ARIA 2017: a Review of Major Changes and Innovations

Abstract

Background: Allergic rhinitis is a disease underestimated by patients, and underdiagnosed and thus undertreated by physicians since most of the patients present with symptoms of moderate-to-severe disease, overall diminished quality of life, impairing sleep quality and cognitive function, and a substantial impact on work productivity, school absenteeism, and costs. The relationship between treating physician and patients is crucial in all chronic diseases. Objectives: Review the main changes and innovations of recent years in the ARIA guidelines. Methods: The most recent publications of the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines were reviewed. Results: ARIA 2016 strengthens the role of patients in the control and treatment of their symptoms by the use of technology, which improves physician-patient communication. The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. It confirms that inhaled corticosteroids are the most effective drugs for the management of seasonal or perennial allergic rhinitis, not surpassed by combination therapies with oral or topical antihistamines. On the other hand, no significant differences between the use of oral or topical antihistamines are evidenced. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. A step-up/step-down individualized approach to AR pharmacotherapy might hold the potential for optimal control of AR symptoms while minimizing side effects and costs. After choosing the best pharmacological therapy, compliance is a critical issue in the management of all chronic diseases. In order to improve compliance, it is important to consider patient preferences and views of patients and their caregivers, as ARIA guidelines remarks in the 2016 update. Conclusion: ARIA guideline has evolved to a technology-based implementation strategy to help rhinitis sufferers to have an active and healthy life and to reduce health and social inequalities caused by this very common disease, irrespective of their age, sex, or socio-economic status.