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Erschienen in:
26.04.2024 | Asthma bronchiale | Kongressabstracts
Is the new ARIA classification of rhinitis impacting our practice?
Erschienen in: Allergo Journal | Ausgabe 3/2024
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Paradigm shift in rhinitis and asthma multimorbidity: Asthma (A), rhinitis (R) 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 [1], is an over-simplification of the links between upper- and lower-airway allergic diseases. With new data, the concept has been re-assessed [2].-
Clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA) and the new ARIA classification were carried out from 1980 to 2005 [3]. Most A patients suffer from R but only 20-40 % of R patients suffer from A [4]. This suggests common pathways between A+R in multimorbid patients and specific pathways in patients with R alone.
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New insights into polysensitisation and multimorbidity were obtained in data from MeDALL (Mechanisms of the Development of Allergy, FP7 EU grant) [5]. At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster [6]. In birth and children's cohorts, mono- and polysensitisation to different allergens represent expressions of distinct diseases [7, 8]. Compared to monosensitisation, polysensitisation was linked with stronger global IgE response, disease phenotypes (R alone versus A+R), symptoms and trajectories. Multimorbidity is partly independent of IgE sensitisation, suggesting distinct causal (genomic) pathways [9]. There is an association between IgE polysensitisation and multimorbidity in age of onset, number of allergic multimorbidities (C [conjunctivitis] and AD), severity of disease, eosinophil levels and total IgE levels.
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Advances in cross-sectional and longitudinal mHealth studies showed a novel phenotype definition: an extreme multimorbid phenotype (A+R+C) with a greater impact on symptoms and work productivity than on the individual diseases [10, 11]. The results of mHealth apps are hypothesis-generating and were confirmed in canonical epidemiologic studies.
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Genomic findings: genomic studies in two different cohorts (MeDALL using transcriptomics and Puerto Rico using RNA sequencing) convincingly found that Toll Like Receptors and IL-17 are involved in rhinitis alone whereas IL-33 and IL-5 are involved in rhinitis and asthma multimorbidity (Fig. 1) [14, 15]. Epigenetic studies in peripheral blood confirmed the links between rhinitis and asthma. Interestingly, in children, there was no specific signature for asthma alone (genetic and epigenetic studies).Fig. 1: Genomic differences between rhinitis alone and rhinitis and asthma (from [14])×