-1 - ARIA (Allergic Rhinitis and its Impact on Asthma) 2008 Update In collaboration with the WorldREPRODUCE. Health 2 Organization, GA LEN andOR AllerGen ALTER NOT DO MATERIAL. COPYRIGHTED -2 - Jean Bousquet, Nikolai Khaltaev, Alvaro A Cruz, Judah Denburg, Wytske Fokkens, Alkis Togias, Torsten Zuberbier, Carlos Baena-Cagnani, G Walter Canonica, Chris van Weel, Ioana Agache, Nadia Aït-Khaled, Claus Bachert, Michael Blaiss, Sergio Bonini, Louis-Philippe Boulet, Philippe-J Bousquet, Paulo Camargos, Kai-Hakon Carlsen, Adnan Custovic, Yuzhi Chen, Ronald Dahl, Pascal Demoly, Habib Douagui, Stephen Durham, Roy Gerth van Wijk, Omer Kalayci, Michael Kaliner, You-Young Kim, Marek L Kowalski, Piotr Kuna, Catherine Lemiere, Le Thi Tuyet Lan, Jing Li, Richard Lockey, Sandra Mavale, Eli O Meltzer, Yousser Mohammad, Joaquim Mullol, Robert Naclerio, Robyn O’Hehir, Ken Ohta, Sandra Ouedraogo, Susanna Palkonen, Nikolaos Papadopoulos, Giovanni Passalacqua, Ruby Pawankar, Todor Popov, Klaus Rabe, José Rosado-Pinto, Glenis Scadding, F Estelle R Simons, Elina Toskala, Erkka Valovirta, Paul van Cauwenberge, De Yun Wang, Magnus Wickman, Barbara Yawn, Arzu Yorgancioglu, Osman Yusuf, REPRODUCE. Heather Zar OR Review Group: Isabella Annesi-Maesano, ALTEREric Bateman, Ali Ben Kheder, Christine Bond, Jacques Bouchard, Daniel Boyake, Peter Burney, William W Busse, Moira Chan-Yeung, Niels Chavannes, Alexander Chuchalin, William Dolen, Lawrence Grouse, MarcNOT Humbert, Sebastian L Johnston, James Kemp, Paul P Kieth, Jean-Michel Klossek, Désirée Larenas, Brian Lipworth, Jean-Luc Malo, Gailen Marshall, Charles Naspitz, Markku DO Nieminen, Bodo Niggemann, Ewa Nizandowska, Yoshitaka Okamoto, Maria Pia Orru, Paul Potter, David Price, Stuart Stollof, Olivier Vandenplas, Giovanni Viegi, Dennis Williams MATERIAL. COPYRIGHTED -3 - GA2LEN (Global Allergy and Asthma European Network), supported by EU Framework programme for research, contract n° 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 REPRODUCE. OR ALTER NOT DO MATERIAL. COPYRIGHTED -4 - 1. Introduction ................................................................................................................................................................................................................................ 8 1.1. The ARIA workshop ........................................................................................................................................................................................................... 8 1.2. Need for an ARIA update .................................................................................................................................................................................................10 1.3. Development of the ARIA update ....................................................................................................................................................................................11 2. Definition and classification of rhinitis .................................................................................................................................................................................12 2.1. Introduction ......................................................................................................................................................................................................................12 2.2. Allergic rhinitis ..................................................................................................................................................................................................................13 2.2.1. Definition of allergic rhinitis ....................................................................................................................................................................................13 2.2.2. Intermittent (IAR) and persistent allergic rhinitis (PER) .........................................................................................................................................14 2.2.3. Severity of allergic rhinitis ......................................................................................................................................................................................15 2.3. Other causes of rhinitis ....................................................................................................................................................................................................17 2.3.1. Infectious rhinitis .....................................................................................................................................................................................................17 2.3.2. Work-related rhinitis ...............................................................................................................................................................................................17 2.3.3. Drug-induced rhinitis ..............................................................................................................................................................................................17 2.3.4. Hormonal rhinitis ....................................................................................................................................................................................................18 2.3.5. Nasal symptoms related to physical and chemical factors ....................................................................................................................................19 2.3.6. Rhinitis in smokers .................................................................................................................................................................................................19 2.3.7. Food-induced rhinitis ..............................................................................................................................................................................................19 2.3.8. NARES and eosinophilic rhinitis ............................................................................................................................................................................20 2.3.9. Rhinitis of the elderly ..............................................................................................................................................................................................REPRODUCE. 20 2.3.10. Emotions...............................................................................................................................................................................................................20 2.3.11. Atrophic rhinitis .....................................................................................................................................................................................................20 2.3.12. Unknown aetiology (idiopathic rhinitis).................................................................................................................................................................21 2.4. Rhinosinusitis ...................................................................................................................................................................................................................OR 21 2.4.1. Clinical definition ....................................................................................................................................................................................................22 2.4.2. Definition for epidemiologic studies .......................................................................................................................................................................24 2.4.3. Definition for research ............................................................................................................................................................................................24 2.4.4. Nasal polyposis ......................................................................................................................................................................................................25 3. Risk factors ..............................................................................................................................................................................................................................26 3.1. Genetics and familial history ............................................................................................................................................................................................26 3.2. Early-life risk factors .........................................................................................................................................................................................................ALTER 26 3.3. Ethnic groups ...................................................................................................................................................................................................................26 3.4. Allergen exposure ............................................................................................................................................................................................................27