Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

J Bousquet^{1

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4}, E Melén^{5

6}, T Haahtela⁷, G H Koppelman⁸, A Togias⁹, R Valenta¹⁰, C A Akdis¹¹, W Czarlewski^{12

13}, M Rothenberg¹⁴, A Valiulis^{15

16}, M Wickman¹⁷, M Akdis¹¹, D Aguilar¹⁸, A Bedbrook^{13

19}, C Bindslev-Jensen^{20

21}, S Bosnic-Anticevich^{22

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24}, L P Boulet²⁵, C E Brightling²⁶, L Brussino^{27

28}, E Burte^{4

29}, M Bustamante^{30

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32}, G W Canonica^{33

34}, L Cecchi³⁵, J C Celedon³⁶, C Chaves Loureiro³⁷, E Costa³⁸, A A Cruz³⁹, M Erhola⁴⁰, B Gemicioglu⁴¹, W J Fokkens⁴², J Garcia-Aymerich^{30

31}, S Guerra⁴³, J Heinrich⁴⁴, J C Ivancevich⁴⁵, T Keil^{46

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48}, L Klimek^{49

50}, P Kuna⁵¹, M Kupczyk⁵¹, V Kvedariene^{52

53}, D E Larenas-Linnemann⁵⁴, N Lemonnier⁵⁵, K C Lodrup Carlsen⁵⁶, R Louis^{57

58}, M Makela⁷, M Makris⁵⁹, M Maurer^{1

2}, I Momas^{60

61}, M Morais-Almeida⁶², J Mullol^{63

64}, R N Naclerio⁶⁵, K Nadeau⁶⁶, R Nadif^{4

29}, M Niedoszytko⁶⁷, Y Okamoto^{68

69}, M Ollert^{20

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70}, N G Papadopoulos⁷¹, G Passalacqua⁷², V Patella^{73

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75}, R Pawankar⁷⁶, N Pham-Thi^{77

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79}, O Pfaar⁸⁰, F S Regateiro^{81

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83}, J Ring^{84

85}, P W Rouadi^{86

87}, B Samolinski⁸⁸, J Sastre⁸⁹, M Savouré^{4

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90}, N Scichilone⁹¹, M H Shamji^{92

93}, A Sheikh⁹⁴, V Siroux⁹⁵, B Sousa-Pinto^{96

97}, M Standl^{98

99}, J Sunyer^{30

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100}, L Taborda-Barata^{101

102}, S Toppila-Salmi⁷, M J Torres¹⁰³, I Tsiligianni^{104

105}, E Valovirta¹⁰⁶, O Vandenplas^{107

108}, M T Ventura^{109

110}, S Weiss¹¹¹, A Yorgancioglu¹¹², L Zhang¹¹³, A H Abdul Latiff¹¹⁴, W Aberer¹¹⁵, I Agache¹¹⁶, M Al-Ahmad¹¹⁷, I Alobid^{118

119}, I J Ansotegui¹²⁰, S H Arshad^{121

122}, E Asayag¹²³, C Barbara¹²⁴, A Baharudin¹²⁵, L Battur¹²⁶, K S Bennoor¹²⁷, E C Berghea¹²⁸, K C Bergmann^{1

2}, D Bernstein¹²⁹, M Bewick¹³⁰, H Blain¹³¹, M Bonini^{132

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134}, F Braido^{135

136}, R Buhl¹³⁷, R S Bumbacea¹³⁸, A Bush¹³⁹, M Calderon¹⁴⁰, M Calvo-Gil¹⁴¹, P Camargos¹⁴², L Caraballo¹⁴³, V Cardona^{144

145}, W Carr¹⁴⁶, P Carreiro-Martins^{147

148}, T Casale¹⁴⁹, A M Cepeda Sarabia^{150

151}, R Chandrasekharan¹⁵², D Charpin¹⁵³, Y Z Chen¹⁵⁴, I Cherrez-Ojeda^{155

156}, T Chivato¹⁵⁷, E Chkhartishvili¹⁵⁸, G Christoff¹⁵⁹, D K Chu¹⁶⁰, C Cingi¹⁶¹, J Correia de Sousa¹⁶², C Corrigan¹⁶³, A Custovic¹⁶⁴, G D'Amato¹⁶⁵, S Del Giacco¹⁶⁶, F De Blay^{167

168}, P Devillier¹⁶⁹, A Didier¹⁷⁰, M do Ceu Teixeira^{171

172}, D Dokic¹⁷³, H Douagui¹⁷⁴, M Doulaptsi¹⁷⁵, S Durham¹⁷⁶, M Dykewicz¹⁷⁷, T Eiwegger¹⁷⁸, Z A El-Sayed¹⁷⁹, R Emuzyte¹⁸⁰, A Fiocchi¹⁸¹, N Fyhrquist¹⁸², R M Gomez¹⁸³, M Gotua¹⁸⁴, M A Guzman¹⁸⁵, J Hagemann⁴⁹, S Hamamah¹⁸⁶, S Halken¹⁸⁷, D M G Halpin¹⁸⁸, M Hofmann^{1

189}, E Hossny¹⁷⁹, M Hrubiško¹⁹⁰, C Irani¹⁹¹, Z Ispayeva¹⁹², E Jares¹⁹³, T Jartti¹⁹⁴, E Jassem¹⁹⁵, K Julge¹⁹⁶, J Just¹⁹⁷, M Jutel^{198

199}, I Kaidashev²⁰⁰, O Kalayci²⁰¹, A F Kalyoncu²⁰², P Kardas²⁰³, B Kirenga²⁰⁴, H Kraxner²⁰⁵, I Kull^{5

6}, M Kulus²⁰⁶, S La Grutta²⁰⁷, S Lau²⁰⁸, L Le Tuyet Thi²⁰⁹, M Levin²¹⁰, B Lipworth²¹¹, O Lourenço²¹², B Mahboub²¹³, E Martinez-Infante²¹⁴, P Matricardi²¹⁵, N Miculinic²¹⁶, N Migueres¹⁶⁷, F Mihaltan²¹⁷, Y Mohammad^{218

219}, M Moniuszko²²⁰, S Montefort²²¹, H Neffen²²², K Nekam²²³, E Nunes²²⁴, D Nyembue Tshipukane²²⁵, R O'Hehir²²⁶, I Ogulur¹¹, K Ohta²²⁷, K Okubo²²⁸, S Ouedraogo²²⁹, H Olze^{230

189}, I Pali-Schöll²³¹, O Palomares²³², K Palosuo²³³, C Panaitescu²³⁴, P Panzner²³⁵, H S Park²³⁶, C Pitsios²³⁷, D Plavec^{238

239}, T A Popov²⁴⁰, F Puggioni²⁴¹, S Quirce²⁴², M Recto²⁴³, M S Repka-Ramirez²⁴⁴, C Robalo Cordeiro³⁷, N Roche^{245

246}, M Rodriguez-Gonzalez²⁴⁷, J Romantowski⁶⁷, N Rosario Filho²⁴⁸, M Rottem²⁴⁹, H Sagara²⁵⁰, F S Serpa²⁵¹, Z Sayah²⁵², S Scheire²⁵³, P Schmid-Grendelmeier²⁵⁴, J C Sisul²⁵⁵, D Sole²⁵⁶, M Soto-Martinez²⁵⁷, M Sova²⁵⁸, A Sperl⁵⁰, O Spranger²⁵⁹, R Stelmach²⁶⁰, C Suppli Ulrik^{261

262}, M Thomas²⁶³, T To²⁶⁴, A Todo-Bom²⁶⁵, P V Tomazic²⁶⁶, M Urrutia-Pereira²⁶⁷, M Valentin-Rostan²⁶⁸, E Van Ganse²⁶⁹, M van Hage^{270

271}, T Vasankari^{272

273}, P Vichyanond²⁷⁴, G Viegi²⁷⁵, D Wallace²⁷⁶, D Y Wang²⁷⁷, S Williams²⁷⁸, M Worm²⁷⁹, P Yiallouros²³⁷, O Yusuf²⁸⁰, F Zaitoun²⁸¹, M Zernotti²⁸², M Zidarn^{283

284}, J Zuberbier^{230

189}, J A Fonseca^{96

97}, T Zuberbier^{1

2}, J M Anto^{30

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32}

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
³ University Hospital Montpellier, Montpellier, France.
⁴ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁵ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁶ Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
⁸ Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
⁹ Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.
¹⁰ Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹¹ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
¹² Medical Consulting Czarlewski, Levallois, France.
¹³ MASK-air, Montpellier, France.
¹⁴ Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁵ Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.
¹⁶ Medical Faculty of Vilnius University, Vilnius, Lithuania.
¹⁷ Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁸ 6AM Data Mining, Barcelona, Spain.
¹⁹ ARIA, Montpellier, France.
²⁰ Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
²¹ Odense Research Center for Anaphylaxis « ORCA », Odense, Denmark.
²² Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
²³ Sydney Local Health District, Sydney, NSW, Australia.
²⁴ Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.
²⁵ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
²⁶ Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK.
²⁷ Department of Medical Sciences, University of Torino, Torino, Italy.
²⁸ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
²⁹ Université Paris-Saclay, UVSQ, UnivParis-Sud, Villejuif, France.
³⁰ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
³¹ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
³² CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
³³ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
³⁴ Personalized medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁵ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
³⁶ Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³⁷ Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³⁸ UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
³⁹ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
⁴⁰ Pirkanmaa Welfare district, Tampere, Finland.
⁴¹ Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
⁴² Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
⁴³ Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA.
⁴⁴ Ludwig Maximilians University Munich, University Hospital Munich - Instituteand Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany.
⁴⁵ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁴⁶ Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁴⁷ Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
⁴⁸ State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany.
⁴⁹ Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁵⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁵¹ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁵² Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁵³ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁵⁴ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁵⁵ Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, La Tronche, France.
⁵⁶ Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
⁵⁷ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁵⁸ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵⁹ Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
⁶⁰ Department of Public Health and Health Products, Paris Descartes University-Sorbonne Paris Cité, EA 4064, Paris, France.
⁶¹ Paris Municipal Department of Social Action, Childhood, and Health, Paris, France.
⁶² Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁶³ ENT Department, Rhinology Unit & Smell Clinic, Hospital Clínic, Barcelona, Spain.
⁶⁴ Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
⁶⁵ Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁶⁶ Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA.
⁶⁷ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁶⁸ Chiba Rosai Hospital, Chiba, Japan.
⁶⁹ Chiba University Hospital, Chiba, Japan.
⁷⁰ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
⁷¹ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷² Allergy and Respiratory Diseases, IRCCS Policlinico San Martino - University of Genoa, Genoa, Italy.
⁷³ Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.
⁷⁴ Agency of Health ASL, Salerno, Italy.
⁷⁵ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁷⁶ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁷⁷ Ecole Polytechnique de Palaiseau, Palaiseau, France.
⁷⁸ IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France.
⁷⁹ Université Paris Cité, Paris, France.
⁸⁰ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁸¹ Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
⁸² Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁸³ Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁸⁴ Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
⁸⁵ Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland.
⁸⁶ Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
⁸⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait.
⁸⁸ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
⁸⁹ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
⁹⁰ French Environment and Energy Management Agency, Angers, France.
⁹¹ PROMISE Department, University of Palermo, Palermo, Italy.
⁹² National Heart and Lung Institute, Imperial College, London, UK.
⁹³ NIHR Imperial Biomedical Research Centre, London, UK.
⁹⁴ Usher Institute, The University of Edinburgh, Edinburgh, UK.
⁹⁵ INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France.
⁹⁶ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
⁹⁷ CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
⁹⁸ Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
⁹⁹ German Center of Lung Research (DZL), Munich, Germany.
¹⁰⁰ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
¹⁰¹ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
¹⁰² UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
¹⁰³ Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain.
¹⁰⁴ International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.
¹⁰⁵ Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
¹⁰⁶ Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland.
¹⁰⁷ Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium.
¹⁰⁸ Université Catholique de Louvain, Yvoir, Belgium.
¹⁰⁹ Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
¹¹⁰ Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
¹¹¹ Harvard Medical School and Channing Division of Network Medicine, Boston, USA.
¹¹² Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
¹¹³ Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China.
¹¹⁴ Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹¹⁵ Department of Dermatology, Medical University of Graz, Graz, Austria.
¹¹⁶ Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
¹¹⁷ Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait.
¹¹⁸ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹¹⁹ Centro Médico Teknon, Barcelona, Spain.
¹²⁰ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹²¹ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹²² David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.
¹²³ Argentine Society of Allergy and Immunopathology, Buenos Aires, Argentina.
¹²⁴ Portuguese National Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal.
¹²⁵ Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
¹²⁶ Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia.
¹²⁷ Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh.
¹²⁸ Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
¹²⁹ Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹³⁰ University of Central Lancashire Medical School, Preston, UK.
¹³¹ Department of Geriatrics, Montpellier University Hospital, MUSE, Montpellier, France.
¹³² Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy.
¹³³ Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy.
¹³⁴ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
¹³⁵ Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.
¹³⁶ IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹³⁷ Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
¹³⁸ Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania.
¹³⁹ Imperial College and Royal Brompton Hospital, London, UK.
¹⁴⁰ Imperial College and National Heart and Lung Institute, London, UK.
¹⁴¹ Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile.
¹⁴² Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
¹⁴³ Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia.
¹⁴⁴ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
¹⁴⁵ ARADyAL Research Network, Barcelona, Spain.
¹⁴⁶ Allergy & Asthma Associates of Southern California, A Medical Group, Southern California Research, Mission Viejo, California, USA.
¹⁴⁷ NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.
¹⁴⁸ Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
¹⁴⁹ Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA.
¹⁵⁰ Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia.
¹⁵¹ SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Columbia.
¹⁵² Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman.
¹⁵³ Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France.
¹⁵⁴ The Capital Institute of Pediatrics, Chaoyang district, Beijing, China.
¹⁵⁵ Universidad Espíritu Santo, Samborondón, Ecuador.
¹⁵⁶ Respiralab Research Group, Guayaquil, Guayas, Ecuador.
¹⁵⁷ School of Medicine, University CEU San Pablo, Madrid, Spain.
¹⁵⁸ David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia.
¹⁵⁹ Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria.
¹⁶⁰ Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁶¹ Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
¹⁶² School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.
¹⁶³ Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
¹⁶⁴ National Heart and Lung Institute, Imperial College London, London, UK.
¹⁶⁵ Division of Respiratory and Allergic Diseases, Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy.
¹⁶⁶ Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
¹⁶⁷ Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
¹⁶⁸ Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
¹⁶⁹ VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France.
¹⁷⁰ Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France.
¹⁷¹ Dr Agostinho Neto University hospital, Praia, Cape Verde.
¹⁷² Immunology, Faculty of Medicine, Cabo Verde University, Praia, Cape Verde.
¹⁷³ Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, Republic of Macedonia.
¹⁷⁴ Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria.
¹⁷⁵ Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
¹⁷⁶ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁷⁷ Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
¹⁷⁸ The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada.
¹⁷⁹ Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁸⁰ Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁸¹ Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
¹⁸² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁸³ School of Health Sciences, Catholic University of Salta, Salta, Argentina.
¹⁸⁴ Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia.
¹⁸⁵ Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile.
¹⁸⁶ Biology of Reproduction department, INSERM 1203, University hospital, Montpellier, France.
¹⁸⁷ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁸⁸ University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK.
¹⁸⁹ Berlin Institute of Health, Berlin, Germany.
¹⁹⁰ Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia.
¹⁹¹ Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon.
¹⁹² Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan.
¹⁹³ Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina.
¹⁹⁴ EDEGO Research Unit, University of Oulu, Oulu, Finland.
¹⁹⁵ Department of Pneumology, Medical University of Gdańsk, Gdansk, Poland.
¹⁹⁶ Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia.
¹⁹⁷ Sorbonne université, Hôpital américain de Paris, Neuilly, France.
¹⁹⁸ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
¹⁹⁹ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁰⁰ Poltava State Medical University, Poltava, Ukraine.
²⁰¹ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
²⁰² School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey.
²⁰³ Department of Family Medicine, Medical University of Lodz, Lodz, Poland.
²⁰⁴ Makerere University Lung Institute, Kampala, Uganda.
²⁰⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
²⁰⁶ Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland.
²⁰⁷ Institute of Translational Pharmacology, National Research Council, Palermo, Italy.
²⁰⁸ Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.
²⁰⁹ University of Medicine and Pharmacy, Hochiminh City, Vietnam.
²¹⁰ Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa.
²¹¹ Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK.
²¹² Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
²¹³ Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE.
²¹⁴ Hospital San Luca, Oaxaca, Mexico.
²¹⁵ Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²¹⁶ Croatian Pulmonary Society, Zagreb, Croatia.
²¹⁷ National Institute of Pneumology M Nasta, Bucharest, Romania.
²¹⁸ National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria.
²¹⁹ Syrian Private University, Damascus, Syria.
²²⁰ Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland.
²²¹ Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
²²² Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina.
²²³ Hungarian Allergy Association, Budapest, Hungary.
²²⁴ Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
²²⁵ ENT Department, University Hospital of Kinshasa, Kinshasa, Congo.
²²⁶ Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
²²⁷ Japan Anti-Tuberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan.
²²⁸ Department of Otolaryngology, Nippon Medical School, Tokyo, Japan.
²²⁹ Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
²³⁰ Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²³¹ Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria.
²³² Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
²³³ Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland.
²³⁴ OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania.
²³⁵ Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
²³⁶ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
²³⁷ Medical School, University of Cyprus, Nicosia, Cyprus.
²³⁸ Srebrnjak Children's Hospital, Zagreb, Croatia.
²³⁹ Medical Faculty, University JJ Strossmayer of Osijek, Osijek, Croatia.
²⁴⁰ Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria.
²⁴¹ Personalized medicine Asthma & Allergy, Rozzano, IRCCS Humanitas Research Center, Milan, Italy.
²⁴² Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
²⁴³ Division of Adult and Pediatric Allergy and Immunology, University of the Philippines- Philippines General Hospital, Manila, Philippines.
²⁴⁴ Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay.
²⁴⁵ Pneumologie, AP-HP Centre, Université de Paris Cité, Hôpital Cochin, Paris, France.
²⁴⁶ UMR 1016, Institut Cochin, Paris, France.
²⁴⁷ Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico.
²⁴⁸ Department of Pediatrics, Federal University of Parana, Curitiba, Brazil.
²⁴⁹ Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel.
²⁵⁰ Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan.
²⁵¹ Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil.
²⁵² SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco.
²⁵³ Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
²⁵⁴ Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland.
²⁵⁵ Allergy & Asthma, Clinica SISUL, FACAAI, SPAAI, Asuncion, Paraguay.
²⁵⁶ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
²⁵⁷ Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica.
²⁵⁸ Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic.
²⁵⁹ Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria.
²⁶⁰ Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
²⁶¹ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
²⁶² Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁶³ University of Southampton, Southampton, UK.
²⁶⁴ The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
²⁶⁵ Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁶⁶ Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria.
²⁶⁷ Universidade Federal dos Pampa, Uruguaiana, Brazil.
²⁶⁸ Allergist, Montevideo, Uruguay.
²⁶⁹ Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France.
²⁷⁰ Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
²⁷¹ Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
²⁷² FILHA, Finnish Lung Health Association, Helsinki, Finland.
²⁷³ Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
²⁷⁴ Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand.
²⁷⁵ Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
²⁷⁶ College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
²⁷⁷ Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²⁷⁸ International Primary Care Respiratory Group IPCRG, Aberdeen, UK.
²⁷⁹ Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany.
²⁸⁰ The Allergy and Asthma Institute, Islamabad, Pakistan.
²⁸¹ Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE.
²⁸² Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Villa Maria, Argentina.
²⁸³ University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
²⁸⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

PMID: 36799120
DOI: 10.1111/all.15679

Free article

Review

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

J Bousquet et al. Allergy. 2023 May.

Free article

. 2023 May;78(5):1169-1203.

doi: 10.1111/all.15679. Epub 2023 Apr 10.

Authors

Affiliations

¹ Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
³ University Hospital Montpellier, Montpellier, France.
⁴ Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
⁵ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁶ Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
⁷ Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
⁸ Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
⁹ Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.
¹⁰ Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹¹ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
¹² Medical Consulting Czarlewski, Levallois, France.
¹³ MASK-air, Montpellier, France.
¹⁴ Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁵ Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.
¹⁶ Medical Faculty of Vilnius University, Vilnius, Lithuania.
¹⁷ Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁸ 6AM Data Mining, Barcelona, Spain.
¹⁹ ARIA, Montpellier, France.
²⁰ Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
²¹ Odense Research Center for Anaphylaxis « ORCA », Odense, Denmark.
²² Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
²³ Sydney Local Health District, Sydney, NSW, Australia.
²⁴ Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.
²⁵ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
²⁶ Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK.
²⁷ Department of Medical Sciences, University of Torino, Torino, Italy.
²⁸ Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy.
²⁹ Université Paris-Saclay, UVSQ, UnivParis-Sud, Villejuif, France.
³⁰ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
³¹ ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
³² CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
³³ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
³⁴ Personalized medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁵ SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
³⁶ Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³⁷ Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³⁸ UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal.
³⁹ Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil.
⁴⁰ Pirkanmaa Welfare district, Tampere, Finland.
⁴¹ Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
⁴² Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
⁴³ Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA.
⁴⁴ Ludwig Maximilians University Munich, University Hospital Munich - Instituteand Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany.
⁴⁵ Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
⁴⁶ Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁴⁷ Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
⁴⁸ State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany.
⁴⁹ Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.
⁵⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁵¹ Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
⁵² Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁵³ Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
⁵⁴ Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico.
⁵⁵ Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, La Tronche, France.
⁵⁶ Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
⁵⁷ Department of Pulmonary Medicine, CHU Liège, Liège, Belgium.
⁵⁸ GIGA I3 Research Group, University of Liège, Liège, Belgium.
⁵⁹ Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
⁶⁰ Department of Public Health and Health Products, Paris Descartes University-Sorbonne Paris Cité, EA 4064, Paris, France.
⁶¹ Paris Municipal Department of Social Action, Childhood, and Health, Paris, France.
⁶² Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
⁶³ ENT Department, Rhinology Unit & Smell Clinic, Hospital Clínic, Barcelona, Spain.
⁶⁴ Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain.
⁶⁵ Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁶⁶ Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA.
⁶⁷ Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
⁶⁸ Chiba Rosai Hospital, Chiba, Japan.
⁶⁹ Chiba University Hospital, Chiba, Japan.
⁷⁰ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
⁷¹ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
⁷² Allergy and Respiratory Diseases, IRCCS Policlinico San Martino - University of Genoa, Genoa, Italy.
⁷³ Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.
⁷⁴ Agency of Health ASL, Salerno, Italy.
⁷⁵ Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy.
⁷⁶ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁷⁷ Ecole Polytechnique de Palaiseau, Palaiseau, France.
⁷⁸ IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France.
⁷⁹ Université Paris Cité, Paris, France.
⁸⁰ Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
⁸¹ Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
⁸² Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁸³ Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁸⁴ Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
⁸⁵ Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland.
⁸⁶ Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
⁸⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait.
⁸⁸ Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland.
⁸⁹ Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain.
⁹⁰ French Environment and Energy Management Agency, Angers, France.
⁹¹ PROMISE Department, University of Palermo, Palermo, Italy.
⁹² National Heart and Lung Institute, Imperial College, London, UK.
⁹³ NIHR Imperial Biomedical Research Centre, London, UK.
⁹⁴ Usher Institute, The University of Edinburgh, Edinburgh, UK.
⁹⁵ INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France.
⁹⁶ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
⁹⁷ CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
⁹⁸ Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
⁹⁹ German Center of Lung Research (DZL), Munich, Germany.
¹⁰⁰ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
¹⁰¹ Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.
¹⁰² UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
¹⁰³ Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain.
¹⁰⁴ International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.
¹⁰⁵ Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
¹⁰⁶ Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland.
¹⁰⁷ Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium.
¹⁰⁸ Université Catholique de Louvain, Yvoir, Belgium.
¹⁰⁹ Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
¹¹⁰ Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy.
¹¹¹ Harvard Medical School and Channing Division of Network Medicine, Boston, USA.
¹¹² Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
¹¹³ Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China.
¹¹⁴ Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹¹⁵ Department of Dermatology, Medical University of Graz, Graz, Austria.
¹¹⁶ Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
¹¹⁷ Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait.
¹¹⁸ Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
¹¹⁹ Centro Médico Teknon, Barcelona, Spain.
¹²⁰ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹²¹ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹²² David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.
¹²³ Argentine Society of Allergy and Immunopathology, Buenos Aires, Argentina.
¹²⁴ Portuguese National Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal.
¹²⁵ Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
¹²⁶ Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia.
¹²⁷ Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh.
¹²⁸ Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
¹²⁹ Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹³⁰ University of Central Lancashire Medical School, Preston, UK.
¹³¹ Department of Geriatrics, Montpellier University Hospital, MUSE, Montpellier, France.
¹³² Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy.
¹³³ Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy.
¹³⁴ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
¹³⁵ Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.
¹³⁶ IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹³⁷ Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany.
¹³⁸ Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania.
¹³⁹ Imperial College and Royal Brompton Hospital, London, UK.
¹⁴⁰ Imperial College and National Heart and Lung Institute, London, UK.
¹⁴¹ Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile.
¹⁴² Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil.
¹⁴³ Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia.
¹⁴⁴ Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
¹⁴⁵ ARADyAL Research Network, Barcelona, Spain.
¹⁴⁶ Allergy & Asthma Associates of Southern California, A Medical Group, Southern California Research, Mission Viejo, California, USA.
¹⁴⁷ NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.
¹⁴⁸ Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
¹⁴⁹ Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA.
¹⁵⁰ Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia.
¹⁵¹ SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Columbia.
¹⁵² Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman.
¹⁵³ Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France.
¹⁵⁴ The Capital Institute of Pediatrics, Chaoyang district, Beijing, China.
¹⁵⁵ Universidad Espíritu Santo, Samborondón, Ecuador.
¹⁵⁶ Respiralab Research Group, Guayaquil, Guayas, Ecuador.
¹⁵⁷ School of Medicine, University CEU San Pablo, Madrid, Spain.
¹⁵⁸ David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia.
¹⁵⁹ Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria.
¹⁶⁰ Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁶¹ Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
¹⁶² School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.
¹⁶³ Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
¹⁶⁴ National Heart and Lung Institute, Imperial College London, London, UK.
¹⁶⁵ Division of Respiratory and Allergic Diseases, Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy.
¹⁶⁶ Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy.
¹⁶⁷ Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
¹⁶⁸ Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
¹⁶⁹ VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France.
¹⁷⁰ Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France.
¹⁷¹ Dr Agostinho Neto University hospital, Praia, Cape Verde.
¹⁷² Immunology, Faculty of Medicine, Cabo Verde University, Praia, Cape Verde.
¹⁷³ Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, Republic of Macedonia.
¹⁷⁴ Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria.
¹⁷⁵ Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
¹⁷⁶ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁷⁷ Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
¹⁷⁸ The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada.
¹⁷⁹ Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
¹⁸⁰ Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹⁸¹ Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
¹⁸² Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁸³ School of Health Sciences, Catholic University of Salta, Salta, Argentina.
¹⁸⁴ Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia.
¹⁸⁵ Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile.
¹⁸⁶ Biology of Reproduction department, INSERM 1203, University hospital, Montpellier, France.
¹⁸⁷ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁸⁸ University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK.
¹⁸⁹ Berlin Institute of Health, Berlin, Germany.
¹⁹⁰ Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia.
¹⁹¹ Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon.
¹⁹² Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan.
¹⁹³ Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina.
¹⁹⁴ EDEGO Research Unit, University of Oulu, Oulu, Finland.
¹⁹⁵ Department of Pneumology, Medical University of Gdańsk, Gdansk, Poland.
¹⁹⁶ Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia.
¹⁹⁷ Sorbonne université, Hôpital américain de Paris, Neuilly, France.
¹⁹⁸ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
¹⁹⁹ ALL-MED Medical Research Institute, Wroclaw, Poland.
²⁰⁰ Poltava State Medical University, Poltava, Ukraine.
²⁰¹ Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey.
²⁰² School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey.
²⁰³ Department of Family Medicine, Medical University of Lodz, Lodz, Poland.
²⁰⁴ Makerere University Lung Institute, Kampala, Uganda.
²⁰⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
²⁰⁶ Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland.
²⁰⁷ Institute of Translational Pharmacology, National Research Council, Palermo, Italy.
²⁰⁸ Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.
²⁰⁹ University of Medicine and Pharmacy, Hochiminh City, Vietnam.
²¹⁰ Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa.
²¹¹ Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK.
²¹² Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.
²¹³ Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE.
²¹⁴ Hospital San Luca, Oaxaca, Mexico.
²¹⁵ Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²¹⁶ Croatian Pulmonary Society, Zagreb, Croatia.
²¹⁷ National Institute of Pneumology M Nasta, Bucharest, Romania.
²¹⁸ National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria.
²¹⁹ Syrian Private University, Damascus, Syria.
²²⁰ Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland.
²²¹ Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
²²² Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina.
²²³ Hungarian Allergy Association, Budapest, Hungary.
²²⁴ Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
²²⁵ ENT Department, University Hospital of Kinshasa, Kinshasa, Congo.
²²⁶ Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
²²⁷ Japan Anti-Tuberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan.
²²⁸ Department of Otolaryngology, Nippon Medical School, Tokyo, Japan.
²²⁹ Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
²³⁰ Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
²³¹ Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria.
²³² Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
²³³ Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland.
²³⁴ OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania.
²³⁵ Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
²³⁶ Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
²³⁷ Medical School, University of Cyprus, Nicosia, Cyprus.
²³⁸ Srebrnjak Children's Hospital, Zagreb, Croatia.
²³⁹ Medical Faculty, University JJ Strossmayer of Osijek, Osijek, Croatia.
²⁴⁰ Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria.
²⁴¹ Personalized medicine Asthma & Allergy, Rozzano, IRCCS Humanitas Research Center, Milan, Italy.
²⁴² Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
²⁴³ Division of Adult and Pediatric Allergy and Immunology, University of the Philippines- Philippines General Hospital, Manila, Philippines.
²⁴⁴ Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay.
²⁴⁵ Pneumologie, AP-HP Centre, Université de Paris Cité, Hôpital Cochin, Paris, France.
²⁴⁶ UMR 1016, Institut Cochin, Paris, France.
²⁴⁷ Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico.
²⁴⁸ Department of Pediatrics, Federal University of Parana, Curitiba, Brazil.
²⁴⁹ Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel.
²⁵⁰ Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan.
²⁵¹ Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil.
²⁵² SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco.
²⁵³ Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
²⁵⁴ Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland.
²⁵⁵ Allergy & Asthma, Clinica SISUL, FACAAI, SPAAI, Asuncion, Paraguay.
²⁵⁶ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
²⁵⁷ Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica.
²⁵⁸ Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic.
²⁵⁹ Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria.
²⁶⁰ Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
²⁶¹ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
²⁶² Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁶³ University of Southampton, Southampton, UK.
²⁶⁴ The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
²⁶⁵ Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁶⁶ Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria.
²⁶⁷ Universidade Federal dos Pampa, Uruguaiana, Brazil.
²⁶⁸ Allergist, Montevideo, Uruguay.
²⁶⁹ Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France.
²⁷⁰ Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
²⁷¹ Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
²⁷² FILHA, Finnish Lung Health Association, Helsinki, Finland.
²⁷³ Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
²⁷⁴ Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand.
²⁷⁵ Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
²⁷⁶ College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
²⁷⁷ Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²⁷⁸ International Primary Care Respiratory Group IPCRG, Aberdeen, UK.
²⁷⁹ Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany.
²⁸⁰ The Allergy and Asthma Institute, Islamabad, Pakistan.
²⁸¹ Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE.
²⁸² Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Villa Maria, Argentina.
²⁸³ University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
²⁸⁴ Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

PMID: 36799120
DOI: 10.1111/all.15679

Abstract

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.

Keywords: IL-33; Toll-like receptors; asthma; multimorbidity; rhinitis.

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References

REFERENCES

1. Anto JM, Bousquet J, Akdis M, et al. Mechanisms of the development of allergy (MeDALL): introducing novel concepts in allergy phenotypes. J Allergy Clin Immunol. 2017;139(2):388-399.
1. Bousquet J, Anto J, Auffray C, et al. MeDALL (mechanisms of the development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy. 2011;66(5):596-604.
1. McHugh T, Levin M, Snidvongs K, Banglawala SM, Sommer DD. Comorbidities associated with eosinophilic chronic rhinosinusitis: a systematic review and meta-analysis. Clin Otolaryngol. 2020;45(4):574-583.
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Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

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Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

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