title: Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement.
abstract: Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Leuven, Belgium.|Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Otorhinolaryngology-Head and Neck Surgery, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium.
authors.forename: P W
authors.initials: PW
authors.lastname: Hellings
authors.affiliation: Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Fokkens
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium.|Department of Otorhinolaryngology, Karolinska Institute, Stockholm, Sweden.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-4742-1665
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Swiss Institute of Allergy and Asthma Research (SIAF), Christine-Kühne Center for Allergy Research and Education, University of Zurich, Davos, Switzerland.
authors.forename: C A
authors.initials: CA
authors.lastname: Akdis
authors.affiliation: Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, Friedrich-Wilhelms-University, Bonn, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bieber
authors.affiliation: Faculty of Medicine, Transylvania University, Brasov, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Agache
authors.affiliation: Department of Otorhinolaryngology, Hospital Clínic Universitari, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bernal-Sprekelsen
authors.affiliation: Department of Biomedical Science, Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center, Humanitas University - Rozzano (Milano), Rozzano, Italy.
authors.forename: G W
authors.initials: GW
authors.lastname: Canonica
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Upper Airways Research Laboratory, Ghent University, Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Gevaert
authors.affiliation: Department of Respiratory Medicine, Ghent University, Ghent, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Joos
authors.affiliation: Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Lund
authors.affiliation: Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muraro
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Onerci
authors.affiliation: Department of Dermatology and Allergy, Comprehensive Allergy-Centre-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Zuberbier
authors.affiliation: European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Pugin
authors.affiliation: European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium.|Department of Immunology and Microbiology, Laboratory of Clinical Immunology, KU Leuven, Leuven, Belgium.
authors.forename: S F
authors.identifier: http://orcid.org/0000-0002-4399-9892
authors.initials: SF
authors.lastname: Seys
authors.affiliation: Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France.
authors.forename: J
authors.initials: J
authors.lastname: Bousquet
mesh_terms: D000328:Adult; D000465:Algorithms; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D057285:Precision Medicine / Q000191:economics / Q000379:methods* / Q000592:standards; D065631:Rhinitis, Allergic / Q000191:economics / Q000628:therapy*; D012852:Sinusitis / Q000191:economics / Q000628:therapy*; D055815:Young Adult
keywords: allergic rhinitis; integrated care pathway; precision medicine; rhinosinusitis