MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis.
The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. Clinical decision support systems (CDSSs) might be beneficial for the assessment of disease control. CDSSs should be based on the best evidence and algorithms to aid patients and health care professionals to jointly determine treatment and its step-up or step-down strategy depending on AR control. Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR [fighting chronic diseases for active and healthy ageing]), one of the reference sites of the European Innovation Partnership on Active and Healthy Ageing, has initiated an allergy sentinel network (the MACVIA-ARIA Sentinel Network). A CDSS is currently being developed to optimize AR control. An algorithm developed by consensus is presented in this article. This algorithm should be confirmed by appropriate trials.
University Hospital, Montpellier, France; MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; INSERM, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health approaches, Paris, and Université Versailles St-Quentin-en-Yvelines, St-Quentin-en-Yvelines, France. Electronic address: jean.bousquet@orange.fr.
Jean
J
Bousquet
Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada.
Holger J
HJ
Schünemann
Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
Peter W
PW
Hellings
Kyomed, Montpellier, France.
Sylvie
S
Arnavielhe
Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium.
Claus
C
Bachert
MACVIA-LR, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
Anna
A
Bedbrook
Allergy-Centre-Charité at the Department of Dermatology, Charité-Universitätsmedizin Berlin, and Secretary General of the Global Allergy and Asthma European Network (GA(2)LEN), Berlin, Germany.
Karl-Christian
KC
Bergmann
Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, Australia.
Sinthia
S
Bosnic-Anticevich
Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada.
Jan
J
Brozek
Imperial College London-National Heart and Lung Institute, Royal Brompton Hospital NHS, London, United Kingdom.
Moises
M
Calderon
Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
G Walter
GW
Canonica
Division of Allergy/Immunology, University of South Florida, Tampa, Fla.
Thomas B
TB
Casale
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Niels H
NH
Chavannes
Department of Medicine, Nova Southeastern University, Davie, Fla.
Linda
L
Cox
RiRL, Cambridge, United Kingdom.
Henry
H
Chrystyn
ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, and GARD Executive Committee, Bahia, Brazil.
Alvaro A
AA
Cruz
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
Ronald
R
Dahl
EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium.
Giuseppe
G
De Carlo
EPAR U707 INSERM, Paris and EPAR UMR-S UPMC, Paris VI, Paris, France; Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France.
Pascal
P
Demoly
Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles Saint-Quentin, St-Quentin-en-Yvelines, France.
Phillipe
P
Devillier
Ecole des Mines, Alès, France.
Gérard
G
Dray
Education for Health, Warwick, United Kingdom.
Monica
M
Fletcher
Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands.
Wytske J
WJ
Fokkens
Center for Research in Health Technologies and Information Systems-CINTESIS, Universidade do Porto; the Allergy Unit, Instituto CUF Porto e Hospital CUF Porto; the Health Information and Decision Sciences Department-CIDES, Faculdade de Medicina, Universidade do Porto; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Joao
J
Fonseca
Universidad Autónoma de Nuevo León, Nuevo León, Mexico.
Sandra N
SN
Gonzalez-Diaz
University of Washington School of Medicine, Faculty of the Department of Neurology, Seattle, Wash.
Lawrence
L
Grouse
Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, and the Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
Thomas
T
Keil
Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland.
Piotr
P
Kuna
Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, Mexico City, Mexico.
Désirée
D
Larenas-Linnemann
Department of Paediatrics, Oslo University Hospital, Oslo, and the Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Karin C
KC
Lodrup Carlsen
Allergy and Asthma Medical Group and Research Center, San Diego, Calif.
Eli O
EO
Meltzer
Unitat de Rinologia i Clínica de l'Olfacte, Servei d'ORL, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain.
Jaoquim
J
Mullol
Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
Antonella
A
Muraro
Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center and Pritzker School of Medicine, University of Chicago, Chicago, Ill.
Robert N
RN
Naclerio
EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium.
Susanna
S
Palkonen
Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, and the Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece.
Nikolaos G
NG
Papadopoulos
Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
Giovanni
G
Passalacqua
Academic Centre of Primary Care, University of Aberdeen, and Research in Real-Life, Cambridge, United Kingdom.
David
D
Price
Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh, United Kingdom.
Dermot
D
Ryan
Department of Prevention of Envinronmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland.
Boleslaw
B
Samolinski
Royal National TNE Hospital, University College London, London, United Kingdom.
Glenis K
GK
Scadding
Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Aziz
A
Sheikh
Service d'Immunologie et Allergie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
François
F
Spertini
Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania.
Arunas
A
Valiulis
Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland.
Erkka
E
Valovirta
Asthma UK, London, United Kingdom.
Samantha
S
Walker
Sachs' Children's Hospital, Stockholm, and the Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Magnus
M
Wickman
Department of Pulmonology, Celal Bayar University Manisa, Turkey, and GARD Executive Committee, Manisa, Turkey.
Arzu
A
Yorgancioglu
Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland.
Tari
T
Haahtela
Allergy-Centre-Charité at the Department of Dermatology, Charité-Universitätsmedizin Berlin, and Secretary General of the Global Allergy and Asthma European Network (GA(2)LEN), Berlin, Germany.
Torsten
T
Zuberbier
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000465:Algorithms; D000066491:Clinical Decision-Making; D003233:Conjunctivitis, Allergic / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D019468:Disease Management; D006801:Humans; D017060:Patient Satisfaction; D065631:Rhinitis, Allergic / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*
Allergic Rhinitis and its Impact on Asthma; Allergic rhinitis; MACVIA-LR; clinical decision support system; conjunctivitis; information and communication technology