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

J Bousquet, E Melén, T Haahtela, G H Koppelman, A Togias, R Valenta, C A Akdis, W Czarlewski, M Rothenberg, A Valiulis, M Wickmann, D Aguilar, M Akdis, I J Ansotegui, C Barbara, A Bedbrook, C Bindslev Jensen, S Bosnic-Anticevich, L P Boulet, C E BrightlingL Brussino, E Burte, M Bustamante, G W Canonica, L Cecchi, J C Celedon, C Chaves-Loureiro, E Costa, A A Cruz, M Erhola, B Gemicioglu, W J Fokkens, J Garcia Aymerich, S Guerra, J Heinrich, J C Ivancevich, T Keil, L Klimek, P Kuna, M Kupczyk, V Kvedariene, D E Larenas-Linnemann, N Lemonnier, K C Lodrup Carlsen, R Louis, M Makris, M Maurer, I Momas, M Morais-Almeida, J Mullol, R N Naclerio, K Nadeau, R Nadif, M Niedoszytko, Y Okamoto, M Ollert, N G Papadopoulos, G Passalacqua, V Patella, R Pawankar, N Pham-Thi, O Pfaar, F S Regateiro, J Ring, P W Rouadi, B Samolinski, J Sastre, M Savouré, N Scichilone, M H Shamji, A Sheikh, V Siroux, B Sousa-Pinto, M Standl, J Sunyer, L Taborda-Barata, S Toppila-Salmi, M J Torres, I Tsiligianni, E Valovirta, O Vandenplas, M T Ventura, S Weiss, A Yorgancioglu, L Zhang, A H Abdul Latiff, W Aberer, I Agache, M Al-Ahmad, I Alobid, H S Arshad, E Asayag, A Baharudin, L Battur, K S Bennoor, E C Berghea, K C Bergmann, D Bernstein, M Bewick, H Blain, M Bonini, F Braido, R Buhl, R Bumbacea, A Bush, M Calderon, G Calvo, P Camargos, L Caraballo, V Cardona, W Carr, P Carreiro-Martins, T Casale, A M Cepeda Sarabia, R Chandrasekharan, D Charpin, Y Z Chen, I Cherrez-Ojeda, T Chivato, E Chkhartishvili, G Christoff, D K Chu, C Cingi, J Correia da Sousa, C Corrigan, A Custovic, G D'Amato, S Del Giacco, F De Blay, P Devillier, A Didier, M do Ceu Teixeira, D Dokic, H Douagui, M Doulaptsi, S Durham, M Dykewicz, T Eiwegger, Z A El-Sayed, R Emuzyte, R Emuzyte, A Fiocchi, N Fyhrquist, R M Gomez, M Gotua, M A Guzman, J Hagemann, S Hamamah, S Halken, D M G Halpin, M Hofmann, E Hossny, M Hrubiško, C Irani, Z Ispayeva, E Jares, T Jartti, E Jassem, K Julge, J Just, M Jutel, I Kaidashev, O Kalayci, O Kalyoncu, P Kardas, B Kirenga, H Kraxner, I Kull, M Kulus, S La Gruta, S Lau, L Le Tuyet Thi, M Levin, B Lipworth, O Lourenço, B Mahboub, M J Mäkelä, E Martinez-Infante, P Matricardi, N Miculinic, N Migueres, F Mihaltan, Y Mohamad, M Moniusko, S Montefort, H Neffen, K Nekam, E Nunes, D Nyembue Tshipukane, R E O'Hehir, I Ogulur, K Ohta, K Okubo, S Ouedraogo, H Olze, I Pali-Schöll, O Palomares, K Palosuo, C Panaitescu, P Panzner, H S Park, C Pitsios, D Plavec, T A Popov, F Puggioni, S Quirce, M Recto, R Repka-Ramirez, C Roballo-Cordeiro, N Roche, M Rodriguez-Gonzales, J Romantowski, N Rosario Filho, M Rottem, H Sagara, F Sarquis-Serpa, Z Sayah, S Scheire, P Schmid-Grendelmeier, J C Sisul, D Sole, M Soto-Martinez, M Sova, A Sperl, O Spranger, R Stelmach, C Suppli Ulrik, M Thomas, T To, A Todo-Bom, P V Tomazic, M Urrutia-Pereira, M Valentin-Rostan, E van Ganse, M Van Hage, T Vasankari, P Vichyanond, G Viegi, D Wallace, D Y Wang, S Williams, M Worm, P Yiallouros, P Yiallouros, O Yusuf, F Zaitoun, M Zernotti, M Zidarn, J Zuberbier, J A Fonseca, T Zuberbier, J M Anto

Research output: Journal article (peer-reviewed)Review article

22 Citations (Scopus)

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 polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (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 sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (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 auto-immune diseases.

Original languageEnglish
Pages (from-to)1169-1203
Number of pages35
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume78
Issue number5
Early online date17 Feb 2023
DOIs
Publication statusPublished - May 2023

Keywords

  • IL-33
  • Toll-like receptors
  • asthma
  • multimorbidity
  • rhinitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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