Reviews and feature article
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision

https://doi.org/10.1016/j.jaci.2010.06.047Get rights and content

Background

Allergic rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally.

Objective

To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of allergic rhinitis on the basis of current best evidence.

Methods

The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group.

Results

This article presents recommendations about the prevention of allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with allergic rhinitis as well as patients with both allergic rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals.

Conclusion

These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.

Section snippets

Review/Consultation group

  • Agache I (Faculty of Medicine, Transylvania University, Brasov, Romania)

  • Ameille J (AP-HP, Unité de pathologie professionnelle, Hôpital Raymond Poincaré, Garches, France)

  • Bachert C (Upper Airway Research Laboratory, University Hospital Ghent, Belgium)

  • Baker A (Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada)

  • Bateman E (Department of Medicine, University of Cape Town, South Africa)

  • Ben Kheder A (Hopital A. Mami,

Objective

Our objective was to develop explicit, unambiguous, and transparent clinical and practical recommendations systematically for the treatment of AR on the basis of current best evidence following the GRADE approach. This article summarizes the ARIA recommendations, and the complete rationale and explanation of all recommendations are provided in the unabridged text of the ARIA guidelines in this article's Online Repository 1 at www.jacionline.org.

Methods

We previously described the methods of the ARIA 2010 Revision,9 and the detailed methods are also provided in the unabridged text of the guidelines in Online Repository 1. We followed the principles for developing transparent, evidence-based guidelines suggested by the World Health Organization.9, 10, 11

We used the previous version of the ARIA guidelines as a starting point for the identification of clinical questions.1 We followed the systematic approach suggested by the GRADE working group

Results

In this article, we present 10 recommendations about the primary, secondary, and tertiary prevention of allergy, AR, and asthma; 31 recommendations about the management of AR; and 7 recommendations about the management of AR and asthma in the same patient. In-depth explanations, search strategies, evidence syntheses, and rationales are presented in Online Repository 1 and this article's Online Repository 2 at www.jacionline.org.

Statements about the underlying values and preferences as well as

Discussion

The updated recommendations of the ARIA guidelines were developed by an international panel following the systematic and transparent GRADE approach.16, 17 The target audience of these guidelines is all physicians treating patients with AR, other health care professionals, health care policy makers,1, 13, 18 and patients.19 Our review of the literature identified many areas where there are few studies or only studies with a high risk of bias are available. We also identified many areas that

References (21)

There are more references available in the full text version of this article.

Cited by (1283)

  • Modified extracorporeal septoplasty: prospective study

    2024, Brazilian Journal of Otorhinolaryngology
  • Allergic Rhinitis and Its Effect on Sleep

    2024, Otolaryngologic Clinics of North America
View all citing articles on Scopus

J.B., S.B., G.W.C., R.GvW., H.J.S., and T.Z. are members of the Global Allergy and Asthma European Network supported by European Commission Framework Programme grant FOOD-CT-2004-506378.

Disclosure of potential conflict of interest: J. L. B. is a member of the GRADE working group; he is an editor of a clinical journal where various drugs are advertised, including those that are the subject of these guidelines; he received honoraria for speaking at conferences and travel reimbursement from GlaxoSmithKline and i3 Research and for expert panel participation from Boehringer Ingelheim. J. B. received fees and honoraria for lectures, expert panel participation and consultations from Allmiral, ALK, AstraZeneca, Chiesi Farmaceutici, Faes Pharma, GlaxoSmithKline, Meda, Merck Sharp and Dohme, Mundifarma, Novartis, Nycomed-Altana, Roche, Sanofi-Aventis, Stallergènes, Schering- Plough, Teva, UCB and Uriach. C. E. B-C. received fees for consultancy, speaker bureau participation, lectures and research grants from Abello, ALK, FAES (Spain), GlaxoSmithKline, Grünenthal (Venezuela), Lofarma (Italy), Merk Serono, MSD, Novartis, Phoenix (Argentina), Sanofi-Aventis, Schering-Plough, and Uriach (Spain). S. B. received consultancy fees and honoraria for editorial activity or participation in sponsored symposia from: ALK, Almirall, AstraZeneca, GlaxoSmithKline, Menarini, Merck Sharp & Dohme, Novartis, Nycomed, Phadia, Schering-Plough, Sigma Tau and Stallergens. G. W. C. received fees and honoraria for lectures, expert panel participation and consultations and research support from A. Menarini, Alcon, Alk-Abellò, Almirall, Anallergo, AstraZeneca, Biofutura Pharma, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Lofarma, Merck Sharp & Dome, Novartis, Nycomed, Pfizer, Phadia, Schering Plough, SigmaTau, Stallergenes, UCB Pharma, Uriach and Valeas. T. C. declares no potential conflict of interest. R.GvW. received fees for lectures, expert panel participation and consultancy from Allergopharma, Allmiral, Alcon, Crucell, Hal, Merck Sharp & Dome, Novartis, Stallargènes and UCB. K. O. received fees and honoraria for lectures, expert panel participation and consultations from AstraZeneca, GlaxoSmithKline, Merck Banyu, Novartis, Schering Plough, Kyorin, Otsuka, and Taisho. H. J. S. is co-chair of the GRADE working group and he supports the implementation of the GRADE approach worldwide. From non-profit organizations he has accepted honoraria and consulting fees for activities in which his work with GRADE is relevant. In the past five years, H. J. S. received no personal payments for service from pharmaceutical for profit organizations. No financial support was received for the preparation of the evidence profiles or provided to the evidence synthesis team that HJS led as part of this work. T. Z. has received fees for consulting from Ansell, Bayer Schering, DST, Fujisawa, HAL, Henkel, Kryolan, Leti, Merck Sharp & Dohme, Novartis, Procter & Gamble, Sanofi-Aventis, Schering Plough, Stallergenes and UCB Pharma. None of the ARIA panel members have received any financial support for the work on these guidelines.

View full text