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  • 1.
    Amaral, Rita
    et al.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Fonseca, Joao A.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Univ Porto, Fac Med, MEDCIDS Dept Community Med Informat & Hlth Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Pereira, Ana M.
    Univ Porto, Fac Med, CINTESIS Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2,Rua Dr Placido Costa S-N, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-20122018In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 8, article id 13Article in journal (Refereed)
    Abstract [en]

    Background: Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Methods: Data from the National Health and Nutrition Examination Surveys (NHANES) 2007-2012 were used (n =30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) >= 300/mm(3)]; FeNO-high (FeNO >= 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm(3) and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI >= 30 kg/m(2)); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and >= 40 years old). Results: Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1-5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and >= 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were"non-classified". Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) >= 2 controller medications (2.03, 1.16-3.57), and FEV1 < LLN (3.21, 1.74-5.94), adjusted for confounding variables. Conclusions: A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.

  • 2.
    Amaral, Rita
    et al.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Pereira, Ana M.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal.
    Jacinto, Tiago
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Fonseca, Joao A.
    Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Fac Med, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Inst & Hosp CUF, Dept Allergy, Porto, Portugal;Univ Porto, MEDCIDS Dept Community Med Informat & Hlth Sci, Fac Med, Porto, Portugal.
    Comparison of hypothesis- and data-driven asthma phenotypes in NHANES 2007-2012: the importance of comprehensive data availability2019In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 17Article in journal (Refereed)
    Abstract [en]

    Background

    Half of the adults with current asthma among the US National Health and Nutrition Examination Survey (NHANES) participants could be classified in more than one hypothesis-driven phenotype. A data-driven approach applied to the same subjects may allow a more useful classification compared to the hypothesis-driven one.

    Aim

    To compare previously defined hypothesis-driven with newly derived data-driven asthma phenotypes, identified by latent class analysis (LCA), in adults with current asthma from NHANES 2007-2012.

    Methods

    Adults (18years) with current asthma from the NHANES were included (n=1059). LCA included variables commonly used to subdivide asthma. LCA models were derived independently according to age groups: <40 and 40years old.

    Results

    Two data-driven phenotypes were identified among adults with current asthma, for both age groups. The proportions of the hypothesis-driven phenotypes were similar among the two data-driven phenotypes (p>0.05). Class A <40years (n=285; 75%) and Class A 40years (n=462; 73%), respectively, were characterized by a predominance of highly symptomatic asthma subjects with poor lung function, compared to Class B <40years (n=94; 25%) and Class B 40years (n=170; 27%). Inflammatory biomarkers, smoking status, presence of obesity and hay fever did not markedly differ between the phenotypes.

    Conclusion

    Both data- and hypothesis-driven approaches using clinical and physiological variables commonly used to characterize asthma are suboptimal to identify asthma phenotypes among adults from the general population. Further studies based on more comprehensive disease features are required to identify asthma phenotypes in population-based studies.

  • 3. Bousquet, J
    et al.
    Arnavielhe, S
    Bedbrook, A
    Bewick, M
    Laune, D
    Mathieu-Dupas, E
    Murray, R
    Onorato, G L
    Pépin, J L
    Picard, R
    Portejoie, F
    Costa, E
    Fonseca, J
    Lourenço, O
    Morais-Almeida, M
    Todo-Bom, A
    Cruz, A A
    da Silva, J
    Serpa, F S
    Illario, M
    Menditto, E
    Cecchi, L
    Monti, R
    Napoli, L
    Ventura, M T
    De Feo, G
    Larenas-Linnemann, D
    Fuentes Perez, M
    Huerta Villabolos, Y R
    Rivero-Yeverino, D
    Rodriguez-Zagal, E
    Amat, F
    Annesi-Maesano, I
    Bosse, I
    Demoly, P
    Devillier, P
    Fontaine, J F
    Just, J
    Kuna, T P
    Samolinski, B
    Valiulis, A
    Emuzyte, R
    Kvedariene, V
    Ryan, D
    Sheikh, A
    Schmidt-Grendelmeier, P
    Klimek, L
    Pfaar, O
    Bergmann, K C
    Mösges, R
    Zuberbier, T
    Roller-Wirnsberger, R E
    Tomazic, P
    Fokkens, W J
    Chavannes, N H
    Reitsma, S
    Anto, J M
    Cardona, V
    Dedeu, T
    Mullol, J
    Haahtela, T
    Salimäki, J
    Toppila-Salmi, S
    Valovirta, E
    Gemicioğlu, B
    Yorgancioglu, A
    Papadopoulos, N
    Prokopakis, E P
    Bosnic-Anticevich, S
    O'Hehir, R
    Ivancevich, J C
    Neffen, H
    Zernotti, E
    Kull, I
    Melen, E
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bachert, C
    Hellings, P
    Palkonen, S
    Bindslev-Jensen, C
    Eller, E
    Waserman, S
    Sova, M
    De Vries, G
    van Eerd, M
    Agache, I
    Casale, T
    Dykewickz, M
    Naclerio, R N
    Okamoto, Y
    Wallace, D V
    MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence.2018In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 8, article id 45Article in journal (Refereed)
    Abstract [en]

    mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.

  • 4.
    Bousquet, J. Jean
    et al.
    CHU, Fondat Partenariale FMC VIA LR, MACVIA France, F-34295 Montpellier 5, France;Villejuif Univ Versailles St Quentin En Yvelines, VIMA Ageing & Chron Dis Epidemiol & Publ Hlth App, INSERM U 1168, UMR S 1168, Montigny Le Bretonneux, France;European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium;Charite Univ Med Berlin, Berlin, Germany;Free Univ Berlin, Berlin, Germany;Humboldt Uniersitat Berlin, Berlin, Germany.
    Schunemann, Holger J.
    McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada.
    Togias, Alkis
    NIAID, DAIT, NIH, 9000 Rockville Pike, Bethesda, MD 20892 USA.
    Erhola, Marina
    Natl Inst Hlth & Welf, Helsinki, Finland.
    Hellings, Peter W.
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium;Univ Hosp Leuven, Dept Otorhinolaryngol, Louvain, Belgium;Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands.
    Zuberbier, Torsten
    Charite Univ Med Berlin, Berlin, Germany;Free Univ Berlin, Berlin, Germany;Humboldt Uniersitat Berlin, Berlin, Germany;Berlin Inst Hlth, Comprehens Allergy Ctr, GA2LEN, Dept Dermatol & Allergy, Berlin, Germany.
    Agache, Ioana
    Transylvania Univ, Fac Med, Brasov, Romania.
    Ansotegui, Ignacio J.
    Hosp Quironsalud Bizkaia, Dept Allergy & Immunol, Erandio, Spain.
    Anto, Josep M.
    Ctr Res Environm Epidemiol CREAL, ISGlobAL, Barcelona, Spain;Hosp del Mar, Res Inst, IMIM, Barcelona, Spain;CIBERESP, Barcelona, Spain;UPF, Barcelona, Spain.
    Bachert, Claus
    Ghent Univ Hosp, ENT Dept, Upper Airways Res Lab, Ghent, Belgium.
    Becker, Sven
    Johannes Gutenberg Univ Mainz, Dept Otolaryngol Head & Neck Surg, Mainz, Germany.
    Bedolla-Barajas, Martin
    Hosp Civil Guadalajara Dr Juan I Menchaca, Guadalarara, Mexico.
    Bewick, Michael
    iQ4U Consultants Ltd, London, England.
    Bosnic-Anticevich, Sinthia
    Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia;Woolcock Emphysema Ctr, Sydney, NSW, Australia;Sydney Local Hlth Dist, Glebe, NSW, Australia.
    Bosse, Isabelle
    Boulet, Louis P.
    Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada.
    Bourrez, Jean Marc
    EFT Hlth France, Paris, France.
    Brusselle, Guy
    Ghent Univ Hosp, Dept Resp Med, Ghent, Belgium.
    Chavannes, Niels
    Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands.
    Costa, Elisio
    Univ Porto, Porto4Ageing, Fac Pharm, UCIBIO,REQUINTE, Porto, Portugal;Univ Porto, Porto4Ageing, Competence Ctr Act & Hlth Ageing, Porto, Portugal.
    Cruz, Alvaro A.
    Univ Fed Bahia, ProAR Nucleo Excelencia Asma, Salvador, BA, Brazil;WHO GARD Planning Grp, Salvador, BA, Brazil.
    Czarlewski, Wienczyslawa
    Med Consulting Czarlewski, Levallois Perret, France.
    Fokkens, Wytske J.
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium;Amsterdam Univ Med Ctr, Dept Otorhinolaryngol, AMC, Amsterdam, Netherlands.
    Fonseca, Joao A.
    Univ Porto, Fac Med, Ctr Res Hlth Technol & Informat Syst, CINITESIS, Porto, Portugal;Medida Lda, Porto, Portugal.
    Gaga, Mina
    Athens Chest Hosp, Resp Med Dept 7, Athens, Greece;Athens Chest Hosp, Asthma Ctr, Athens, Greece.
    Haahtela, Tari
    Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland;Univ Helsinki, Helsinki, Finland.
    Illario, Maddalena
    Medida Lda, Porto, Portugal;Campania Reg, Div Hlth Innovat, Naples, Italy;Federico II Univ Hosp Naples, R&D, Naples, Italy;Federico II Univ Hosp Naples, DISMET, Naples, Italy.
    Klimek, Ludger
    Ctr Rhinol & Allergol, Wiesbaden, Germany.
    Kuna, Piotr
    Med Univ Lodz, Barlicki Univ Hosp, Div Internal Med Asthma & Allergy, Lodz, Poland.
    Kvedariene, Violeta
    Vilnius Univ, Fac Med, Vilnius, Lithuania.
    Le, L. T. T.
    Univ Med & Pharm, Hochiminh City, Vietnam.
    Larenas-Linnemann, Desiree
    Med Sur Clin Fdn & Hosp, Ctr Excellence Asthma & Allergy, Mexico City, DF, Mexico.
    Laune, Daniel
    KYomed INNOV, Montpellier, France.
    Lourenco, Olga M.
    Univ Beira Interior, Fac Hlth Sci, Covilha, Portugal;Univ Beira Interior, Hlth Sci Res Ctr, CICS UBI, Covilha, Portugal.
    Menditto, Enrica
    Univ Naples Federico II, CIRFF, Naples, Italy.
    Mullo, Joaquin
    Hosp Clin Barcelona, ENT Dept, Rhinol Unit, Barcelona, Spain;Hosp Clin Barcelona, ENT Dept, Smell Clin, Barcelona, Spain;Univ Barcelona, CIBERES, IDIBAPS, Clin & Expt Resp Immunoallergy, Barcelona, Spain.
    Okamoto, Yashitaka
    Chiba Univ Hosp, Dept Otorhinolaryngol, Chiba, Japan.
    Papadopoulos, Nikos
    Univ Manchester, Royal Manchester Childrens Hosp, Div Infect Immun & Resp Med, Manchester, Lancs, England;Univ Athens, Athens Gen Childrens Hosp P&A Kyriakou, Pediat Clin 2, Allergy Dept, Athens, Greece.
    Pham-Thi, Nhan
    Picard, Robert
    Minist Econ Ind & Numer, Conseil Gen Econ, Paris, France.
    Pinnock, Hilary
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland.
    Roche, Nicolas
    Hop Univ Paris, Ctr Hop Cochin, Pneumol & Soins Intensifs Resp, Paris, France.
    Roller-Wirnsberger, Regina E.
    Med Univ Graz, Dept Internal Med, Graz, Austria.
    Rolland, Christine
    Assoc Asthme & Allergie, Paris, France.
    Samolinski, Boleslaw
    Med Univ Warsaw, Dept Prevent Environm Hazards & Allergol, Warsaw, Poland.
    Sheikh, Aziz
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland.
    Toppila-Salmi, Sanna
    Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland;Univ Helsinki, Helsinki, Finland.
    Tsiligianni, Ioanna
    Univ Crete, Fac Med, Dept Social Med, Hlth Planning Unit, Iraklion, Greece;IPCRG, Aberdeen, Scotland.
    Valiulis, Arunas
    Vilnius Univ, Fac Med, Inst Clin Med, Vilnius, Lithuania;Vilnius Univ, Fac Med, Inst Hlth Sci, Vilnius, Lithuania.
    Valovirta, Erkka
    Univ Turku, Dept Lung Dis & Clin Immunol, Turku, Finland;Terveystalo Allergy Clin, Turku, Finland.
    Vasankari, Tuula
    Finnish Lung Assoc, FILHA, Helsinki, Finland.
    Ventura, Maria-Teresa
    Walker, Samantha
    Univ Bari, Med Sch, Unit Geriatr Immunoallergol, Bari, Italy.
    Williams, Sian
    Univ Turku, Dept Lung Dis & Clin Immunol, Turku, Finland;Terveystalo Allergy Clin, Turku, Finland.
    Akdis, Cezmi A.
    Univ Zurich, Swiss Inst Allergy & Asthma Res SIAF, Davos, Switzerland.
    Annesi-Maesano, Isabella
    INSERM, Dept Inst Pierre Louis Epidemiol & Publ Hlth, Epidemiol Allerg & Resp Dis, Paris, France;Sorbonne Univ, Med Sch St Antoine, Paris, France.
    Arnavielhe, Sylvie
    KYomed INNOV, Montpellier, France.
    Basagana, Xavier
    Ctr Res Environm Epidemiol CREAL, ISGlobAL, Barcelona, Spain;Hosp del Mar, Res Inst, IMIM, Barcelona, Spain;CIBERESP, Barcelona, Spain;UPF, Barcelona, Spain.
    Bateman, Eric
    Univ Cape Town, Dept Med, Cape Town, South Africa.
    Bedbrook, Anna
    CHU, Fondat Partenariale FMC VIA LR, MACVIA France, F-34295 Montpellier 5, France.
    Bennoor, K. S.
    Natl Inst Dis Chest & Hosp, Dept Resp Med, Dhaka, Bangladesh.
    Benveniste, Samuel
    Broca Hosp, Natl Ctr Expertise Cognit Stimulat CEN STIMCO, Paris, France.
    Bergmann, Karl C.
    Charite Univ Med Berlin, Berlin, Germany;Free Univ Berlin, Berlin, Germany;Humboldt Uniersitat Berlin, Berlin, Germany;Berlin Inst Hlth, Comprehens Allergy Ctr, GA2LEN, Dept Dermatol & Allergy, Berlin, Germany.
    Bia, Slawomir
    Warsaw Med Univ, Div Lab Med, Fac Pharm, Dept Biochem & Clin Chem, Warsaw, Poland.
    Billo, Nils
    Global Alliance Chron Resp Dis WHO GARD, Joensuu, Finland.
    Bindslev-Jensen, Carsten
    Odense Univ Hosp, Odense Res Ctr Anaphylaxis, Dept Dermatol, Odense, Denmark;Odense Univ Hosp, Odense Res Ctr Anaphylaxis, Allergy Ctr, Odense, Denmark;Termofischer Sci, Uppsala, Sweden.
    Bjermer, Leif
    Univ Hosp, Dept Resp Med & Allergol, Lund, Sweden.
    Blain, Hubert
    Montpellier Univ Hosp, Dept Geriatr, Montpellier, France;Univ Montpellier, EA Euromov 2991, Montpellier, France.
    Bonini, Mateo
    Univ Cattolica Sacro Cuore, F Policlin Gemelli IRCCS, UOC Pneumol, Ist Med Interna, Rome, Italy;Royal Brompton Hosp, Natl Heart & Lung Inst, London, England;Imperial Coll, London, England.
    Bonniaud, Philippe
    CHU, Dijon, France.
    Bouchard, Jacques
    Lavals Univ, Clin Med, Quebec City, PQ, Canada;Hop Malbaie, Med Dept, Quebec City, PQ, Canada.
    Briedis, Vitalis
    Univ Hlth, Dept Clin Pharm Lithuanian, Kaunas, Lithuania.
    Brightling, Christofer E.
    Univ Hosp Leicester NHS Trust, Inst Lung Hlth, Resp Biomed Unit, Leicester, Leics, England;Univ Leicester, Dept Infect Immun & Inflammat, Leicester, Leics, England.
    Brozek, Jan
    McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada.
    Buhl, Roland
    Johannes Gutenberg Univ Mainz, Univ Med, Mainz, Germany.
    Buonaiuto, Roland
    Municipal Pharm, Sarno, Italy.
    Canonica, Giorgo W.
    Humanitas Univ, Humanitas Res Hosp, Personalized Med Clin Asthma & Allergy, Milan, Italy.
    Cardona, Victoria
    Hosp Valle De Hebron, Dept Internal Med, Allergy Sect, Barcelona, Spain;ARADyAL Res Network, Barcelona, Spain.
    Carriazo, Ana M.
    Reg Minist Hlth Andalusia, Seville, Spain.
    Carr, Warner
    Allergy & Asthma Associates Southern Calif, Mission Viejo, CA USA.
    Cartier, Christine
    Adv Solut Accelerator, Clapiers, France.
    Casale, Thomas
    Univ S Florida, Div Allergy Immunol, Tampa, FL USA.
    Cecchi, Lorenzo
    USL Toscana Ctr, SOS Allergol & Clin Immunol, Prato, Italy.
    Cepeda Sarabia, Alfonso M.
    Simon Bolivar Univ, Metropolitan Univ, Allergy & Immunol Lab, Barranquilla, Colombia;SLaai, Barranquilla, Colombia.
    Chkhartishvili, Eka
    Grigol Robakidze Univ, David Tvildiani Med Univ, AIETI Med Sch, Chachava Clin, Tbilisi, Georgia.
    Chu, Derek K.
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium.
    Cingi, Cemal
    Eskisehir Osmangazi Univ, Med Fac, ENT Dept, Eskisehir, Turkey.
    Colgan, Elaine
    Dept Hlth Social Serv & Publ Safety, Belfast, Antrim, North Ireland.
    de Sousa, Jaime Correia
    Univ Minho, Sch Med, Life & Hlth Sci Res Inst ICVS, Braga, Portugal;ICVS 3Bs, PT Govt Associate Lab, Braga, Portugal.
    Courbis, Anne Lise
    Ecole Mines, Ales, France.
    Custovic, Adnan
    Univ Manchester, Ctr Resp Med & Allergy, Inst Inflammat & Repair, Manchester, Lancs, England;Univ Hosp South Manchester, Manchester, Lancs, England.
    Cvetkosvki, Biljana
    Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia;Woolcock Emphysema Ctr, Sydney, NSW, Australia;Sydney Local Hlth Dist, Glebe, NSW, Australia.
    D'Amato, Gennaro
    High Specialty Hosp A Cardarelli, Dept Resp Dis, Div Resp & Allerg Dis, Naples, Italy.
    da Silva, Jane
    Univ Hosp Fed Univ Santa Catarina HU UFSQ, Allergy Serv, Florianopolis, SC, Brazil.
    Dantas, Carina
    Caritas Diocesana Coimbra, Coimbra, Portugal;Ageing Coimbra EIP AHA Reference Site, Coimbra, Portugal.
    Dokic, Dejand
    Univ Clin Pulmonol & Allergy, Med Fac Skopje, Skopje, Macedonia.
    Dauvilliers, Yves
    Hop Gui de Chauliac Montpellier, Sleep Unit, Dept Neurol, Inserm U1061, Montpellier, France.
    Dedeu, Antoni
    AQuAS, Barcelna, Spain;European Reg & Local Hlth Assoc, EUREGHA, Brussels, Belgium.
    De Feo, Giulia
    Univ Salerno, Scuola Med Salernitana, Dept Med Surg & Dent, Salerno, Italy.
    Devillier, Philippe
    Univ Paris Saclay, Hop Foch, Pole Malad Voies Resp, UPRES EA220, Suresnes, France.
    Di Capua, Stefania
    Farmacie Golfi Grp, Massa Lubrense, Italy.
    Dykewickz, Marc
    St Louis Univ, Sch Med, Sect Allergy & Immunol, St Louis, MO USA.
    Dubakiene, Ruta
    Vilnius Univ, Clin Infect Chest Dis Dermatol & Allergol, Vilnius, Lithuania.
    Ebisawa, Motohiro
    Sagamihara Natl Hosp, Clin Res Ctr Allergy & Rheumatol, Sagamihara, Kanagawa, Japan.
    El-Gamal, Yaya
    Ain Shams Univ, Childrens Hosp, Pediat Allergy & Immunol Unit, Cairo, Egypt.
    Eller, Esben
    Odense Univ Hosp, Odense Res Ctr Anaphylaxis, Dept Dermatol, Odense, Denmark;Odense Univ Hosp, Odense Res Ctr Anaphylaxis, Allergy Ctr, Odense, Denmark;Termofischer Sci, Uppsala, Sweden.
    Emuzyte, Regina
    Vilnius Univ, Fac Med, Clin Childrens Dis, Vilnius, Lithuania.
    Farrell, John
    ICVS 3Bs, PT Govt Associate Lab, Braga, Portugal.
    Fink-Wagner, Antjie
    Global Allergy & Asthma Platform GAAPP, Vienna, Austria.
    Fiocchi, Alessandro
    Bambino Gesu Childrens Res Hosp Holy See, Dept Pediat Med, Div Allergy, Rome, Italy.
    Fontaine, Jean F.
    Gemicioglu, Bilun
    Istanbul Univ Cerrahpasa, Cerrahpasa Fac Med, Dept Pulm Dis, Istanbul, Turkey.
    Schmid-Grendelmeir, Peter
    Univ Hosp Zurich, Dept Dermatol, Allergy Unit, Zurich, Switzerland.
    Gamkrelidze, Amiran
    Natl Ctr Dis Control & Publ Hlth Georgia, Tbilisi, Georgia.
    Garcia-Aymerich, Judith
    Ctr Res Environm Epidemiol CREAL, ISGlobAL, Barcelona, Spain.
    Gomez, Maximiliano
    Hosp San Bernardo Salta, Allergy & Asthma Unit, Salta, Argentina.
    Gonzalez Diaz, Sandra
    Univ Autonoma Nuevo Leon, San Nicolas De Los Garza, Mexico.
    Gotua, Maia
    Georgian Assoc Allergol & Clin Immunol, Ctr Allergy & Immunol, Tbilisi, Georgia.
    Guldemond, Nick A.
    Erasmus Univ, Inst Hlth Policy & Management iBMG, Rotterdam, Netherlands.
    Guzman, Maria-Antonieta
    Univ Chile, Clin Hosp, Immunol & Allergy Div, Santiago, Chile.
    Hajjam, Jawad
    Conseil Reg Pays Loire, Ctr Expertise Partenariat Europeen Innovat Vieill, Gerontopole Auton Longevite Pays Loire, Centich Ctr Expertise Natl Technol Informat & Com, Nantes, France.
    Hourihane, John O'B
    Univ Coll Cork, Dept Paediat & Child Hlth, Cork, Ireland.
    Humbert, Marc
    Univ Paris Sud, Le Kremlin Bicetre, France;Hop Bicetre, Serv Pneumol, Inserm UMR 5999, Le Kremlin Bicetre, France.
    Iaccarino, Guido
    Univ Salerno, Dept Med & Surg, Baronissi, Italy.
    Ierodiakonou, Despo
    Univ Crete, Fac Med, Dept Social Med, Hlth Planning Unit, Iraklion, Greece;Univ Turku, Dept Lung Dis & Clin Immunol, Turku, Finland;Terveystalo Allergy Clin, Turku, Finland.
    Ivancevich, Juan C.
    Clin Santa Isabel, Serv Alergia & Immunol, Buenos Aires, DF, Argentina.
    Joos, Guy
    Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada.
    Jung, Ki-Suck
    Hallym Univ, Coll Med, Sacred Heart Hosp, Anyang, Gyeonggi Do, South Korea.
    Jutel, Marek
    Wroclaw Med Univ, Dept Clin Immunol, Wroclaw, Poland.
    Kaidashev, Igor
    Ukrainian Med Stomatol Acad, Poltava, Ukraine.
    Kalayci, Omer
    Hacettepe Univ, Pediat Allergy & Asthma Unit, Sch Med, Ankara, Turkey.
    Kardas, Przemyslaw
    Med Univ Lodz, Dept Family Med 1, Lodz, Poland.
    Keil, Thomas
    Charite Univ Med Berlin, Inst Social Med Epidemiol & Hlth Econ, Berlin, Germany;Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany.
    Khaitov, Mussa
    Fed Med Biol Agcy, Natl Res Ctr, Inst Immunol, Lab Mol Immunol, Moscow, Russia.
    Khaltaev, Nikolai
    GARD Chairman, Geneva, Switzerland.
    Kleine-Tebbe, Jorg
    Allergy & Asthma Ctr Westend, Berlin, Germany.
    Kowalski, Marek L.
    Med Univ Lodz, Hlth Ageing Res Ctr, Dept Immunol & Allergy, Lodz, Poland.
    Kritikos, Vicky
    Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia;Woolcock Emphysema Ctr, Sydney, NSW, Australia;Sydney Local Hlth Dist, Glebe, NSW, Australia.
    Kull, Inger
    Karolinska Inst, Soder Sjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden.
    Leonardini, Lisa
    Mattone Int Program, Bologna, Veneto Region, Italy.
    Lieberman, Philip
    Univ Tennessee, Coll Med, Dept Internal Med, Div Allergy, Germantown, TN USA;Univ Tennessee, Coll Med, Dept Internal Med, Div Immunol, Germantown, TN USA;Univ Tennessee, Coll Med, Dept Pediat, Div Allergy, Germantown, TN USA;Univ Tennessee, Coll Med, Dept Pediat, Div Immunol, Germantown, TN USA.
    Lipworth, Brian
    Univ Dundee, Ninewells Hosp, Med Res Inst, Scottish Ctr Resp Res Cardiovasc & Diabet Med, Dundee, Scotland.
    Carlsen, Karin C. Lodrup
    Oslo Univ Hosp, Dept Paediat, Oslo, Norway;Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway.
    Loureiro, Claudia C.
    Ctr Hosp Univ Coimbra, Imunoalergol, Coimbra, Portugal;Univ Coimbra, Fac Med, Coimbra, Portugal.
    Louis, Renaud
    CHU Sart Tilman, Dept Pulm Med, Liege, Belgium;GIGA I3 Res Grp, Liege, Belgium.
    Mair, Alpana
    Scottish Govt, DG Hlth & Social Care, Edinburgh, Midlothian, Scotland.
    Marien, Gert
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium.
    Mahboub, Bassam
    Rashid Hosp, Dept Pulm Med, Dubai, U Arab Emirates.
    Malva, Joao
    Ageing Coimbra EIP AHA Reference Site, Coimbra, Portugal;Univ Coimbra, Fac Med, Coimbra Inst Clin & Biomed Res iCBR, Coimbra, Portugal.
    Manning, Patrick
    Bon Secours Hosp, Dept Med RCSI, Dublin, Ireland.
    Keenoy, Esteban De Manuel
    Int Ctr Excellence Chronic Res Barakaldo, Kronikgune, Baracaldo, Bizkaia, Spain.
    Marshall, Gallen D.
    Univ Mississippi, Med Ctr, Div Clin Immunol & Allergy, Lab Behav Immunol Res, Jackson, MS 39216 USA.
    Masjedi, Mohamed R.
    Iranian Anti Tobacco Assoc, Tobacco Control Res Ctr, Tehran, Iran.
    Maspero, Jorge F.
    Argentine Assoc Allergy & Clin Immunol, Buenos Aires, DF, Argentina.
    Mathieu-Dupas, Eve
    KYomed INNOV, Montpellier, France.
    Matricardi, Poalo M.
    Charite Med Univ, Dept Pediat Pneumol & Immunol, AG Mol Allergol & Immunomodulat, Berlin, Germany.
    Melen, Eric
    Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Melo-Gomes, Elisabete
    Fac Med Lisbon, PNDR, Portuguese Natl Programme Resp Dis, Lisbon, Portugal.
    Meltzer, Eli O.
    Allergy & Asthma Med Grp & Res Ctr, San Diego, CA USA.
    Mercier, Jacques
    Univ Montpellier, CHRU, Dept Physiol, Res,PhyMedExp,INSERM U1046,CNRS,UMR 9214, Montpellier, France.
    Miculinic, Neven
    Croatian Pulm Soc, Zagreb, Croatia.
    Mihaltan, Florin
    Natl Inst Pneumol M Nasta, Bucharest, Romania.
    Milenkovic, Branislava
    Univ Belgrade, Fac Med, Clin Ctr Serbia, Serbian Assoc Asthma & COPD,Clin Pulm Dis, Belgrade, Serbia.
    Moda, Giuliana
    Reg Piemonte, Turin, Italy.
    Mogica-Martinezl, Maria-Dolores
    Mohammad, Yousser
    Tishreen Univ, Natl Ctr Res Chron Resp Dis, Sch Med, Latakia, Syria;Syrian Private Univ, Damascus, Syria.
    Montefort, Steve
    Univ Med, Fac Med & Surg, La Valette, Malta.
    Monti, Ricardo
    Univ Torino, Dept Med Sci, Allergy & Clin Immunol Unit, Turin, Italy;Mauriziano Hosp, Turin, Italy.
    Morais-Almeida, Mario
    CUF Descobertas Hosp, Allergy Ctr, Lisbon, Portugal.
    Moesges, Raft
    Univ Cologne, Med Fac, Inst Med Stat & Computat Biol, Cologne, Germany;CRI Clin Res Int Ltd, Hamburg, Germany.
    Munter, Lars
    Danish Commitee Hlth Educ, Copenhagen East, Denmark.
    Muraro, Antonella
    Padua Gen Univ Hosp, Food Allergy Referral Ctr Veneto Reg, Dept Women & Child Hlth, Padua, Italy.
    Murray, Ruth
    MedScript Ltd, Paraparomu, New Zealand;OPC, Cambridge, England.
    Naclerio, Robert
    Johns Hopkins Sch Med, Baltimore, MD USA.
    Napoli, Luigi
    Consortium Pharm & Serv COSAFER, Salerno, Italy.
    Namazova-Baranova, Leila
    Russian Acad Med Sci, Sci Ctr Childrens Hlth, Moscow, Russia.
    Neffen, Hugo
    Ctr Allergy Immunol & Resp Dis, Santa Fe, Argentina.
    Nekam, Kristoff
    Hosp Hosp Ler Bros Buda, Budapest, Hungary.
    Neou, Angelo
    Hautambulanz & Rothhaar Study Ctr, Berlin, Germany.
    Novellino, Enrico
    Univ Naples Federico II, Dept Pharm, Naples, Italy.
    Nyembue, Dieudonne
    Univ Hosp Kinshasa, ENT Dept, Kinshasa, DEM REP CONGO.
    O'Hehir, Robin
    Monash Univ, Alfred Hosp, Dept Allergy Immunol & Resp Med, Melbourne, Vic, Australia;Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia.
    Ohta, Ken
    Tokyo Natl Hosp, Natl Hosp Org, Tokyo, Japan.
    Okubo, Kimi
    Nippon Med Sch, Dept Otolaryngol, Tokyo, Japan.
    Onorato, Gabrielle
    CHU, Fondat Partenariale FMC VIA LR, MACVIA France, F-34295 Montpellier 5, France.
    Ouedraogo, Solange
    Ctr Hosp Univ Pediat Charles de Gaulle, Ouagadougou, Burkina Faso.
    Pali-Schoell, Isabella
    Univ Vet Med, Messerli Res Inst, Dept Comparat Med, Vienna, Austria;Med Univ, Vienna, Austria.
    Palkonen, Susanna
    EFA European Federat Allergy & Airways Dis Patien, Brussels, Belgium.
    Panzner, Peter
    Charles Univ Prague, Fac Med, Dept Immunol & Allergol, Plzen, Czech Republic;Charles Univ Prague, Fac Hosp Pilsen, Plzen, Czech Republic.
    Park, Hae-Sim
    Ajou Univ, Dept Allergy & Clin Immunol, Sch Med, Suwon, South Korea.
    Pepin, Jean-Louis
    Univ Grenoble Alpes, Lab HP2, Grenoble, France;INSERM, U1042, Grenoble, France;CHU Grenoble, Grenoble, France.
    Pereira, Ana-Maria
    CUF Porto Hosp & Inst, Allergy Unit, Porto, Portugal;Univ Porto, Ctr Res Hlth Technol & Informat Syst, CINTESIS, Porto, Portugal.
    Pfaar, Oliver
    Philipps Univ Marburg, Univ Hosp Marburg, Sect Rhinol & Allergy, Dept Otorhinolaryngol Head & Neck Surg, Marburg, Germany.
    Paulino, Ema
    Farmacias Holon, Lisbon, Portugal.
    Phillips, Jim
    Ctr Empowering Patients & Communities, Faulkland, Somerset, England.
    Plavec, Davor
    Childrens Hosp Srebrnjak, Zagreb, Croatia;Univ JJ Strossmayer, Sch Med, Osijek, Croatia.
    Popov, Ted A.
    Univ Hosp Sv Ivan Rilski, Sofia, Bulgaria.
    Portejoie, Fabienne
    CHU, Fondat Partenariale FMC VIA LR, MACVIA France, F-34295 Montpellier 5, France.
    Price, David
    Univ Aberdeen, Acad Ctr Primary Care, Aberdeen, Scotland;Res Real Life, Cambridge, England.
    Prokopakis, Emmanuel P.
    Univ Crete, Dept Otorhinolaryngol, Sch Med, Iraklion, Greece.
    Pugin, Benoit
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium.
    Raciborski, Filip
    Med Univ Warsaw, Dept Prevent Environm Hazards & Allergol, Warsaw, Poland.
    Rajabian-Soderlund, Rojin
    Karolinska Univ Hosp, Dept Nephrol & Endocrinol, Stockholm, Sweden.
    Reitsma, Sietze
    European Forum Res & Educ Allergy & Airway Dis EU, Brussels, Belgium;Amsterdam Univ Med Ctr, Dept Otorhinolaryngol, AMC, Amsterdam, Netherlands.
    Rodo, Xavier
    Ctr Res Environm Epidemiol CREAL, ISGlobAL, Barcelona, Spain.
    Romano, Antonino
    Univ Cattolica Sacro Cuore, Allergy Unit, Presidio Columbus, Rome, Italy;IRCCS Oasi Maria SS, Troina, Italy.
    Rosario, Nelson
    Univ Parana, Hosp Clin, Curitiba, Parana, Brazil.
    Rottem, Menahenm
    Emek Med Ctr, Div Allergy Asthma & Clin Immunol, Afula, Israel.
    Ryan, Dermot
    Univ Edinburgh, Allergy & Resp Res Grp, Edinburgh, Midlothian, Scotland.
    Salimaki, Johanna
    Assoc Finnish Pharmacists, Helsinki, Finland.
    Sanchez-Borges, Mario M.
    Ctr Medicodocente Trinidad & Clin El Avila, Allergy & Clin Immunol Dept, Caracas, Venezuela.
    Sisul, Juan-Carlos
    Soc Paraguaya Alergia Asma & Inmunol, Asuncion, Paraguay.
    Sole, Dirceu
    Univ Fed Sao Paulo, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil.
    Somekh, David
    EHEE, Dromahair, Ireland.
    Sooronbaev, Talant
    Euro Asian Resp Soc, Kyrgyzstan Natl Ctr Cardiol & Internal Med, Bishkek, Kyrgyzstan.
    Sova, Milan
    Univ Hosp Olomouc, Dept Resp Med, Olomouc, Czech Republic.
    Spranger, Otto
    Global Allergy & Asthma Platform GAAPP, Vienna, Austria.
    Stellato, Cristina
    Univ Salerno, Scuola Med Salernitana, Dept Med Surg & Dent, Salerno, Italy.
    Stelmach, Rafael
    Univ Sao Paulo, Fac Med, Hosp Clin, Pulm Div,Heart Inst InCor, Sao Paulo, Brazil.
    Ulrik, Charlotte Suppli
    Hvidovre Univ Hosp, Dept Resp Med, Copenhagen, Denmark;Univ Copenhagen, Copenhagen, Denmark.
    Thibaudon, Michel
    RNSA, Brussieu, France.
    To, Teresa
    Sidkkids Hosp, Toronto, ON, Canada;Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada.
    Todo-Bom, Ana
    Ctr Hosp Univ Coimbra, Imunoalergol, Coimbra, Portugal;Univ Coimbra, Fac Med, Coimbra, Portugal.
    Tomazic, Peter, V
    Med Univ Graz, Dept ENT, Graz, Austria.
    Valero, Antonio A.
    Univ Barcelona, IDIBAPS, Pneumol & Allergy Dept, CIBERES, Barcelona, Spain;Univ Barcelona, IDIBAPS, Clin & Expt Resp Immunoallergy, Barcelona, Spain.
    Valenta, Rudolph
    Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria;NRC Inst Immunol FMBA Russia, Moscow, Russia;Sechenov First Moscow State Med Univ, Dept Clin Immunol & Allergy, Lab Immunopathol, Moscow, Russia.
    Valentin-Rostan, Marylin
    van der Kleij, Rianne
    Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands;Univ Med Ctr, Dept Obstet & Gynaecol, Erasmus MC, Rotterdam, Netherlands.
    Vandenplas, Olivier
    Catholic Univ Louvain, Ctr Hosp Univ UCL Namur, Dept Chest Med, Yvoir, Belgium.
    Vezzani, Giorgio
    AUSL Reggio Emilia, Arcispedale SMaria Nuova IRCCS, Pulm Unit, Dept Med Specialties, Reggio Emilia, Italy.
    Viart, Frederic
    Adv Solut Accelerator, Clapiers, France.
    Vieg, Giovanni
    CNR, Pulm Environm Epidemiol Unit, Inst Clin Physiol, Pisa, Italy;CNR, Inst Biomed & Mol Immunol A Monroy, Palermo, Italy.
    Wallace, Dana
    Nova Southeastern Univ, Ft Lauderdale, FL 33314 USA.
    Wagenmann, Martin
    Univ Klinikum Dusseldorf, HNO Klin, Dept Otorhinolaryngol, Dusseldorf, Germany.
    Wang, De Y.
    Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Otolaryngol, Singapore, Singapore.
    Waserman, Susan
    McMaster Univ, Dept Med Clin Immunol & Allergy, Hamilton, ON, Canada.
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Williams, Dennis M.
    Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA.
    Wong, Gary
    CHUL, Malad Infect & Immunitaires, Quebec City, PQ, Canada.
    Wroczynski, Piotr
    Warsaw Med Univ, Div Lab Med, Fac Pharm, Dept Biochem & Clin Chem, Warsaw, Poland.
    Yiallouros, Panayiotis K.
    Cyprus Univ Technol, Cyprus Int Inst Environm & Publ Hlth Assoc Harvar, Limassol, Cyprus;Hosp Archbishop Makarios III, Dept Pediat, Nicosia, Cyprus.
    Yorgancioglu, Arzu
    Celal Bayar Univ, Fac Med, Dept Pulm Dis, Manisa, Turkey.
    Yusuf, Osman M.
    Allergy & Asthma Inst, Islamabad, Pakistan.
    Zar, Heahter J.
    Red Cross Childrens Hosp, Dept Paediat & Child Hlth, Cape Town, South Africa;Univ Cape Town, MRC, Unit Child & Adolescent Hlth, Cape Town, South Africa.
    Zeng, Stephane
    Bull DSAS, Echirolles, France.
    Zernotti, Mario
    Univ Catolica Cordoba, Cordoba, Argentina.
    Zhang, Luo
    Beijing TongRen Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China;Beijing Inst Otolaryngol, Beijing, Peoples R China.
    Zhong, Nan S.
    Guangzhou Med Univ, Affiliated Hosp 1, Guangzhou Inst Resp Dis, State Key Lab Resp Dis, Guangzhou, Guangdong, Peoples R China.
    Zidarn, Mihaela
    Univ Clin Resp & Allerg Dis, Golnik, Slovenia.
    Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases2019In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 44Article, review/survey (Refereed)
    Abstract [en]

    Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.

    Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care.

    Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.

  • 5.
    Bousquet, J.
    et al.
    CHRU Arnaud Villeneuve, Fdn Partenariale FMC VIA LR, MACVIA France, Montpellier, France; VIMA Ageing Chron Dis Epidemiol Publ Hlth App, INSERM U, Villejuif, France; Univ Versailles St Quentin en Yvelines, UMRS, Montigny Le Bretonneux, France; Euforea, Brussels, Belgium; Humboldt Univ, Berlin Inst Hlth, Comprehens Allergy Ctr, Berlin, Germany; Charite Univ Med Berlin, Dept Dermatol & Allergy, Berlin, Germany.
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Zurkuhlen, A.
    Gesundheitsregion KölnBonn ‑ HRCB Projekt GmbH, Kohln, Germany.
    Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma2019In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 16Article, review/survey (Refereed)
    Abstract [en]

    Aims: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.

    Methods: MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.

    Stakeholders: Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors.

    Results: MASK is deployed in 23 countries and 17 languages. 26,000 users have registered.

    EU grants (2018): MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).

    Lessons learnt: (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

  • 6.
    Garcia-Larsen, Vanessa
    et al.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Med Grp, London, England.;Imperial Coll London, Natl Heart & Lung Inst, Resp Epidemiol Occupat Med & Publ Hlth Grp, Emmanuel Kaye Bldg,Manresa Rd, London SW3 6LR, England..
    Arthur, Rhonda
    Kings Coll London, Dept Nutr, London, England..
    Potts, James F.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Med Grp, London, England..
    Howarth, Peter H.
    Univ Southampton, Fac Med, London, England..
    Ahlstrom, Matti
    Helsinki Univ Hosp, Skin & Allergy Hosp, Southampton, Hants, England..
    Haahtela, Tari
    Helsinki Univ Hosp, Skin & Allergy Hosp, Southampton, Hants, England..
    Loureiro, Carlos
    Coimbra Univ Hosp, Immunoallergol Dept, Helsinki, Portugal..
    Bom, Ana Todo
    Coimbra Univ Hosp, Immunoallergol Dept, Helsinki, Portugal..
    Brozek, Grzegorz
    Med Univ Silesia, Coll Med, Dept Epidemiol, Katowice, Poland..
    Makowska, Joanna
    Med Univ Lodz, Dept Immunol Rheumatol & Allergy, Coimbra, Poland..
    Kowalski, Marek L.
    Med Univ Lodz, Dept Immunol Rheumatol & Allergy, Coimbra, Poland..
    Thilsing, Trine
    Univ Southern Denmark, Inst Clin Res, Res Unit Occupat & Environm Med, Coimbra, Denmark..
    Keil, Thomas
    Charite, Inst Social Med Epidemiol & Hlth Econ, Lodz, Germany.;Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany..
    Matricardi, Paolo M.
    Charite, Dept Pediat, Berlin, Germany..
    Toren, Kjell
    Univ Gothenburg, Sect Occupat & Environm Med, Odense, Sweden..
    van Zele, Thibaut
    Univ Ghent, Upper Airway Res Lab, Ghent, Belgium..
    Bachert, Claus
    Karolinska Inst, Div ENT Dis, Stockholm, Sweden..
    Rymarczyk, Barbara
    Med Univ Silesia, Clin Dept Internal Dis Allergol & Clin Immunol, Katowice, Poland..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, S-90187 Umea, Sweden..
    Nizankowska-Mogilnicka, Ewa
    Jagiellonian Univ, Sch Med, Krakow, Poland..
    Burney, Peter G. J.
    Imperial Coll London, Natl Heart & Lung Inst, Populat Hlth & Occupat Med Grp, London, England..
    Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults?: Results from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) Survey2017In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 7, article id 3Article in journal (Refereed)
    Abstract [en]

    Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA(2)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA(2)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing. Results: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score >= 1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (beta-coefficient -2.34;95% confidence interval [CI] -4.09,-0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted beta-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing. Conclusion and clinical relevance: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.

  • 7. Gülen, Theo
    et al.
    Dahlén, Barbro
    Sander, Birgitta
    Hägglund, Hans
    Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Nilsson, Gunnar
    The significance of diagnosing associated clonal mast cell diseases in patients with venom-induced anaphylaxis and the role of bone marrow investigation2013In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 3, no 1, p. 22-Article in journal (Refereed)
    Abstract [en]

    Hymenoptera venom allergy (HVA) represents a particular risk for exceptionally severe anaphylactic sting reactions in patients with clonal mast cell disorders (CMD). Nevertheless, conventional investigations are not sufficient to do accurate risk assessments. Increased levels of baseline serum tryptase (sBT) (>11.4 μg/L) is highly associated with severe anaphylactic reactions and with a possible underlying CMD. The measurement of baseline serum tryptase, thus, has opened the possibility to screen for CMD. In the present study, we sought to investigate whether bone marrow evaluation provides more accurate diagnosis in patients with HVA.

    Three patients of the same sex and similar age with HVA were enrolled in this clinical study. The patients underwent comprehensive allergy work-up including skin prick testing, measurements of serum total IgE concentrations and baseline serum tryptase. Bone-marrow biopsies were also performed in all three patients to assess underlying CMD.

    We evaluated characteristics of the bone marrow mast cells by pathology, flow cytometry and detection of D816V mutation by using current WHO-criteria, which led to changes in the final diagnosis compared to the assessments done by classical allergy work-up and measurements of sBT. Three distinct diagnostic outcomes including systemic mastocytosis, monoclonal mast cell activation syndrome and non-clonal HVA were revealed.

    We conclude that a bone marrow investigation is required for the correct diagnosis of hymenoptera venom-induced anaphylactic reactions in patients with elevated baseline tryptase levels (>11.4 μg/L), and this has important implications for management strategies.

  • 8.
    Tsolakis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Rydell, N.
    Thermo Fisher Sci, ImmunoDiagnost, Uppsala, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Characterization of a subgroup of non-type 2 asthma with cow's milk hypersensitivity in young subjects2019In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 12Article in journal (Refereed)
    Abstract [en]

    Background: Asthma with atopy is often characterized by type 2 inflammation but less progress has been made in defining non-type 2 asthma. We have previously identified a subgroup of young non-atopic asthmatics with perceived food hypersensitivity and poor asthma control. Objective: Our aim was to further characterize this subgroup of non-type 2 asthmatics, including the use of a broad panel of inflammation-related proteins. Methods: Sex-and age-matched subjects (10-35 years old) were divided into three groups with regard to history of asthma and atopy: non-atopic asthmatics with perceived cow's milk hypersensitivity but with IgE antibodies < 0.35 kU(A)/L (NAA; n = 24), non-atopic controls with IgE < 0.35 kU(A)/L (NAC; n = 24), and atopic asthmatics with IgE >= 0.35 kU(A)/L (AA; n = 29). Serum or plasma were analysed using the multi-allergen tests Phadiatop and fx5 (Immuno-CAP), a multiplex immunoassay comprising 92 inflammation-related proteins (Proseek Inflammation), and an ELISA for human neutrophil lipocalin (S-HNL). Fraction of exhaled nitric oxide (FeNO), blood eosinophil (B-Eos) count, C-reactive protein (CRP), airway responsiveness to methacholine - (PD20), and asthma-related quality of life (mAQLQ) were also measured. Results: NAA had lower FeNO (p < 0.001) and B-Eos count (p < 0.001), but scored worse on mAQLQ (p = 0.045) compared with AA. NAA displayed higher levels of matrix metalloproteinase-1 (MMP-1) compared with both NAC (p = 0.011) and AA (p = 0.001), and lower - PD20 compared with NAC (p < 0.001). In NAA, S-HNL correlated negatively with -PD20 (rho = -0.048, p < 0.05) and CRP correlated negatively with mAQLQ (rho = -0.439, p < 0.05). Conclusion: In a subgroup of non-atopic young asthmatics with perceived cow's milk hypersensitivity we observed poor asthma-related quality of life, airway hyperresponsiveness, and clinically relevant non-type 2 inflammation. MMP-1 was elevated in this group, which deserves further studies.

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