EUFOREA meeting on defining disease states in allergic rhinitis: towards a unified language in AR

G K Scadding¹, D M Conti^{2

3}, S Scheire⁴, V Backer⁵, M Blaiss⁶, L O Cardell^{7

8}, W De Yun⁹, A K Ellis¹⁰, W Fokkens¹¹, A T Fox¹², T Gilbert Kruz¹³, S Halken¹⁴, P W Hellings^{2

15

16}, V Hox¹⁷, L Kalogjera¹⁸, S Lau¹⁹, S Marinho²⁰, M McDonald²¹, R Mösges^{22

23}, J Mullol²⁴, S Nasser²⁵, R Pawankar²⁶, D Price^{27

28}, D Ryan²⁹, G Scadding³⁰, P Smith³¹, M Sosa Kostrábová¹³, M Vazquez-Ortiz³², U Wahn³³, L Zhang³⁴, P Gevaert⁴

Affiliations

¹ Royal National ENT Hospital and University College, London, United Kingdom.
² Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid, Calle Francisco Tomás y Valiente, no. 2, Ciudad Universitaria de Cantoblanco, Madrid, Spain.
³ Allergy and Clinical Immunology Research Unit, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
⁴ Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium.
⁵ Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
⁶ Medical College of Georgia at Augusta University, Augusta, GA, United States.
⁷ Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁹ Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁰ Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
¹¹ Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands.
¹² Guy's & St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
¹³ Patient Advisory Board, European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium.
¹⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁵ Laboratory of Upper Airways Research, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium.
¹⁶ Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
¹⁷ Department of Otorhinolaryngology, Cliniques Universitaires Saint Luc, Brussels, Belgium.
¹⁸ Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Centre "Sestre milosrdnice", Zagreb School of Medicine, Zagreb, Croatia.
¹⁹ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²⁰ Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom.
²¹ The Allergy Clinic, Johannesburg, South Africa.
²² ClinCompetence Cologne GmbH, Cologne, Germany.
²³ Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
²⁴ Rhinology Unit & Smell Clínic, Department of Otorhinolaryngology, Hospital Clínic Barcelona, Universitat de Barcelona; FRCB-IDIBAPS; CIBERES, Barcelona, Catalonia, Spain.
²⁵ Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
²⁶ Department of Pediatrics, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
²⁷ Observational and Pragmatic Research Institute, Singapore, Singapore.
²⁸ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
²⁹ Usher Institute, University of Edinburgh, Edinburgh, Scotland.
³⁰ Allergy Department, Royal Brompton Hospital, London, United Kingdom.
³¹ Griffth University, Southport, QLD, Australia.
³² Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
³³ Charite University Medicine, Berlin, Germany.
³⁴ Department of Otolaryngology Head and Neck Surgery and Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

PMID: 39963330
PMCID: PMC11830706
DOI: 10.3389/falgy.2024.1531788

EUFOREA meeting on defining disease states in allergic rhinitis: towards a unified language in AR

G K Scadding et al. Front Allergy. 2025.

. 2025 Feb 3:5:1531788.

doi: 10.3389/falgy.2024.1531788. eCollection 2024.

Authors

Affiliations

¹ Royal National ENT Hospital and University College, London, United Kingdom.
² Escuela de Doctorado UAM, Centro de Estudios de Posgrado, Universidad Autónoma de Madrid, Calle Francisco Tomás y Valiente, no. 2, Ciudad Universitaria de Cantoblanco, Madrid, Spain.
³ Allergy and Clinical Immunology Research Unit, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
⁴ Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium.
⁵ Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
⁶ Medical College of Georgia at Augusta University, Augusta, GA, United States.
⁷ Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁹ Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁰ Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
¹¹ Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands.
¹² Guy's & St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
¹³ Patient Advisory Board, European Forum for Research and Education in Allergy and Airway Diseases, Brussels, Belgium.
¹⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁵ Laboratory of Upper Airways Research, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium.
¹⁶ Clinical Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
¹⁷ Department of Otorhinolaryngology, Cliniques Universitaires Saint Luc, Brussels, Belgium.
¹⁸ Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Centre "Sestre milosrdnice", Zagreb School of Medicine, Zagreb, Croatia.
¹⁹ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
²⁰ Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom.
²¹ The Allergy Clinic, Johannesburg, South Africa.
²² ClinCompetence Cologne GmbH, Cologne, Germany.
²³ Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
²⁴ Rhinology Unit & Smell Clínic, Department of Otorhinolaryngology, Hospital Clínic Barcelona, Universitat de Barcelona; FRCB-IDIBAPS; CIBERES, Barcelona, Catalonia, Spain.
²⁵ Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
²⁶ Department of Pediatrics, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
²⁷ Observational and Pragmatic Research Institute, Singapore, Singapore.
²⁸ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
²⁹ Usher Institute, University of Edinburgh, Edinburgh, Scotland.
³⁰ Allergy Department, Royal Brompton Hospital, London, United Kingdom.
³¹ Griffth University, Southport, QLD, Australia.
³² Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
³³ Charite University Medicine, Berlin, Germany.
³⁴ Department of Otolaryngology Head and Neck Surgery and Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

PMID: 39963330
PMCID: PMC11830706
DOI: 10.3389/falgy.2024.1531788

Abstract

Allergic rhinitis (AR), the most prevalent immunological disease, affects approximately 400 million individuals globally and can significantly impact quality of life (QoL). Despite nearly 25 years of guidelines, AR remains largely under- diagnosed, suboptimally treated and poorly controlled. In the light of new knowledge and treatment options, there is a necessity to update or revise fundamental AR definitions to facilitate communication across diverse specialties engaged in its treatment and to improve patient care. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) convened a meeting of experts and patient representatives to deliberate the optimal methodology for measuring AR treatment responses and establishing novel treatment goals. This paper presents a consensus on revised AR definitions, including control, severe allergic rhinoconjunctivitis (SARC), refractory severe allergic rhinoconjunctivitis (R-SARC), remission, resolution, improvement, exacerbation, treatable traits (TTs), treat to target, relapse, progression, disease modification, and prevention.

Keywords: allergen immunotherapy (AIT); allergic rhinitis; biologics; control; definitions; quality of life; refractory severe allergic rhinoconjunctivitis (R-SARC); severe allergic rhinoconjunctivitis (SARC).

© 2025 Scadding, Conti, Scheire, Backer, Blaiss, Cardell, De Yun, Ellis, Fokkens, Fox, Gilbert Kruz, Halken, Hellings, Hox, Kalogjera, Lau, Marinho, McDonald, Mösges, Mullol, Nasser, Pawankar, Price, Ryan, Scadding, Smith, Sosa Kostrábová, Vazquez-Ortiz, Wahn, Zhang and Gevaert.

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Conflict of interest statement

GKS: Honoraria for articles, speaker and advisory boards: ALK, Bayer, Chiesi, GlaxoSmithKline, Haleon, Noucor, Sanofi- Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Vice President and AR lead for EUFOREA, and Chair/ member Data Monitoring Committees on SLIT for ALK. DMC: Serves as Academic Manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and as Review Editor at Frontiers in Allergy, Rhinology Section. SS: Serves as the Patient Education Manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA). VB: Has received research grants, participated in advisory boards, and developed pharmaceutical studies for GSK, AstraZeneca, Sanofi, Regeneron, Novartis, MSD, Pharmaxis, ALK Abello, Birk NPC, Chiesi and Menarini. MB: Consultation and Advisory Boards: GSK, TerSera Pharma. Bryn Pharma, Soundhealth, Prollergy, and ALK. Speakers Bureau: AstraZeneca, Sanofi, Regeneron, and ALK. AKE: has participated in advisory boards for Abbvie, ALK-Abelló, AstraZeneca, Bausch Health, Circassia Ltd, laxoSmithKline, LEO Pharma, Johnson & Johnson, Merck, Miravo, Mylan, Novartis, Pediapharm and Pfizer, has been a speaker for ALK, Aralez, AstraZeneca, Bausch Health, Boehringer-Ingelheim, CACME, Meda, Medexus, Mylan, Merck, Novartis, Pfizer, The ACADEMY, and Takeda. Her institution has received research grants from AstraZeneca, Bayer, LLC, Circassia Ltd, Green Cross Pharmaceuticals, GlaxoSmithKline, Sun Pharma, Merck, Novartis, Pfizer, Regeneron and Sanofi. She has also served as an independent consultant to Allergy Therapeutics, Bayer, LLC, Ora Inc., and Regeneron in the past. WF: The department of Otorhino. SN: speaker and advisory boards for ALK and Astra Zeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

**Figure 1**
Algorithm for confirmation of refractory severe allergic rhinoconjunctivitis (R-SARC).

**Figure 2**
VAS scores and their interpretation.

See this image and copyright information in PMC

References

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EUFOREA meeting on defining disease states in allergic rhinitis: towards a unified language in AR

Affiliations

EUFOREA meeting on defining disease states in allergic rhinitis: towards a unified language in AR

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials