Journal Article Ahead of print
PubMed: 41877472 DOI: 10.1111/all.70305
Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part II-Guidelines on Oral and Ocular Treatments.
Allergy
Authors: Rafael José Vieira, Bernardo Sousa-Pinto, Jean Bousquet, Holger J Schünemann, Torsten Zuberbier, Antonio Bognanni, Alkis Togias, Boleslaw Samolinski, Arunas Valiulis, Sian Williams, Anna Bedbrook, Wienczyslawa Czarlewski, Maria Jose Torres, Mohamed H Shamji, Mário Morais-Almeida, G Walter Canonica, Leticia de Las Vecillas, Mark S Dykewicz, Cristina Jacomelli, Ludger Klimek, Lucas Leemann, Olga Lourenço, Nikolaos G Papadopoulos, Ana Margarida Pereira, Marine Savouré, Sanna K Toppila-Salmi, Maria Teresa Ventura, Juan José Yepes-Nuñez, Alvaro A Cruz, Giorgio Ciprandi, Bilun Gemicioglu, Mattia Giovannini, Brigita Gradauskiene, Tuomas Jartti, Miloš Jeseňák, Piotr Kuna, Violeta Kvedariene, Désirée E Larenas-Linnemann, Amir H A Latiff, Yousser Mohammad, Ken Ohta, Padukudru A Mahesh, Isabella Pali-Schöll, Oliver Pfaar, Frederico S Regateiro, Nicolas Roche, Luís Taborda-Barata, Charlotte Suppli Ulrik, Giovanni Viegi, Luo Zhang … and 181 other authors
Affiliations
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
- ARIA (Allergic Rhinitis and Its Impact on Asthma), Montpellier, France.
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania.
- Clinic of Asthma, Allergy and Chronic Lung Diseases, Vilnius, Lithuania.
- International Primary Care Respiratory Group IPCRG, Edinburgh, UK.
- Allergy Unit, Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain.
- National Heart and Lung Institute (NHLI), Imperial College, London, UK.
- NIHR Imperial Biomedical Research Centre, London, UK.
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
- "Respiriamo Insieme" Association, Asthma & Allergy Center, Padova, Italy.
- Department of Otolaryngology, Head & Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
- Allergology & Rhinology Department, Center for Rhinology and Allergology, Wiesbaden, Germany.
- Department of Political Science, University of Zürich, Zürich, Switzerland.
- RISE-Health, Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Department of Otorhinolaryngology, University of Eastern Finland and the North Savo Wellbeing Services County, Kuopio, Finland.
- University of Bari Medical School, Bari, Italy.
- Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
- School of Medicine, Universidad de los Andes, Bogotá, DC, Colombia.
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá, University Hospital, Bogotá, DC, Colombia.
- Fundacao ProAR and (Faculdade de Medicina da) Universidade Federal da Bahia, Salvador, Bahia, Brazil.
- Allergology Department, Casa di Cura Villa Montallegro, Genova, Italy.
- Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
- Department of Pulmonary Diseases, Institute of Pulmonology and Tuberculosis, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
- Department of Health Sciences, University of Florence, Florence, Italy.
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Department of Pediatrics and Adolescent Medicine, University of Turku, and Turku University Hospital, Turku, Finland.
- Institute of Clinical Immunology and Medical Genetics, Department of Paediatrics and Adolescent Medicine, Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine, Martin, Slovakia.
- Comenius University, Bratislava, Slovakia.
- University Hospital Martin, Martin, Slovakia.
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
- National Center for Research in Chronic Respiratory Diseases, Collaborating With WHO-EMRO Tishreen University School of Medicine, Latakia, Syria.
- Pharmacy Department, Al-Sham Private University, Damascus, Syria.
- Japan Antituberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan.
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India.
- Department of Biological Sciences and Pathophysiology, University of Veterinary Medicine, Vienna, Austria.
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
- Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
- Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- RISE-Health, Faculty of Health Sciences, and UBIAir-Clinical & Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal.
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France.
- UMR 1016, Institut Cochin, Paris, France.
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
- Department of Immunoallergology, Unidade Local de Saúde, Cova da Beira, Covilhã, Portugal.
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
- Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Abstract
BACKGROUND
Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)-EAACI guidelines, this manuscript presents the ARIA-EAACI 2024-2025 recommendations for oral and ocular treatments.
METHODS
The ARIA-EAACI 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs.
RESULTS
Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented.
CONCLUSION
This ARIA-EAACI 2024-2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.
MeSH
Histamine Antagonists, Rhinitis, Allergic, Hypersensitivity, Rhinitis, Therapeutics, Asthma, Leukotriene Antagonists