Methodology for the Development of the Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI 2024-2025 Guidelines: From Evidence-to-Decision Frameworks to Digitalised Shared Decision-Making Algorithms
- PMID: 41268627
- PMCID: PMC12862529
- DOI: 10.1111/all.70100
Methodology for the Development of the Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI 2024-2025 Guidelines: From Evidence-to-Decision Frameworks to Digitalised Shared Decision-Making Algorithms
Abstract
The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines produced their first edition in 1999, with subsequent revisions in 2008, 2010, 2016 and 2019. A new iteration of ARIA-ARIA 2024-2025-in collaboration with EAACI is currently being developed, focusing on the management of allergic rhinitis. ARIA 2024-2025 follows the GRADE framework and is endorsed by the European Academy of Allergy and Clinical Immunology (EAACI). A set of approaches has been used to develop guideline questions, including surveying key opinion leaders and using artificial intelligence (AI)-based tools to analyse web searches on allergic rhinitis and to generate questions. Each prioritised guideline question is assessed through an Evidence-to-Decision (EtD) framework. EtDs support the systematic and transparent formulation of recommendations, comprising 12 criteria for which the best available evidence should be sought. In the context of ARIA-EAACI 2024-2025, such evidence is derived not only from randomised controlled trials but also-among others-from patient-generated data sources that better reflect the affected individuals' perspectives. Moreover, ARIA-EAACI 2024-2025 incorporates evidence on planetary health. Developed guideline recommendations will support the creation of digitalised decision algorithms and care pathways. This paper describes the methodology used to develop the person-centred, digitally enabled and AI-assisted ARIA-EAACI 2024-2025. Among others, it describes (i) the development and prioritisation of guideline questions, (ii) sources of evidence for EtDs and (iii) the development of digitalised decision algorithms and care pathways.
Keywords: ENT (rhinitis, sinusitis, nasal polyps…); allergic rhinitis; asthma; guidelines.
© 2025 The Author(s). Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Conflict of interest statement
Conflicts of interest (CoIs) of all participants were managed according to the Guidelines International Network (GIN) CoI declaration and management principles reviewed by the AWMF (
Before participation, all guideline panel members and members of the evidence‐synthesis team completed a standardised disclosure‐of‐interests (DoI) form provided by the AWMF. This form collected information about current and previous (past 3 years) interests in the healthcare sector, including direct financial interests and indirect (e.g., non‐financial and intellectual) interests. Guideline panel members were required to report all interests in the DoI form, regardless of whether they would see such interests as having a thematic reference to the guideline or representing a conflict of interest.
Staff providing administrative support to ARIA‐EAACI 2024–2025 judged every DoI form in the assessment on whether a disclosed interest was considered a CoI. The completed DoI forms are to be made available to all panel members during the project. At every meeting, guideline panellists were reminded of the DoI forms and prompted to make new disclosures. ARIA staff and members reviewed new disclosures, but previously documented disclosures or judgments are never removed or changed. The forms will receive a final update prior to guideline submission and will be included with the published guidelines.
The guideline panel was composed so that most of its members did not have a CoI. Absence of CoI is required for those chairing the panel discussions and gathering and summarising evidence for the EtDs. No individual was excluded from the guideline panel due to direct or indirect CoI. However, only those without CoI were allowed to make judgements or participate in the voting process for judgements or recommendations.
J. Bousquet reports personal fees from Cipla, Menarini, Mylan, Novartis, Purina, Sanofi‐Aventis, Teva, Noucor, other from KYomed‐Innov, other from Mask‐air‐SAS, outside the submitted work. M. Hyland reports grants from GSK, from AstraZeneca, from null, outside the submitted work. A. Cruz reports grants, personal fees and non‐financial support from AstraZeneca, personal fees from Chiesi, grants and personal fees from Eurofarma, personal fees from Farmoquimica, grants from EMS, grants and personal fees from GSK, grants and personal fees from Sanofi, outside the submitted work. J. Sastre reports grants and personal fees from Sanofi, personal fees from GSK, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Mundipharma and personal fees from Faes Farma, outside the submitted work. D. Wallace reports as an author on the JTFPP practice parameters on Rhinitis, the most recent being 2020 and I have been an author on several previous ARIA and MASK‐related articles. M. Wagenmann reports personal fees from Allergopharma, personal fees from ALK‐Abello, grants and personal fees from AstraZeneca, personal fees from CSL Behring, grants and personal fees from GSK, personal fees from HAL Allergy, personal fees from Leti Pharma, personal fees from M.S.D., personal fees from Novartis, grants and personal fees from Regeneron, grants and personal fees from Sanofi, personal fees from Stallergenes, grants from Takeda, outside the submitted work. O. Pfaar reports grants and/or personal fees and/or travel support from AEDA, Alfried Krupp Krankenhaus, ALK‐Abelló, Allergopharma, Almirall, Altamira Therapeutics, ASIT Biotech, AstraZeneca, Bencard Allergie GmbH/Allergy Therapeutics, Blueprint, Cliantha, Deutsche AllergieLiga e.V., Deutsche Forschungsgemeinschaft, Dustri‐Verlag, ECM Expro & Conference Management GmBH, Forum für Medizinische Fortbildung, Georg‐Thieme‐Verlag, GSK, HAL Allergy Holding B.V./HAL Allergie GmbH, Immunotek, Ingress Health, Institut für Disease Management (Essen, Germany), IQVIA Commercial, Japanese Society of Allergology, Königlich Dänisches Generalkonsulat, Laboratorios LETI/LETI Pharma, Lilly, Lofarma, Medizinische Hochschule Hannover, med update europe GmbH, Meinhardt Congress GmbH, Novartis, Paul‐Ehrlich‐Institut, Paul‐Martini‐Stiftung, PneumoLive, Pohl‐Boskamp, Procter & Gamble, Red Maple Trials Inc., R.G. Aerztefortbildung, ROXALL Medizin, Sanofi‐Aventis, Sanofi Genzyme, Springer Publisher, Stallergenes Greer, streamedup! GmbH, Technical University Dresden, Wiley Publishers, Wort & Bild Verlag, Verlag ME; outside the submitted work, Oliver Pfaar is Vice President of the European Academy of Allergy and Clinical Immunology (EAACI), a member of EAACI Excom as well as a member of the external board of directors of the German Society of Allergy and Clinical Immunology (DGAKI); coordinator, main‐ or co‐author of different position papers and guidelines in rhinology, allergology and allergen immunotherapy; and he is Editor‐in‐Chief of Clinical Translational Allergy and Associate Editor of Allergy. T. Iinuma reports a grant from Sanofi, outside the submitted work. J. Davies reports grants from Australian National Health and Medical Research Council, grants from Australian Research Council, non‐financial support from Sullivan Nicolaides Pathology Queensland, non‐financial support from ThermoFisher Sweden, non‐financial support from Swisens SA Switzerland, non‐financial support from Kenelec Australia, non‐financial support from Abacus Dx Australia, grants from Bayer Healthcare, grants from Australian Department of Health and Ageing, grants from Australian Medical Research Future Fund, outside the submitted work; in addition, Dr. Davies has a patent US PTO 14/311944 issued, a patent AU2008/316301 issued and a patent PCT/AU2024/051221 pending. I. Tsiligianni reports grants from Chiesi, GSK Hellas, Menarini, AstraZeneca Greece, outside the submitted work. B. Gradauskiene reports grants from AstraZeneca, personal fees from Berlin‐Chemie Menarini, personal fees from Viatris, outside the submitted work. I. Ansotegui reports personal fees from Bayer, personal fees from Eurodrug, personal fees from Gebro, personal fees from Menarini, personal fees from M.S.D., personal fees from Roxall, personal fees from Sanofi, personal fees from Cipla, personal fees from Glenmark, personal fees from Opella, outside the submitted work. A. Fiocchi reports Danone Advisory board member, Abbott—Consultant, paid to institution, Aimmune—Advisory board member, Ferrero—Consultant, Novartis—Advisory board member, Sanofi—Advisory board member, Stallergenes—Advisory board member. M. Kupczyk reports personal fees from Adamed, personal fees from Abbvie, personal fees and non‐financial support from AstraZeneca, personal fees and non‐financial support from Berlin‐Chemie, personal fees and non‐financial support from Chiesi, personal fees from EMMA, personal fees from GSK, personal fees from HAL Allergy, personal fees from Sunpharm, personal fees from HVD, personal fees from LEK‐AM, personal fees from Polpharma, personal fees from Teva, personal fees from Sanofi, personal fees from Zentiva, personal fees from Stada, outside the submitted work. JC. Ivancevich reports personal fees from Laboratorios Casasco Argentina, outside the submitted work. A. Todo‐Bom reports personal fees from GSK, grants and personal fees from LETI, personal fees from Mylan, grants from AbbVie, grants from Sanofi and grants from Roxal, outside the submitted work. L. Tuyet reports grants from AstraZeneca, grants from Boehringer Ingelheim, grants from Glaxo Smith Kline, grants from M.S.D., grants from Hyphens, grants from Tedis, grants from Novartis and grants from Orient Pharma, outside the submitted work. N. Papadopoulos reports grants from Nestle, Numil, Vianex, Vibrant, personal fees from Abbott, AstraZeneca, GSK, HAL, Menarini, Novartis, Danone Nutricia, OM Pharma, Regeneron, Sanofi, outside the submitted work. S. Toppila‐Salmi reports grants and other support from Sanofi Pharma, grants and other support from GSK, other support from OrionPharma, other support from ALK‐Abelló, other support from AstraZeneca, other support from Clario, outside the submitted work. R. Naclerio reports personal fees from Sanofi, personal fees from Lyra, outside the submitted work. M. Soyka reports other from Sanofi, other from M.S.D., other from GSK, other from AstraZeneca, outside the submitted work. N. Roche reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, grants and personal fees from GSK, personal fees from AstraZeneca, personal fees from Chiesi, grants and personal fees from Pfizer, personal fees from Sanofi, personal fees from Zambon, personal fees from M.S.D., personal fees from Austral, personal fees from Biosency, outside the submitted work. C. Suppli Ulrik reports personal fees from AZ, personal fees from GSK, grants and personal fees from BI, personal fees from TEVA, personal fees from Pfizer, personal fees from Orion, grants and personal fees from Sanofi, personal fees and non‐financial support from Novartis, personal fees from Chiesi, personal fees from Covis Pharma, personal fees from Berlin‐Chemie, outside the submitted work. D. Chu reports being a GRADE Working Group member, supports the development of allergy guidelines internationally and holds an E.J. Moran Campbell Career Award and a CIHR Inclusive Excellence Prize in Patient Engagement. Y. Okamoto reports personal fees from Torii Pharmaceutical Co. Ltd., personal fees from Tanabe Mitsubishi Pharmaceutical Co. Ltd., personal fees from Kirin Holdings Co. Ltd., personal fees from Shionogi Co. Ltd., personal fees from Stallergenes Greer and personal fees from Diichi‐Sankyo, outside the submitted work. H. Olze received fees (lectures, advisory boards, research grants) from F. Hoffmann‐La Roche Ltd., Sanofi‐Aventis Deutschland GmbH, AstraZeneca GmbH, GlaxoSmithKline GmbH and Co. KG and Novartis, outside the present work. J. Mullol reports personal fees and other from Sanofi‐Genzyme and Regeneron, grants, personal fees and other from Viatris/Meda Pharma, grants and personal fees from Noucor/Uriach Group, personal fees from Menarini, personal fees from UCB, personal fees and other from AstraZeneca, grants, personal fees and other from GSK, personal fees from M.S.D., personal fees and other from Lilly, personal fees and other from Glenmark, outside the submitted work. M. Torres reports personal fees from Leti Laboratories, personal fees from Aimmune Therapeutics, personal fees from Diater Laboratories, grants from European Commission, grants from SEAIC, grants from ISCIII, outside the submitted work. H. Kraxner reports Speaker's fee and congress support from Sanofi, Speaker's fee and congress support from Viatris, Speaker's fee and congress support from Berlin‐Chemie, Speaker's fee and congress support from Ewopharma; Advisory Board membership: Sanofi. M. Makris reports personal fees from ELPEN, personal fees from MENARINI, personal fees from AstraZeneca, personal fees from Novartis, personal fees from CHIESI, personal fees from GSK, personal fees from ThermoFisher, personal fees from Vianex, outside the submitted work. D. Sakurai reports grants and personal fees from Torii, grants and personal fees from Tanabe Mitsubishi, personal fees from Shionogi, grants and personal fees from Taiho, grants and personal fees from Kyorin, personal fees from Meiji Seika Pharma, personal fees from Thermo Fisher Scientific Diagnostics, grants and personal fees from Tsumura, personal fees from Hisamitsu, personal fees from Novartis, personal fees from Sanofi, personal fees from AstraZeneca, outside the submitted work. J. Correia‐de‐Sousa reports other from Boheringer Ingelheim, personal fees and other from GSK, grants, personal fees and other from AstraZeneca, personal fees from Bial, non‐financial support from Mundipharma, personal fees from Sanofi, other from Novartis, personal fees from M.S.D., personal fees from Medinfar, outside the submitted work. M. Bourgoin‐Heck reports non‐financial support from Thermofisher, personal fees from ALK, personal fees from Takeda, personal fees from Biocryst, personal fees from DBV, outside the submitted work. O. Palomares received research grants from MINECO, Ministerio de Ciencia e Innovación, CAM, Inmunotek S.L., Novartis and AstraZeneca and fees for giving scientific lectures or participation in Advisory Boards from AstraZeneca, Pfizer, GlaxoSmithKline, Inmunotek S.L., Novartis and Sanofi‐Genzyme. M. Moniuszko reports having received in the past personal fees and other support from Berlin‐Chemie/Menarini, personal fees and other support from AstraZeneca, personal fees and other support from GlaxoSmithKline, personal fees and other support from Novartis, personal fees and other support from Chiesi, personal fees and other support from Celon Pharma, personal fees and other support from Takeda, personal fees and other support from Polfarmex, personal fees and other support from CSL Behring, personal fees from Glenmark Pharmaceuticals, personal fees and other support from Sanofi, outside the submitted work. D. Larenas Linnemann reports personal fees from ALK, Armstrong, Astrazeneca national and global, Bayer, Chiesi, Grunenthal, Grin, GSK national and global, Viatris, Menarini, M.S.D., Novartis, Pfizer, Sanofi, Siegfried, Carnot, Syneos Health, grants from Abbvie, Bayer, Lilly, Sanofi, Astrazeneca, Pfizer, Novartis, Pulmonair, GSK, Chiesi, Biopharma, outside the submitted work; and Editor‐in‐Chief of Immune System (Karger)—member of asthma committee ACAAI—subgroup chair of allergen immunotherapy Practice Parameter Update JTF AAAAI/ACAAI 2024—member of allergen immunotherapy committee AAAAI—chair of allergen immunotherapy committee CMICA—member of allergic asthma task force EAACI. M. Worm reports other from AbbVie Deutschland GmbH & Co. KG, other from Aimmune Therapeutics UK Limited, other from ALK‐Abelló Arzneimittel GmbH, other from Allergopharma GmbH & Co KG, other from Almirall Hermal GmbH, other from Amgen GmbH, other from AstraZeneca GmbH, other from Bayer AG, other from Bencard Allergy GmbH, other from Bioprojet Pharma, other from Boehringer Ingelheim Pharma GmbH & Co. KG, other from Bristol Myers Squibb GmbH & Co. KGaA, other from Galderma Laboratorium GmbH, other from Glaxo Smith Kline GmbH & Co. KG, other from Infectopharm Arzneimittel und Consilium GmbH, other from LEO Pharma GmbH, other from Lilly Deutschland GmbH, other from Mylan Germany GmbH (A Viatris Company), other from Novartis AG, other from Octapharm AG, other from Pfizer Pharma GmbH, other from Sanofi‐Aventis Deutschland GmbH/Ðenzyme Europe B. B., outside the submitted work. T. Kosak Soklic reports personal fees from Meda AB, outside the submitted work. P. Devillier reports personal fees from ALK‐Abello, personal fees and non‐financial support from Stallergenes, personal fees and non‐financial support from AstraZeneca, personal fees from Chiesi, personal fees from GlaxoSmithKline, personal fees from Menarini, personal fees from Viatris, personal fees from Procter & Gamble Health, outside the submitted work. L. Cecchi reports personal fees from Menarini, personal fees from Chiesi, personal fees from AstraZeneca, personal fees from GSK, personal fees from Novartis, personal fees from Thermofisher, personal fees from Sanofi, outside the submitted work. G. Roberts reports grants from the National Institute of Health Research, grants from the National Institutes of Health, grants from Action Medical Research, grants from EU IMI2, other support from ALK‐Abello, non‐financial support and other support from ThermoFisher, other support from AstraZeneca, other support from Viatris, outside the submitted work. E. Compalati reports personal fees from Lofarma spa during the conduct of the study. D. Choudhury reports personal fees from Athaneum, others from ESPGHAN, others from the British Society of Allergy and Clinical Immunology (BSACI) ‐ Standards of Care Committee, others from Respiratory Allergy, International Primary Care Respiratory Group, outside the submitted work. R. Buhl reports personal fees from AstraZeneca, Berlin‐Chemie, Celltrion, Chiesi, Cipla, Sanofi and Teva, as well as grants to Mainz University Hospital and personal fees from Boehringer Ingelheim, GlaxoSmithKline, Novartis and Roche, outside the submitted work. L. de las Vecillas reports fees for Lectures/Advisory Boards from AstraZeneca, GSK, LETI labs and Allergy Therapeutics, outside the submitted work. She has received a Research grant from the Spanish Society of Allergy and Clinical Immunology Foundation and from the ISCIII, outside the submitted work. L. Taborda‐Barata reports personal fees from LETI, personal fees from Sanofi and personal fees from Diater, outside the submitted work. J. Bernstein reports personal fees from Pfizer, personal fees from Lilly and personal fees from Sanofi. S. Del Giacco reports grants and personal fees from AstraZeneca, grants and personal fees from GSK, grants and personal fees from Sanofi, personal fees from Chiesi, personal fees from Menarini, outside the submitted work. M. Giovannini reports personal fees from Sanofi, from Thermo Fisher Scientific, outside the submitted work. N. Miculinic reports personal fees from Salvus d.o.o. Pharma Industry, personal fees from Viatris Ltd., outside the submitted work. J. da Silva reports grants, personal fees and others from Novartis, grants and personal fees from Takeda, outside the submitted work. G. Paoletti reports other from LoFarma, other from GSK and other from Astrazeneca, outside the submitted work. H. Schünemann reports and develops guidelines on Allergic Rhinitis in Asthma (ARIA), and his academic institution received research funding for it. The other authors declare no conflicts of interest, outside the submitted work.
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