Abstract
BackgroundThe variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma.ObjectivesWe assessed specific aspects of allergic respiratory disease (ARD) that are not explicitly addressed in the guidelines in order to issue specific recommendations and thus optimize clinical practice.MethodsUsing the Delphi technique, 40 Spanish allergists were surveyed to reach consensus on 71 items related to ARD.ResultsConsensus was achieved for 95.7% of the items. These included the following: the clinical manifestations of ARD are heterogeneous and individual airborne allergens can be related to specific clinical profiles; the optimal approach in patients with ARD is based on the global assessment of rhinoconjunctivitis and asthma; aeroallergens are largely responsible for the clinical features and severity of the disease; and clinical expression is associated with the period of environmental exposure to the allergen. Pharmacological treatment of ARD is often based on the intensity of symptoms recorded during previous allergen exposures and cannot always be administered following a step-up approach, as recommended in clinical practice guidelines. Allergen immunotherapy (AIT) is the only option for overall treatment of respiratory symptoms using an etiological approach. AIT can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment.ConclusionsThe present study highlights gaps in current asthma and rhinitis guidelines and addresses specific aspects of ARD, such as global assessment of both asthma and rhinitis or the specific role of variable allergen exposure in the clinical expression of the disease.
Highlights
The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma
In the literature review carried out, we found that most guidelines and position papers on rhinitis [2,3,4,5,6] emphasize the relationship between asthma and rhinitis (Table 1), and specific sections of some asthma guidelines discuss the relationship between asthma and rhinitis [7,8,9,10] (Table 2)
Among the items for which consensus was achieved, it is especially interesting that experts consider that individual aeroallergens may be related to specific clinical profiles and should be taken into account for patient management
Summary
The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma. Since the publication of the ARIA document in 2001 [1], the “one airway” concept has been accepted almost unanimously by the medical community to describe specific aspects of patients diagnosed with rhinoconjunctivitis with or without asthma. Current classifications of asthma and/or allergic rhinitis by consensus guidelines cannot be universally applied to patients with allergic respiratory disease owing to their high heterogeneity. A comprehensive understanding of patients with allergic respiratory disease (ARD) requires that specific aspects of the etiological agent be addressed in the guidelines
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
