect costs are substantial (1). Both nose (1). It was defined in 1929 (2): ÔThe three cardinal allergic rhinitis and asthma are systemic inflammatory symptoms in nasal reactions occurring in allergy are conditions and are often co-morbidities. sneezing, nasal obstruction and mucous dischargeÕ. Although asthma and other forms of allergic disease Allergic rhinitis is a global health problem that causes have been described in antiquity, Ôhay
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