[en] BACKGROUND: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., "real-world data"). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. METHODS: We assessed the MASK-air® app data (May 2015-December 2020) by users self-reporting AR (16-90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication. RESULTS: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71-0.80). CONCLUSION: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Sousa-Pinto, Bernardo ; MEDCIDS - Department of Community Medicine, Information and Health Decision ; CINTESIS - Center for Health Technology and Services Research, University of ; RISE - Health Research Network, University of Porto, Porto, Portugal.
Schünemann, Holger J; Department of Health Research Methods, Evidence, and Impact & Department of
Sá-Sousa, Ana ; MEDCIDS - Department of Community Medicine, Information and Health Decision ; CINTESIS - Center for Health Technology and Services Research, University of ; RISE - Health Research Network, University of Porto, Porto, Portugal.
Vieira, Rafael José ; MEDCIDS - Department of Community Medicine, Information and Health Decision ; CINTESIS - Center for Health Technology and Services Research, University of ; RISE - Health Research Network, University of Porto, Porto, Portugal.
Amaral, Rita ; MEDCIDS - Department of Community Medicine, Information and Health Decision ; CINTESIS - Center for Health Technology and Services Research, University of ; RISE - Health Research Network, University of Porto, Porto, Portugal.
Anto, Josep M; ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain. ; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. ; Universitat Pompeu Fabra (UPF), Barcelona, Spain. ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Klimek, Ludger ; Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz
Czarlewski, Wienczyslawa; Medical Consulting Czarlewski, Levallois, France.
Mullol, Joaquim; Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical &
Pfaar, Oliver ; Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology
Bedbrook, Anna; ARIA, Montpellier, France.
Brussino, Luisa; Department of Medical Sciences, Allergy and Clinical Immunology Unit, University
Kvedariene, Violeta; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine,
Larenas-Linnemann, Desirée ; Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and
Okamoto, Yoshitaka; Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan.
Ventura, Maria Teresa; University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari,
Agache, Ioana ; Transylvania University Brasov, Brasov, Romania.
Ansotegui, Ignacio J; Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao,
Bergmann, Karl C; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member ; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP,
Bosnic-Anticevich, Sinthia; Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical
Brozek, Jan; Department of Health Research Methods, Evidence, and Impact & Department of
Canonica, G Walter; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy. ; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center
Cardona, Victoria ; Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron &
Carreiro-Martins, Pedro; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar ; NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon,
Casale, Thomas; Division of Allergy/Immunology, University of South Florida, Tampa, Florida, USA.
Cecchi, Lorenzo ; SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy.
Chivato, Tomas; School of Medicine, University CEU San Pablo, Madrid, Spain.
Chu, Derek K; Department of Medicine and Health Research Methods, Evidence & Impact, McMaster
Cingi, Cemal ; ENT Department, Medical Faculty, Eskisehir Osmangazi University, Eskisehir
Costa, Elísio M; UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy
Cruz, Alvaro A ; Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group
Del Giacco, Stefano; Department of Medical Sciences and Public Health and Unit of Allergy and Clinical
Devillier, Philippe; VIM Suresnes, UMR_0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch,
Eklund, Patrik; Department of Computing Science, Umeå University, Umeå, Sweden.
Fokkens, Wytske J; Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location
Gemicioglu, Bilun; Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa
Haahtela, Tari ; Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki
Ivancevich, Juan Carlos; Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina.
Ispayeva, Zhanat; President of Kazakhstan Association of Allergology and Clinical Immunology,
Jutel, Marek; Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland. ; ALL-MED Medical Research Institute, Wrocław, Poland.
Kuna, Piotr; Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital,
Kaidashev, Igor; Poltava State Medical University, Poltava, Ukraine.
Khaitov, Musa ; National Research Center, Institute of Immunology, Federal Medicobiological
Kraxner, Helga; Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University,
Laune, Daniel; KYomed INNOV, Montpellier, France.
Lipworth, Brian; Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine,
Louis, Renaud ; Centre Hospitalier Universitaire de Liège - CHU > > Service de pneumologie - allergologie
Makris, Michael; Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology,
Monti, Riccardo; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico
Morais-Almeida, Mario ; Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal.
Mösges, Ralph; IMSB, Medical Faculty, University at Cologne, and ClinCompetence Cologne GmbH,
Niedoszytko, Marek ; Department of Allergology, Medical University of Gdańsk, Gdansk, Poland.
Papadopoulos, Nikolaos G ; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
Patella, Vincenzo ; Division of Allergy and Clinical Immunology, Department of Medicine, Agency of
Pham-Thi, Nhân; Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des
Regateiro, Frederico S; Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de
Reitsma, Sietze; Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC,
Rouadi, Philip W ; Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University ; ENT Department, Dar Al Shifa Hospital- Salmiya, Salmiya, Kuwait.
Samolinski, Boleslaw; Department of Prevention of Environmental Hazards, Allergology and Immunology,
Sheikh, Aziz; Usher Institute, The University of Edinburgh, Edinburgh, UK.
Sova, Milan; Department of Pulmonary Medicine and Tuberculosis, University Hospital Brno,
Todo-Bom, Ana; Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of
Taborda-Barata, Luis; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal. ; UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, ; Department of Immunoallergology, Cova da Beira University Hospital Centre,
Toppila-Salmi, Sanna; Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki,
Sastre, Joaquin; Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of
Tsiligianni, Ioanna; Health Planning Unit, Department of Social Medicine, Faculty of Medicine,
Valiulis, Arunas; Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty
Vandenplas, Olivier ; Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur
Wallace, Dana; Nova Southeastern University, Fort Lauderdale, Florida, USA.
Waserman, Susan; Department of Medicine, Clinical Immunology and Allergy, McMaster University,
Yorgancioglu, Arzu; Celal Bayar University, Department of Pulmonology, Manisa, Turkey.
Zidarn, Mihaela; University Clinic of Respiratory and Allergic Diseases, Golnick, Slovenia. ; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Zuberbier, Torsten ; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member ; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP
Fonseca, Joao A ; MEDCIDS - Department of Community Medicine, Information and Health Decision ; CINTESIS - Center for Health Technology and Services Research, University of ; RISE - Health Research Network, University of Porto, Porto, Portugal.
Bousquet, Jean ; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member ; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, ; University Hospital Montpellier, Montpellier, France.
Comparison of rhinitis treatments using MASK-air® data and considering the minimal important difference.
Publication date :
October 2022
Journal title :
Allergy
ISSN :
0105-4538
eISSN :
1398-9995
Publisher :
Wiley-Blackwell, Oxford, Gb
Volume :
77
Issue :
10
Pages :
3002-3014
Peer reviewed :
Peer Reviewed verified by ORBi
Funding number :
MASK-air® has been supported by EU grants (POLLAR, EIT Health; Structural and Development Funds, Twinning, EIP on AHA and H2020) and educational grants from Mylan-Viatris, ALK, GSK, Novartis and Uriach./
Portnoy JM, Van Osdol T, Williams PB. Evidence-based strategies for treatment of allergic rhinitis. Curr Allergy Asthma Rep. 2004;4(6):439-446.
Bousquet J, Devillier P, Arnavielhe S, et al. Treatment of allergic rhinitis using mobile technology with real-world data: the MASK observational pilot study. Allergy. 2018;73(9):1763-1774.
Bedard A, Basagana X, Anto JM, et al. Mobile technology offers novel insights into the control and treatment of allergic rhinitis: the MASK study. J Allergy Clin Immunol. 2019;144(1):135-143 e136.
Bedard A, Basagana X, Anto JM, et al. Treatment of allergic rhinitis during and outside the pollen season using mobile technology. A MASK Study. Clin Transl Allergy. 2020;10(1):62.
Bousquet J, Anto JM, Bachert C, et al. ARIA digital anamorphosis: digital transformation of health and care in airway diseases from research to practice. Allergy. 2021;76(1):168-190.
Bousquet J, Meltzer EO, Couroux P, et al. Onset of action of the fixed combination intranasal azelastine-fluticasone propionate in an allergen exposure chamber. J Allergy Clin Immunol Pract. 2018;6(5):1726-1732 e1726.
Patel P, Salapatek AM, Tantry SK. Effect of olopatadine-mometasone combination nasal spray on seasonal allergic rhinitis symptoms in an environmental exposure chamber study. Ann Allergy Asthma Immunol. 2019;122(2):160-166 e161.
Bousquet J, Schunemann HJ, Togias A, et al. Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80 e73.
Bousquet J, Bewick M, Arnavielhe S, et al. Work productivity in rhinitis using cell phones: the MASK pilot study. Allergy. 2017;72(10):1475-1484.
Laune D, Arnavielhe S, Viart F, et al. Adaptation of the general data protection regulation (GDPR) to a smartphone app for rhinitis and asthma (MASK-air[R]). Rev mal Respir. 2019;36(9):1019-1031.
Samreth D, Arnavielhe S, Ingenrieth F, et al. Geolocation with respect to personal privacy for the allergy diary app - a MASK study. World Allergy Organ J. 2018;11(1):15.
Kopp-Kubel S. International nonproprietary names (INN) for pharmaceutical substances. Bull World Health Organ. 1995;73(3):275-279.
Harrison XA, Donaldson L, Correa-Cano ME, et al. A brief introduction to mixed effects modelling and multi-model inference in ecology. PeerJ. 2018;6:e4794.
Mouelhi Y, Jouve E, Castelli C, Gentile S. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020;18(1):136.
Schunemann HJ, Guyatt GH. Commentary--goodbye M(C)ID! Hello MID, where do you come from? Health Serv Res. 2005;40(2):593-597.
Pfaar O, Sousa-Pinto B, Devillier P, et al. Effects of allergen immunotherapy in the MASK-air study: a proof-of-concept analysis. Allergy. 2021;76(10):3212-3214.
Burte E, Leynaert B, Marcon A, et al. Long-term air pollution exposure is associated with increased severity of rhinitis in 2 European cohorts. J Allergy Clin Immunol. 2020;145(3):834-842 e836.
Hampel FC, Ratner PH, Van Bavel J, et al. Double-blind, placebo-controlled study of azelastine and fluticasone in a single nasal spray delivery device. Ann Allergy Asthma Immunol. 2010;105(2):168-173.
Cook CE. Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense. J Man Manip Ther. 2008;16(4):E82-E83.
Menditto E, Costa E, Midao L, et al. Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study. Clin Exp Allergy. 2019;49(4):442-460.
Bousquet J, Devillier P, Anto JM, et al. Daily allergic multimorbidity in rhinitis using mobile technology: a novel concept of the MASK study. Allergy. 2018;73(8):1622-1631.
Bedard A, Anto JM, Fonseca JA, et al. Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air([R]) app. Allergy. 2020;75(7):1672-1688.
Bedard A, Sofiev M, Arnavielhe S, et al. Interactions between air pollution and pollen season for rhinitis using Mobile technology: a MASK-POLLAR study. J Allergy Clin Immunol Pract. 2020;8(3):1063-1073 e1064.
Sousa-Pinto B, Eklund P, Pfaar O, et al. Validity, reliability and responsiveness of daily monitoring visual analogue scales in MASK-air®. Clin Transl Allergy. 2021;11(7):e12062.
Bousquet PJ, Combescure C, Klossek JM, Daures JP, Bousquet J. Change in visual analog scale score in a pragmatic randomized cluster trial of allergic rhinitis. J Allergy Clin Immunol. 2009;123(6):1349-1354.
