Abstract
Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results: The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
Highlights
Worldwide, both the number of patients affected by allergies and the costs of allergic diseases are increasing rapidly
In patients with seasonal allergic rhinitis (AR), intranasal corticosteroids (INCSs) are recommended, or possibly a combination of INCSs + OAH
In patients with severe seasonal AR, a fixed combination of INCSs+ INAH or INCSs alone is recommended; the choice of therapy depends on the patient’s preferences
Summary
Both the number of patients affected by allergies and the costs of allergic diseases are increasing rapidly. Recommendations for pharmacotherapy for allergic rhinitis –– Oral or intranasal H1-antihistamines are less effective in controlling all rhinitis symptoms than intranasal corticosteroids (INCSs) [5, 6, 7, 8, 9, 10] They are effective in many patients with mild to moderate disease and many prefer oral medication. In Germany, there is no arrangement for SHI patients with severe AR symptoms, for whom antihistamines and INCSs are not effective These patients usually use arbitrary combinations of different preparations and drug groups, whereas only the fixed combination MPAzeFlu (combined intranasal FP and azelastine (Aze) in a nasal spray) has evidence-based efficacy in the therapeutic area. The overall algorithm was found appropriate and no change was needed
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