Current controversies and challenges in allergic rhinitis management

David Price; Pete Smith; Peter Hellings; Nikos Papadopoulos; Wytske Fokkens; Antonella Muraro; Ruth Murray; Alison Chisholm; Pascal Demoly; Glenis Scadding; Joaquim Mullol; Phil Lieberman; Claus Bachert; Ralph Mösges; Dermot Ryan; Jean Bousquet

doi:10.1586/1744666X.2015.1081814

Current controversies and challenges in allergic rhinitis management

David Price^*, Pete Smith, Peter Hellings, Nikos Papadopoulos, Wytske Fokkens, Antonella Muraro, Ruth Murray, Alison Chisholm, Pascal Demoly, Glenis Scadding, Joaquim Mullol, Phil Lieberman, Claus Bachert, Ralph Mösges, Dermot Ryan, Jean Bousquet

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.

Original language	English
Pages (from-to)	1205-1217
Number of pages	13
Journal	Expert Review of Clinical Immunology
Volume	11
Issue number	11
DOIs	https://doi.org/10.1586/1744666X.2015.1081814
Publication status	Published - 2 Nov 2015

Keywords / Materials (for Non-textual outputs)

allergic rhinitis
clinical relevance
control
guidelines
randomized controlled trials, real life

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10.1586/1744666X.2015.1081814Licence: All Rights Reserved

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Price, D., Smith, P., Hellings, P., Papadopoulos, N., Fokkens, W., Muraro, A., Murray, R., Chisholm, A., Demoly, P., Scadding, G., Mullol, J., Lieberman, P., Bachert, C., Mösges, R., Ryan, D., & Bousquet, J. (2015). Current controversies and challenges in allergic rhinitis management. Expert Review of Clinical Immunology, 11(11), 1205-1217. https://doi.org/10.1586/1744666X.2015.1081814

@article{e4ba8c86174a4c49a511b6b666df45bb,

title = "Current controversies and challenges in allergic rhinitis management",

abstract = "There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.",

keywords = "allergic rhinitis, clinical relevance, control, guidelines, randomized controlled trials, real life",

author = "David Price and Pete Smith and Peter Hellings and Nikos Papadopoulos and Wytske Fokkens and Antonella Muraro and Ruth Murray and Alison Chisholm and Pascal Demoly and Glenis Scadding and Joaquim Mullol and Phil Lieberman and Claus Bachert and Ralph M{\"o}sges and Dermot Ryan and Jean Bousquet",

note = "Funding Information: This paper has been supported by an unrestricted educational grant from Meda. D Price has board membership with Aerocrine, Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis and Teva. Consultancy: A Almirall, Amgen, AstraZe-neca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundi-pharma, Napp, Novartis, Pfizer and Teva; grants and unrestricted funding for investigator-initiated studies from UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, Almirall, AstraZe-neca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Napp, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva and Zentiva; payments for lectures/ speaking: Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, SkyePharma, Takeda and Teva; payment for manuscript preparation: Mundipharma and Teva; patents (planned, pending or issued): AKL Ltd; payment for the development of educational materials: Glax-oSmithKline, Novartis; stock/stock options: shares in AKL Ltd which produces phytopharmaceuticals and owns 80% of Research in Real Life Ltd and its subsidiary social enterprise Optimum Patient Care; received payment for travel/accommodations/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis and Teva; funding for patient enrollment or completion of research: Almirral, Chiesi, Teva and Zentiva; and peer reviewer for grant committees: Medical Research Council (2014), Efficacy and Mechanism Evaluation program (2012), HTA (2014). P Smith has received honoraria for GSK, MSD, Mundipharma and Meda. P Hellings is the recipient of unrestricted research grants of Meda, Stallergenes and ALK. N Papadopoulos has received grants from GSK, Nestle and Merck; provided consultancy to GSK, Abbvie, Novartis, Menarini, Meda and Alk-Abello; is on the speakers bureau for Novartis, Allegopharma, Uriach, GSK, Stallergenes and MSD; and has provided educational presentations for Abbvie, Sanofi and Meda. W Fokkens has received an educational grant from MEDA and research grants from GSK, Biopharma. A Muraro has lectured for Meda, Nutricia, Novartis, Allergopharma; was the Secretary General of EAACI in 2013–2015 and the President of EAACI from 2015 to 2017. R Murray is the Director of a Medical and Scientific Affairs consultancy, who has provided consultancy services to Meda, MACVIA ARIA and RIRL. P Demoly is a consultant (and a speaker) for Stallergenes, Circassia, ALK, DBV and Chiesi, and was a speaker for Merck, Astra Zeneca, Pierre Fabre M{\'e}dicaments, Menarini, Allergo-pharma, Allergy Therapeutics Ltd, Thermo Fischer Scientific and Glax-oSmithKline. G Scadding has received research grants from GSK and ALK, as well as honoraria for articles, consulting, lectures/chairing and/ or advisory boards from ALK, Bausch & Lomb, Church & Dwight, Cir-cassia, GSK, Groupo Uriach, Meda, Merck, Ono, Shionogi and Staller-genes. J Mullol is or has been a member of national and international scientific advisory boards (consulting), received fees for lectures, and grants for research projects from ALK-Abell{\'o}, Boehringer Ingelheim, Crucell, Esteve, FAES, GSK, Hartington Pharmaceuticals, Johnson & Johnson, Meda Pharma, MSD, Novartis, Pierre Fabre, Sanofi-Aventis, Schering Plough, UCB, Uriach Group and Zambon. P Lieberman is a speaker for Meda, Teva, Merck, Genentech, Mylan, and a consultant for Sanofi, Novartis, Genentech and Mylan. C Bachert is on the speaker{\textquoteright}s bureau for Meda. R M{\"o}sges receives personal fees, or grants from ALK-Abello, Allergy Therapeutics, Allergopharma, Bencard, Biotech-Tools, Bayer, GSK, HAL, Johnson + Johnson, Lofarma, MSD, Menar-ini, Faes, Novartis, Leti, Optima, AIPrevent, Servier, Stada, Stallergenes, UCB, Ursapharm, Bitop, Hulka, Arthrocare, Meda and Ohropax. He has received non-financial support from Greer, Roxall, UCB and Atmos. Outside the submitted work, Ralph M{\"o}sges is a member of the guidelines task force of the German Academy of Otorhinolaryngology. He is the chairman of ISCOANA, the International Standardization Committee of the European Rhinologic Society (ERS), the Chairman of the ENT-section of the European Academy of Allergy, Asthma and Clinical Immunology (EAACI) and a Vice-president of INTERASMA. D Ryan is paid consultancy fees by Stallergenes, Uriach and Teva. He has lectured on behalf of Meda, GSK, AZ, Chiesi, Thermo Fisher, Boehringer, Novartis and Almirall. He is the Director of Health Strategy at Optimum Patient Care. J Bousquet has received honoraria for scientific and advisory boards: Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach; lectures during meetings for the following: Almirall, AstraZeneca, Chiesi, GSK, Meda, Menarini, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach; and is on the Board of Directors for Stallergenes. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Publisher Copyright: {\textcopyright} 2015 Taylor & Francis.",

year = "2015",

month = nov,

day = "2",

doi = "10.1586/1744666X.2015.1081814",

language = "English",

volume = "11",

pages = "1205--1217",

journal = "Expert Review of Clinical Immunology",

issn = "1744-666X",

publisher = "Expert Reviews Ltd.",

number = "11",

}

Price, D, Smith, P, Hellings, P, Papadopoulos, N, Fokkens, W, Muraro, A, Murray, R, Chisholm, A, Demoly, P, Scadding, G, Mullol, J, Lieberman, P, Bachert, C, Mösges, R, Ryan, D & Bousquet, J 2015, 'Current controversies and challenges in allergic rhinitis management', Expert Review of Clinical Immunology, vol. 11, no. 11, pp. 1205-1217. https://doi.org/10.1586/1744666X.2015.1081814

TY - JOUR

T1 - Current controversies and challenges in allergic rhinitis management

AU - Price, David

AU - Smith, Pete

AU - Hellings, Peter

AU - Papadopoulos, Nikos

AU - Fokkens, Wytske

AU - Muraro, Antonella

AU - Murray, Ruth

AU - Chisholm, Alison

AU - Demoly, Pascal

AU - Scadding, Glenis

AU - Mullol, Joaquim

AU - Lieberman, Phil

AU - Bachert, Claus

AU - Mösges, Ralph

AU - Ryan, Dermot

AU - Bousquet, Jean

N1 - Funding Information: This paper has been supported by an unrestricted educational grant from Meda. D Price has board membership with Aerocrine, Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis and Teva. Consultancy: A Almirall, Amgen, AstraZe-neca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundi-pharma, Napp, Novartis, Pfizer and Teva; grants and unrestricted funding for investigator-initiated studies from UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, Almirall, AstraZe-neca, Boehringer Ingelheim, Chiesi, Eli Lilly, GlaxoSmithKline, Meda, Merck, Mundipharma, Napp, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva and Zentiva; payments for lectures/ speaking: Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, SkyePharma, Takeda and Teva; payment for manuscript preparation: Mundipharma and Teva; patents (planned, pending or issued): AKL Ltd; payment for the development of educational materials: Glax-oSmithKline, Novartis; stock/stock options: shares in AKL Ltd which produces phytopharmaceuticals and owns 80% of Research in Real Life Ltd and its subsidiary social enterprise Optimum Patient Care; received payment for travel/accommodations/meeting expenses from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis and Teva; funding for patient enrollment or completion of research: Almirral, Chiesi, Teva and Zentiva; and peer reviewer for grant committees: Medical Research Council (2014), Efficacy and Mechanism Evaluation program (2012), HTA (2014). P Smith has received honoraria for GSK, MSD, Mundipharma and Meda. P Hellings is the recipient of unrestricted research grants of Meda, Stallergenes and ALK. N Papadopoulos has received grants from GSK, Nestle and Merck; provided consultancy to GSK, Abbvie, Novartis, Menarini, Meda and Alk-Abello; is on the speakers bureau for Novartis, Allegopharma, Uriach, GSK, Stallergenes and MSD; and has provided educational presentations for Abbvie, Sanofi and Meda. W Fokkens has received an educational grant from MEDA and research grants from GSK, Biopharma. A Muraro has lectured for Meda, Nutricia, Novartis, Allergopharma; was the Secretary General of EAACI in 2013–2015 and the President of EAACI from 2015 to 2017. R Murray is the Director of a Medical and Scientific Affairs consultancy, who has provided consultancy services to Meda, MACVIA ARIA and RIRL. P Demoly is a consultant (and a speaker) for Stallergenes, Circassia, ALK, DBV and Chiesi, and was a speaker for Merck, Astra Zeneca, Pierre Fabre Médicaments, Menarini, Allergo-pharma, Allergy Therapeutics Ltd, Thermo Fischer Scientific and Glax-oSmithKline. G Scadding has received research grants from GSK and ALK, as well as honoraria for articles, consulting, lectures/chairing and/ or advisory boards from ALK, Bausch & Lomb, Church & Dwight, Cir-cassia, GSK, Groupo Uriach, Meda, Merck, Ono, Shionogi and Staller-genes. J Mullol is or has been a member of national and international scientific advisory boards (consulting), received fees for lectures, and grants for research projects from ALK-Abelló, Boehringer Ingelheim, Crucell, Esteve, FAES, GSK, Hartington Pharmaceuticals, Johnson & Johnson, Meda Pharma, MSD, Novartis, Pierre Fabre, Sanofi-Aventis, Schering Plough, UCB, Uriach Group and Zambon. P Lieberman is a speaker for Meda, Teva, Merck, Genentech, Mylan, and a consultant for Sanofi, Novartis, Genentech and Mylan. C Bachert is on the speaker’s bureau for Meda. R Mösges receives personal fees, or grants from ALK-Abello, Allergy Therapeutics, Allergopharma, Bencard, Biotech-Tools, Bayer, GSK, HAL, Johnson + Johnson, Lofarma, MSD, Menar-ini, Faes, Novartis, Leti, Optima, AIPrevent, Servier, Stada, Stallergenes, UCB, Ursapharm, Bitop, Hulka, Arthrocare, Meda and Ohropax. He has received non-financial support from Greer, Roxall, UCB and Atmos. Outside the submitted work, Ralph Mösges is a member of the guidelines task force of the German Academy of Otorhinolaryngology. He is the chairman of ISCOANA, the International Standardization Committee of the European Rhinologic Society (ERS), the Chairman of the ENT-section of the European Academy of Allergy, Asthma and Clinical Immunology (EAACI) and a Vice-president of INTERASMA. D Ryan is paid consultancy fees by Stallergenes, Uriach and Teva. He has lectured on behalf of Meda, GSK, AZ, Chiesi, Thermo Fisher, Boehringer, Novartis and Almirall. He is the Director of Health Strategy at Optimum Patient Care. J Bousquet has received honoraria for scientific and advisory boards: Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach; lectures during meetings for the following: Almirall, AstraZeneca, Chiesi, GSK, Meda, Menarini, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach; and is on the Board of Directors for Stallergenes. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Publisher Copyright: © 2015 Taylor & Francis.

PY - 2015/11/2

Y1 - 2015/11/2

N2 - There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.

AB - There are many obstacles in the path of effective allergy management, in general, and allergic rhinitis (AR) control, in particular. Chief among them are: insufficient symptom relief in some patients provided by some currently considered first-line AR treatments in real life; an over-reliance on randomized controlled trials to direct AR guideline recommendations; the need for a broader interpretation of the AR evidence base (to include randomized controlled trials and real-life studies); poorly designed and interpreted studies; and lack of an AR control concept and common language of control. These controversies are fully reviewed here and challenging solutions have been presented.

KW - allergic rhinitis

KW - clinical relevance

KW - control

KW - guidelines

KW - randomized controlled trials, real life

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U2 - 10.1586/1744666X.2015.1081814

DO - 10.1586/1744666X.2015.1081814

M3 - Review article

C2 - 26325631

AN - SCOPUS:84945457564

SN - 1744-666X

VL - 11

SP - 1205

EP - 1217

JO - Expert Review of Clinical Immunology

JF - Expert Review of Clinical Immunology

IS - 11

ER -

Current controversies and challenges in allergic rhinitis management

Abstract

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