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Allergic Rhinitis and its Impact on Asthma (ARIA) Classes in MASK-air Users

Sousa-Pinto B1,2, Savouré M3, Vieira RJ1,2, Amaral R1,2,4,5, Czarlewski W6,7,8, Bedbrook A7,8, Valiulis A9,10, Kvedariene V11,12, Brussino L13,14, Gemicioglu B15,16, Haahtela T17, Klimek L18,19, Kraxner H20, Larenas-Linnemann DE21, Pfaar O22, Regateiro FS23-26, Samolinski B27, Taborda-Barata L26,28, Toppila-Salmi S17,29, Ventura MT30,31, Ansotegui IJ32, Braido F33,34, Canonica GW35,36, Cecchi L37, Cruz AA38, Devillier P39, Fokkens WJ40, Gil-Mata S1,2, Giuliano AFM41, Ivancevich JC42, Kuna P43, Kupczyk M43, Louis G44,45, Louis R45,46, Makris M47, Morais Almeida M48, Mullol J49, Nadif R50,51, Niedoszytko M52, Okamoto Y53,54, Ollert M55,56, Papadopoulos NG57, Patella V58-60, Pawankar R61, Pereira AM1,2,62, Pétré B44, Pham-Thi N63-65, Roche N51,66,67, Rouadi PW68,69, Sastre J70, Scichilone N71, Sheikh A72, Sova M73, Todo-Bom A74, Yorgancioglu A75, Zidarn M76,77, Anto JM78-80, Zuberbier T81,82, Fonseca JA1,2, Bousquet J7,8,51,81,82

1MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
2CINTESIS@RISE– Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
3Université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
4Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
5Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
6Medical Consulting Czarlewski, Levallois, France
7MASK-air, Montpellier, France
8ARIA, Montpellier, France
9Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
10Clinic of Asthma, Allergy and Chronic Lung Diseases, Vilnius, Lithuania
11Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
12Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
13Department of Medical Sciences, University of Torino, Torino, Italy
14Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
15Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
16Institute of Pulmonology and Tuberculosis, Istanbul University-Cerrahpaşa, Istanbul, Turkey
17Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
18Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
19Center for Rhinology and Allergology, Wiesbaden, Germany
20Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
21Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
22Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
23Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
24Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Portugal
25Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
26UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
27Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
28Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
29Department of Allergy, Skin and Allergy Hospital, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
30Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
31Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
32Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
33Department of Internal Medicine (DIM), University of Genoa, Genoa, Italy
34Respiratory and Allergy Clinic, IRCCS - Policlinico San Martino, Genoa, Italy
35Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
36IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
37SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
38Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
39VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
40Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, the Netherlands
41Department of Internal Medicine 'A. Murri' and Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
42Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
43Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
44Department of Public Health, University of Liège, Liège, Belgium
45GIGA I3 Research Group, University of Liège, Liège, Belgium
46Department of Pulmonary Medicine, CHU Liège, Liège, Belgium
47Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
48Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
49Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy, FRCB-IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
50Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
51Inserm, Equipe d’Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
52Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
53Chiba Rosai Hospital, Chiba, Japan
54Chiba University Hospital, Chiba, Japan
55Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
56Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
57Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
58Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
59Agency of Health ASL, Salerno, Italy
60Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
61Department of Pediatrics, Nippon Medical School, Tokyo, Japan
62Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
63Ecole Polytechnique de Palaiseau, Palaiseau, France
64IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France
65Université Paris Cité, Paris, France
66Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France
67UMR 1016, Institut Cochin, Paris, France
68Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
69Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
70Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
71PROMISE Department, University of Palermo, Palermo, Italy
72Usher Institute, The University of Edinburgh, Edinburgh, UK
73Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
74Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
75Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
76University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
77University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
78ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
79Universitat Pompeu Fabra (UPF), Barcelona, Spain
80CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
81Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
82Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

J Investig Allergol Clin Immunol 2025; Vol. 35(5)
doi: 10.18176/jiaci.1047

Background: The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines classify rhinitis as "intermittent" or "persistent" and "mild" or "moderate-severe".
Objectives: To assess ARIA classes in a real-world study in terms of phenotypic differences and their association with asthma.
Methods: We performed a cross-sectional real-world study based on users of the MASK-air® app who reported data for at least 3 different months. We assessed the frequency of users according to the ARIA classes and compared these classes in terms of rhinitis symptoms, use of comedication, frequency of comorbid asthma, and the association between comorbid asthma and rhinitis control.
Results: A total of 2273 users (180 796 days) were assessed. Most users had moderate-severe rhinitis (n=2003; 88.1%) and persistent rhinitis (n=1144; 50.3%). The frequency of patients with probable asthma was 35.7% (95%CI, 34.5%-37.0%) for intermittent rhinitis and 48.5% (95%CI, 47.1%-49.9%) for persistent rhinitis. The maximum values on the visual analog scale (VAS) for rhinitis symptoms and the combined symptom medication score were lower in patients with mild rhinitis than in those with moderate-severe rhinitis (irrespective of whether they had persistent or intermittent rhinitis). In most ARIA classes, VAS nose and VAS eye and rhinitis comedication were more frequent in patients with rhinitis+asthma than in those with rhinitis alone.
Conclusion: This study suggests that the presence of asthma is more closely related to persistence of rhinitis than to severity and that the presence of comorbid asthma may be associated with poorer control of rhinitis across the different ARIA classes.

Key words: Allergic rhinitis, Asthma, mHealth