Severe Chronic Allergic (and Related) Diseases: A Uniform Approach – A MeDALL – GA²LEN – ARIA Position Paper

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.

A Randomized Controlled Trial to Assess Adherence to Allergic Rhinitis Treatment following a Daily Short Message Service (SMS) via the Mobile Phone

“…Furthermore, improvement of the adherence to treatment in AR is essential to achieve better disease control [7]. This is particularly important in AR patients, whose perception of ‘normal' disease control is not always the same as therapeutically defined disease control, which contributes to poor adherence to treatment [6]. …”

“…Despite great advances in guideline-based treatment algorithms, the level of AR control remains inadequate for many patients [3,4]. While up to 20% of AR patients do not respond satisfactorily to adequate medication treatment [5,6], it is estimated that only about 50% of the patients seek medical care because they underestimate the disease or manage it with inadequate expectancy about the results of the treatment [5]. Thus, to achieve long-term control of AR, a variety of approaches are needed, including appropriate medication, patient education, and adequate adherence to medication [4,7].…”

Clinical Relevance of Cluster Analysis in Phenotyping Allergic Rhinitis in a Real-Life Study

“…The hypothesis-driven stratification of patients with allergic rhinitis (AR) generally embeds clinical outcomes, disease severity or control [3]. No objective parameters or biomarkers have been identified to stratify patients with AR.…”

Integrated Allergy and Asthma Prevention and Care: Report of the MeDALL/AIRWAYS ICPs Meeting at the Ministry of Health and Care Services, Oslo, Norway

“…They include rhinitis, asthma, atopic eczema and diseases associated with food allergy. Although control has been achieved with many patients, there are needs that have not yet been met including the prevention and the management of severe disease [1]. Moreover, allergic diseases should be diagnosed and managed early in childhood in order to promote active and healthy ageing [2].…”