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Thorax 04/2013; · 6.84 Impact Factor
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J. Bousquet,
N. Khaltaev,
A. A. Cruz,
J. Denburg,
W. J. Fokkens,
A. Togias,
T. Zuberbier,
C. E. Baena-Cagnani,
G. W. Canonica,
C. Van Weel, [......],
B. Niggemann,
E. Nizankowska-Mogilcka,
Y. Okamoto,
M. P. Orru,
P. Potter,
D. Price,
S. W. Stoloff,
O. Vandenplas,
G. Viegi,
D. Williams
Allergic Rhinitis and Its Impact on Asthma (ARIA). 01/2013;
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M Bonini,
C Bachert,
C E Baena-Cagnani,
A Bedbrook,
J L Brozek,
G W Canonica,
A A Cruz,
W J Fokkens,
R Gerth van Wijk,
L Grouse, [......],
G K Scadding,
H J Schünemann,
D M Thomas,
M Triggiani,
A Yorgancioglu,
O M Yusuf,
T Zuberbier,
R Pawankar, J Bousquet,
S Bonini
Current Opinion in Allergy and Clinical Immunology 12/2012; · 4.11 Impact Factor
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J Bousquet,
H J Schünemann,
B Samolinski,
P Demoly,
C E Baena-Cagnani,
C Bachert,
S Bonini,
L P Boulet,
P J Bousquet,
J L Brozek, [......],
M Wickman,
S Wöhrl,
J Wright,
B P Yawn,
P K Yiallouros,
H J Zar,
M E Zernotti,
N Zhong,
M Zidarn,
T Zuberbier
[show abstract]
[hide abstract]
ABSTRACT: Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.
The Journal of allergy and clinical immunology 10/2012; · 9.17 Impact Factor
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P W Hellings,
W J Fokkens,
C Akdis,
C Bachert,
C Cingi,
D Dietz de Loos,
P Gevaert,
V Hox,
L Kalogjera,
V Lund,
J Mullol,
N G Papadopoulos,
G Passalacqua,
C Rondón,
G Scadding,
M Timmermans,
E Toskala,
N Zhang, J Bousquet
[show abstract]
[hide abstract]
ABSTRACT: State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment. This group with so-called severe chronic upper airway disease (SCUAD) represents a therapeutic challenge. The concept of control of disease has only recently been introduced in the field of AR and CRS. In case of poor control of symptoms despite guideline-directed pharmacotherapy, one needs to consider the presence of SCUAD but also treatment-related, diagnosis-related and/or patient-related factors. Treatment-related issues of uncontrolled upper airway disease are linked with the correct choice of treatment and route of administration, symptom-oriented treatment and the evaluation of the need for immunotherapy in allergic patients. The diagnosis of AR and CRS should be reconsidered in case of uncontrolled disease, excluding concomitant anatomic nasal deformities, global airway dysfunction and systemic diseases. Patient-related issues responsible for the lack of control in chronic upper airway inflammation are often but not always linked with adherence to the prescribed medication and education. This review is an initiative taken by the ENT section of the EAACI in conjunction with ARIA and EPOS experts who felt the need to provide a comprehensive overview of the current state of the art of control in upper airway inflammation and stressing the unmet needs in this domain.
Allergy 10/2012; · 6.27 Impact Factor
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E Pace,
V Scafidi,
D Di Bona,
L Siena,
G Chiappara,
M Ferraro,
S La Grutta,
S Gallina,
R Speciale,
A Ballacchino,
C Bachert, J Bousquet,
M Gjomarkaj
[show abstract]
[hide abstract]
ABSTRACT: Chronic rhinosinusitis (CRS) is an inflammation of the nose and of the paranasal sinuses. The involvement of the respiratory epithelium in the mechanisms of CRS is poorly understood.
Among proteins expressed by nasal epithelial cells in CRS, IL-19 may have key functions. We here aimed to determine the expression and regulation of IL-19.
Nasal biopsies from normal subjects (n = 12), subjects with CRS but without nasal polyps (NP) (CRSsNP, n = 12) and with CRS with NP (CRSwNP, n = 15) were collected. Human Asthma Gene Array and real-time PCR were used to evaluate gene expression, western blot analysis and immunohistochemistry for protein expression. Results for IL-19 were confirmed by real-time PCR. The constitutive and stimulated (LPS, TGF β) expression of IL-19 and cell proliferation were evaluated in a nasal epithelial cell line (RPMI 2650).
Human Asthma Gene Array showed an increased IL-19 gene expression in NP from patients with CRS in comparison with normal subjects. Real-time PCR confirmed the IL-19 mRNA up-regulation in patients with CRSwNP and showed an up-regulation of IL-19, at lower extent, in patients with chronic rhinosinusitis without nasal polyps (CRSsNP) in comparison with normal subjects. Western blot analysis confirmed that IL-19 is increased also at protein level in patients with CRSwNP in comparison with normal subjects. In NP, IL-19 is highly expressed in the metaplastic nasal epithelium when compared to normal or hyperplastic epithelium. LPS stimulation increased IL-19 expression, and recombinant IL-19 increased cell proliferation in nasal epithelial cells.
IL-19 is overexpressed in the epithelium in CRSwNP and increases epithelial cell proliferation.
Allergy 05/2012; 67(7):878-86. · 6.27 Impact Factor
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B Samoliński,
A Fronczak,
P Kuna,
C A Akdis,
J M Anto,
A Z Bialoszewski,
P G Burney,
A Bush,
A Czupryniak,
R Dahl, [......],
N Papadopoulos,
F Raciborski,
D Sienkiewicz,
A Tomaszewska,
E Von Mutius,
D Willman,
A Włodarczyk,
O Yusuf,
T Zuberbier, J Bousquet
[show abstract]
[hide abstract]
ABSTRACT: The leading priority for the Polish Presidency of the Council of the European Union was to reduce health inequalities across European societies, and, within its framework, prevention and control of respiratory diseases in children. This very important paper contain proposal of international cooperation on the prevention, early detection and monitoring of asthma and allergic diseases in childhood which will be undertaken by the EU member countries as a result of EU conclusion developed during the Polish Presidency of the Council of the European Union. This will result in collaboration in the field of chronic diseases, particularly respiratory diseases, together with the activity of the network of national institutions and NGOs in this area. Paper also contains extensive analysis of the socio-economic, political, epidemiological, technological and medical factors affecting the prevention and control of childhood asthma and allergy presented during Experts presidential conference organized in Warsaw-Ossa 21-22 September 2011.
Allergy 04/2012; 67(6):726-31. · 6.27 Impact Factor
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A Yorgancıoğlu,
C Özdemir,
Ö Kalaycı,
A F Kalyoncu,
C Bachert,
C E Baena-Cagnani,
T B Casale,
Y Z Chen,
A A Cruz,
P Demoly, [......],
Y Mohammad,
J Mullol,
K Ohta,
N G Papadopoulos,
R Pawankar,
B Samolinski,
H J Schünemann,
O M Yusuf,
T Zuberbier, J Bousquet
[show abstract]
[hide abstract]
ABSTRACT: Allergic rhinitis and asthma represent global health problems for all age groups. Asthma and rhinitis frequently co-exist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization (WHO) workshop in 1999 and was published in 2001. ARIA has reclassified allergic rhinitis as mild/moderate-severe and intermittent/persistent. This classification schema closely reflects the impact of allergic rhinitis on patients. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of allergic rhinitis and asthma co-morbidities based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation). ARIA has been disseminated and implemented in over 50 countries of the world. In Turkey, it is important to make a record of ARIA achievements and to identify the still unmet clinical, research and implementation needs in order to strengthen the 2011 EU Priority on allergy and asthma in children.
Tuberkuloz ve toraks 03/2012; 60(1):92-7.
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J Ring,
C Akdis,
H Behrendt,
R P Lauener,
G Schäppi,
M Akdis,
W Ammann,
O de Beaumont,
T Bieber,
J Bienenstock, [......],
M Ollert,
L O'Mahony,
R Pawankar,
H Renz,
T Platts-Mills,
C Roduit,
C Schmidt-Weber,
C Traidl-Hoffmann,
U Wahn,
E Rietschel
Allergy 02/2012; 67(2):141-3. · 6.27 Impact Factor
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Prof Jean Bousquet, J Bousquet,
J M Anto,
P Demoly,
H J Schünemann,
A Togias,
M Akdis,
C Auffray,
C Bachert,
T Bieber, [......],
M Wickman,
D Williams,
S Wöhrl,
J Wright,
A Yorgancioglu,
O M Yusuf,
H J Zar,
M E Zernotti,
M Zidarn,
N Zhong
[show abstract]
[hide abstract]
ABSTRACT: Abstract
Concepts of disease severity, activity, control and responsiveness
to treatment are linked but different. Severity refers to
the loss of function of the organs induced by the disease process
or to the occurrence of severe acute exacerbations. Severity
may vary over time and needs regular follow-up. Control
is the degree to which therapy goals are currently met.
These concepts have evolved over time for asthma in guidelines,
task forces or consensus meetings. The aim of this paper
is to generalize the approach of the uniform definition of severe
asthma presented to WHO for chronic allergic and associated
diseases (rhinitis, chronic rhinosinusitis, chronic urticaria
and atopic dermatitis) in order to have a uniform definition
of severity, control and risk, usable in most situations. It
is based on the appropriate diagnosis, availability and accessibility
of treatments, treatment responsiveness and associated
factors such as comorbidities and risk factors. This uniform
definition will allow a better definition of the phenotypes
of severe allergic (and related) diseases for clinical
practice, research (including epidemiology), public health
purposes, education and the discovery of novel therapies.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2012; · 2.83 Impact Factor
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J Bousquet,
J M Anto,
P Demoly,
H J Schünemann,
A Togias,
M Akdis,
C Auffray,
C Bachert,
T Bieber,
P J Bousquet, [......],
D Williams,
S Wöhrl,
J Wright,
A Yorgancioglu,
O M Yusuf,
H J Zar,
M E Zernotti,
M Zidarn,
N Zhong,
T Zuberbier
[show abstract]
[hide abstract]
ABSTRACT: Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
International Archives of Allergy and Immunology 01/2012; 158(3):216-31. · 2.40 Impact Factor
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D Jarvis,
R Newson,
J Lotvall,
D Hastan,
P Tomassen,
T Keil,
M Gjomarkaj,
B Forsberg,
M Gunnbjornsdottir,
J Minov, [......],
P Howarth,
U Krämer,
J Baelum,
C Loureiro,
L Kasper, P J Bousquet,
J Bousquet,
C Bachert,
W Fokkens,
P Burney
[show abstract]
[hide abstract]
ABSTRACT: The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population-based epidemiological surveys.
The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps. The prevalence of self-reported current asthma by age group was determined. The association of asthma with CRS in each participating centre was assessed using logistic regression analyses, controlling for age, sex and smoking, and the effect estimates were combined using standard methods of meta-analysis.
Over 52,000 adults aged 18-75 years and living in 19 centres in 12 countries took part. In most centres, and overall, the reported prevalence of asthma was lower in older adults (adjusted OR for 65-74 years compared with 15-24 years: 0.72; 95% CI: 0.63-0.81). In all centres, there was a strong association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20-3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57-13.17). CRS in the absence of nasal allergies was positively associated with late-onset asthma.
Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.
Allergy 11/2011; 67(1):91-8. · 6.27 Impact Factor
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J Bousquet,
L Heinzerling,
C Bachert,
N G Papadopoulos,
P J Bousquet,
P G Burney,
G W Canonica,
K H Carlsen,
L Cox,
T Haahtela, [......],
B Rogala,
A Romano,
D Ryan,
P Schmid-Grendelmeier,
A Todo-Bom,
R Valenta,
S Woehrl,
O M Yusuf,
T Zuberbier,
P Demoly
[show abstract]
[hide abstract]
ABSTRACT: This pocket guide is the result of a consensus reached between members of the Global Allergy and Asthma European Network (GA(2) LEN) and Allergic Rhinitis and its Impact on Asthma (ARIA). The aim of the current pocket guide is to offer a comprehensive set of recommendations on the use of skin prick tests in allergic rhinitis-conjunctivitis and asthma in daily practice. This pocket guide is meant to give simple answers to the most frequent questions raised by practitioners in Europe, including 'practicing allergists', general practitioners and any other physicians with special interest in the management of allergic diseases. It is not a long or detailed scientific review of the topic. However, the recommendations in this pocket guide were compiled following an in-depth review of existing guidelines and publications, including the 1993 European Academy of Allergy and Clinical Immunology position paper, the 2001 ARIA document and the ARIA update 2008 (prepared in collaboration with GA(2) LEN). The recommendations cover skin test methodology and interpretation, allergen extracts to be used, as well as indications in a variety of settings including paediatrics and developing countries.
Allergy 11/2011; 67(1):18-24. · 6.27 Impact Factor
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K Ohta,
P-J Bousquet,
H Aizawa,
K Akiyama,
M Adachi,
M Ichinose,
M Ebisawa,
G Tamura,
A Nagai,
S Nishima,
T Fukuda,
A Morikawa,
Y Okamoto,
Y Kohno,
H Saito,
H Takenaka,
L Grouse, J Bousquet
[show abstract]
[hide abstract]
ABSTRACT: Asthma and rhinitis are common co-morbidities everywhere in the world but nation-wide studies assessing rhinitis in asthmatics using questionnaires based on guidelines are not available.
To assess the prevalence, classification, and severity of rhinitis using the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria in Japanese patients with diagnosed and treated asthma.
The study was performed from March to August 2009. Patients in physicians' waiting rooms, or physicians themselves, filled out questionnaires on rhinitis and asthma based on ARIA and Global Initiative for Asthma (GINA) diagnostic guides. The patients answered questions on the severity of the diseases and a Visual Analog Scale. Their physicians made the diagnosis of rhinitis.
In this study, 1910 physicians enrolled 29,518 asthmatics; 15,051 (51.0%) questionnaires were administered by physician, and 26,680 (90.4%) patients were evaluable. Self- and physician-administered questionnaires gave similar results. Rhinitis was diagnosed in 68.5% of patients with self-administered questionnaires and 66.2% with physician-administered questionnaires. In this study, 994 (7.6%) patients with self-administered and 561 (5.2%) patients with physician-administered questionnaires indicated rhinitis symptoms on the questionnaires without a physician's diagnosis of rhinitis. Most patients with the physician's diagnosis of rhinitis had moderate/severe rhinitis. Asthma control was significantly impaired in patients with a physician's diagnosis of rhinitis for all GINA clinical criteria except exacerbations. There were significantly more patients with uncontrolled asthma as defined by GINA in those with a physician's diagnosis of rhinitis (25.4% and 29.7%) by comparison with those without rhinitis (18.0% and 22.8%).
Rhinitis is common in asthma and impairs asthma control.
Allergy 07/2011; 66(10):1287-95. · 6.27 Impact Factor
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Marek L Kowalski,
J S Makowska,
M Blanca,
S Bavbek,
G Bochenek, J Bousquet,
P Bousquet,
G Celik,
P Demoly,
E R Gomes,
E Niżankowska-Mogilnicka,
A Romano,
M Sanchez-Borges,
M Sanz,
M J Torres,
A De Weck,
A Szczeklik,
K Brockow
[show abstract]
[hide abstract]
ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for 21-25% of reported adverse drug events which include immunological and nonimmunological hypersensitivity reactions. This study presents up-to-date information on pathomechanisms, clinical spectrum, diagnostic tools and management of hypersensitivity reactions to NSAIDs. Clinically, NSAID hypersensitivity is particularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and variety of late cutaneous and organ-specific reactions. Diagnosis of hypersensitivity to a NSAID includes understanding of the underlying mechanism and is necessary for prevention and management. A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, including clinical history, in vitro testing and/or provocation test with a culprit or alternative drug depending on the type of the reaction. The diagnostic process should result in providing the patient with written information both on forbidden and on alternative drugs.
Allergy 07/2011; 66(7):818-29. · 6.27 Impact Factor
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I. Baiardini,
F. Braido,
C. Bindslev-Jensen,
P. J. Bousquet,
Z. Brzoza,
G. W. Canonica,
E. Compalati,
A. Fiocchi,
W. Fokkens,
R. Gerth van Wijk, [......],
E. Ridolo,
S. S. Saini,
M. Sanchez-Borges,
G. E. Senna,
I. Terreehorst,
A. Todo Bom,
E. Toubi, J. Bousquet,
T. Zuberbier,
M. Maurer
[show abstract]
[hide abstract]
ABSTRACT: To cite this article: Baiardini I, Braido F, Bindslev-Jensen C, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, Giménez-Arnau A, Godse K, Grattan C, Grob JJ, La Grutta S, Kalogeromitros D, Kocatürk E, Lombardi C, Mota-Pinto A, Ridolo E, Saini SS, Sanchez-Borges M, Senna GE, Terreehorst I, Todo Bom A, Toubi E, Bousquet J, Zuberbier T, Maurer M. Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA2LEN taskforce position paper. Allergy 2011; 66: 840–844.AbstractThe aim of this Global Allergy and Asthma European Network (GA2LEN) consensus report is to provide recommendations and suggestions for assessing patient-reported outcomes (PROs) including health-related quality of life in patients with urticaria. We recommend that PROs should be used both in clinical trials and routine practice for the evaluation of urticaria patients. We suggest that PROs should be considered as the primary outcome of future clinical trials. Two validated and disease-specific instruments for assessing PROs are available, the urticaria activity score (for symptoms) and the chronic urticaria questionnaire on quality of life CU-Q2oL. This latter tool, CU-Q2oL, is available in many languages and should be preferred, where available, over more generic instruments for assessing urticaria-specific effects on quality of life. CU-Q2oL is only suited for the investigation of patients with chronic spontaneous urticaria. Similar instruments for other forms of urticaria have yet to be developed and validated. Also, tools for assessing other chronic spontaneous urticaria PROs besides quality of life and symptoms are needed.
Allergy 06/2011; 66(7):840 - 844. · 6.27 Impact Factor
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D Hastan,
W J Fokkens,
C Bachert,
R B Newson,
J Bislimovska,
A Bockelbrink, P J Bousquet,
G Brozek,
A Bruno,
S E Dahlén, [......],
B Lundbäck,
E Salagean,
A Todo-Bom,
P Tomassen,
E Toskala,
C M van Drunen,
J Bousquet,
T Zuberbier,
D Jarvis,
P Burney
[show abstract]
[hide abstract]
ABSTRACT: Chronic rhinosinusitis (CRS) is a common health problem, with significant medical costs and impact on general health. Even so, prevalence figures for Europe are unavailable. In this study, conducted by the GA²LEN network of excellence, the European Position Paper on Rhinosinusitis and nasal Polyps (EP³OS) diagnostic criteria are applied to estimate variation in the prevalence of Chronic rhinosinusitis (CRS) for Europe.
A postal questionnaire was sent to a random sample of adults aged 15-75 years in 19 centres in Europe. Participants reported symptoms of CRS, and doctor diagnosed CRS, allergic rhinitis, age, gender and smoking history. Definition of CRS was based on the EP³OS diagnostic criteria: the presence of more than two of the symptoms: (i) nasal blockage, (ii) nasal discharge, (iii) facial pain/pressure or (iv) reduction in sense of smell, for >12 weeks in the past year--with at least one symptom being nasal blockage or discharge.
Information was obtained from 57,128 responders living in 19 centres in 12 countries. The overall prevalence of CRS by EP³OS criteria was 10.9% (range 6.9-27.1). CRS was more common in smokers than in nonsmokers (OR 1.7: 95% CI 1.6-1.9). The prevalence of self-reported physician-diagnosed CRS within centres was highly correlated with the prevalence of EP³OS-diagnosed CRS.
This is the first European international multicentre prevalence study of CRS. In this multicentre survey of adults in Europe, about one in ten participants had CRS with marked geographical variation. Smoking was associated with having CRS in all parts of Europe.
Allergy 05/2011; 66(9):1216-23. · 6.27 Impact Factor
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M. Maurer,
K. Weller,
C. Bindslev-Jensen,
A. Giménez-Arnau,
P. J. Bousquet, J. Bousquet,
G. W. Canonica,
M. K. Church,
K. V. Godse,
C. E. H. Grattan,
M. W. Greaves,
M. Hide,
D. Kalogeromitros,
A. P. Kaplan,
S. S. Saini,
X. J. Zhu,
T. Zuberbier
[show abstract]
[hide abstract]
ABSTRACT: To cite this article: Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CEH, Greaves MW, Hide M, Kalogeromitros D, Kaplan AP, Saini SS, Zhu XJ, Zuberbier T. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy 2011; 66: 317–330.AbstractChronic spontaneous urticaria, formerly also known as chronic idiopathic urticaria and chronic urticaria (CU), is more common than previously thought. At any time, 0.5–1% of the population suffers from the disease (point prevalence). Although all age groups can be affected, the peak incidence is seen between 20 and 40 years of age. The duration of the disease is generally 1–5 years but is likely to be longer in more severe cases, cases with concurrent angioedema, in combination with physical urticaria or with a positive autologous serum skin test (autoreactivity). Chronic spontaneous urticaria has major detrimental effects on quality of life, with sleep deprivation and psychiatric comorbidity being frequent. It also has a large impact on society in terms of direct and indirect health care costs as well as reduced performance at work and in private life. In the majority of patients, an underlying cause cannot be identified making a causal and/or curative treatment difficult. Nonsedating H1-antihistamines are the mainstay of symptomatic therapy, but treatment with licensed doses relieves symptoms effectively in <50% of patients. Although guideline-recommended updosing up to fourfold increases symptom control in many patients, a substantial number of patients have only little benefit from H1-antihistamines. Consequently, there is a great need for new therapeutic strategies.
Allergy 02/2011; 66(3):317 - 330. · 6.27 Impact Factor
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J. L. Brożek,
E. A. Akl,
E. Compalati,
J. Kreis,
L. Terracciano,
A. Fiocchi,
E. Ueffing,
J. Andrews,
P. Alonso-Coello,
J. J. Meerpohl, [......],
M. Helfand,
J. Watine,
M. Afilalo,
V. Welch,
A. Montedori,
I. Abraha,
A. R. Horvath, J. Bousquet,
G. H. Guyatt,
H. J. Schünemann
[show abstract]
[hide abstract]
ABSTRACT: To cite this article: Brożek JL, Akl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A, Ueffing E, Andrews J, Alonso-Coello P, Meerpohl JJ, Lang DM, Jaeschke R, Williams JW Jr, Phillips B, Lethaby A, Bossuyt P, Glasziou P, Helfand M, Watine J, Afilalo M, Welch V, Montedori A, Abraha I, Horvath AR, Bousquet J, Guyatt GH, Schünemann HJ, for the GRADE Working Group. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 3 of 3. The GRADE approach to developing recommendations. Allergy 2011; 66: 588–595.AbstractThis is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients’ values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients’ values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.
Allergy 01/2011; 66(5):588 - 595. · 6.27 Impact Factor
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J Bousquet,
J Anto,
C Auffray,
M Akdis,
A Cambon-Thomsen,
T Keil,
T Haahtela,
B N Lambrecht,
D S Postma,
J Sunyer, [......],
E Toskala,
P van Cauwenberge,
A J M van Oosterhout,
R Varraso,
L von Hertzen,
M Wickman,
C Wijmenga,
M Worm,
J Wright,
T Zuberbier
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ABSTRACT: The origin of the epidemic of IgE-associated (allergic) diseases is unclear. MeDALL (Mechanisms of the Development of ALLergy), an FP7 European Union project (No. 264357), aims to generate novel knowledge on the mechanisms of initiation of allergy and to propose early diagnosis, prevention, and targets for therapy. A novel phenotype definition and an integrative translational approach are needed to understand how a network of molecular and environmental factors can lead to complex allergic diseases. A novel, stepwise, large-scale, and integrative approach will be led by a network of complementary experts in allergy, epidemiology, allergen biochemistry, immunology, molecular biology, epigenetics, functional genomics, bioinformatics, computational and systems biology. The following steps are proposed: (i) Identification of 'classical' and 'novel' phenotypes in existing birth cohorts; (ii) Building discovery of the relevant mechanisms in IgE-associated allergic diseases in existing longitudinal birth cohorts and Karelian children; (iii) Validation and redefinition of classical and novel phenotypes of IgE-associated allergic diseases; and (iv) Translational integration of systems biology outcomes into health care, including societal aspects. MeDALL will lead to: (i) A better understanding of allergic phenotypes, thus expanding current knowledge of the genomic and environmental determinants of allergic diseases in an integrative way; (ii) Novel diagnostic tools for the early diagnosis of allergy, targets for the development of novel treatment modalities, and prevention of allergic diseases; (iii) Improving the health of European citizens as well as increasing the competitiveness and boosting the innovative capacity of Europe, while addressing global health issues and ethical issues.
Allergy 01/2011; 66(5):596-604. · 6.27 Impact Factor
