Summary

Allergic rhinitis is a worldwide health problem and prevalence of the disease is increasing, with economic and social consequences. An initiative from ARIA (Allergic Rhinitis and its Impact on Asthma), an NGO working with the World Health Organization, has forwarded three main developments in the management of allergic rhinitis. Firstly, ARIA has provided new evidence-based guidelines for the treatment of rhinitis that can be used worldwide, including in developing countries. The guidelines were designed to be used by the specialist as well as by the primary caregiver. Secondly, ARIA proposes a new subdivision of allergic rhinitis and suggests evidence-based management of the disease using a stepwise approach. Thirdly, ARIA notes that asthma and rhinitis are common comorbidities and proposes that allergic patients are treated globally to combine treatment of upper and lower airway disease.

Allergic Rhinitis and its Impact on Asthma (ARIA)

Exposure to traffic-related air pollution and risk of development of childhood asthma: A systematic review and meta-analysis

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.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-achievements-5jz0kxyiic.pdf

Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs

http://www.rcot.org/datafile/_file/_doctor/5db40baae1bcaa82875bcb53a61a80c8.pdf

Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens

Background: Developmental periods in early life may be particularly vulnerable to impacts of environmental exposures. Human research on this topic has generally focused on single exposure–health effect relationships. The “exposome” concept encompasses the totality of exposures from conception onward, complementing the genome. Objectives: The Human Early-Life Exposome (HELIX) project is a new collaborative research project that aims to implement novel exposure assessment and biomarker methods to characterize early-life exposure to multiple environmental factors and associate these with omics biomarkers and child health outcomes, thus characterizing the “early-life exposome.” Here we describe the general design of the project. Methods: In six existing birth cohort studies in Europe, HELIX will estimate prenatal and postnatal exposure to a broad range of chemical and physical exposures. Exposure models will be developed for the full cohorts totaling 32,000 mother–child pairs, and biomarkers will be measured in a subset of 1,200 mother–child pairs. Nested repeat-sampling panel studies (n = 150) will collect data on biomarker variability, use smartphones to assess mobility and physical activity, and perform personal exposure monitoring. Omics techniques will determine molecular profiles (metabolome, proteome, transcriptome, epigenome) associated with exposures. Statistical methods for multiple exposures will provide exposure–response estimates for fetal and child growth, obesity, neurodevelopment, and respiratory outcomes. A health impact assessment exercise will evaluate risks and benefits of combined exposures. Conclusions: HELIX is one of the first attempts to describe the early-life exposome of European populations and unravel its relation to omics markers and health in childhood. As proof of concept, it will form an important first step toward the life-course exposome.

/pdf/the-human-early-life-exposome-helix-project-rationale-and-diwsaozk5y.pdf

The Human Early-Life Exposome (HELIX): Project Rationale and Design

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.

/pdf/medall-mechanisms-of-the-development-of-allergy-an-57actxp3z0.pdf

MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine

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MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine