Allergic Rhinitis and Its Impact on Asthma ( <scp>ARIA</scp> )‐ <scp>EAACI</scp> Guidelines—2024–2025 Revision: Part I—Guidelines on Intranasal Treatments
Bernardo Sousa‐Pinto, Jean Bousquet, Rafael José Vieira, Holger J. Schünemann, Torsten Zuberbier, Antonio Bognanni, Alkis Togias, Bolesław Samoliński, Arunas Valiulis, Sian Williams, Anna Bedbrook, Wienczyslawa Czarlewski, Marı́a José Torres, Mohamed H. Shamji, Mário Morais‐Almeida, Giorgio Walter Canonica, Leticia de las Vecillas, Mark S. Dykewicz, Cristina Jacomelli, Ludger Klimek, Lucas Leemann, Olga Lourenço, Yuliia Palamarchuk, Nikolaos G. Papadopoulos, Ana Margarida Pereira, Marine Savouré, Sanna Toppila‐Salmi, Maria Teresa Ventura, Juan José Yepes-Núñez, Álvaro A. Cruz, Giorgio Ciprandi, Bilun Gemicioğlu, Mattia Giovannini, Brigita Gradauskienė, Tuomas Jartti, Miloš Jeseňák, Piotr Kuna, Violeta Kvedarienė, Désirée Larenas‐Linnemann, Amir Hamzah Abdul Latiff, Yousser Mohammad, Ken Ohta, P A Mahesh, Isabella Pali‐Schöll, Oliver Pfaar, Frederico S. Regateiro, Nicolás Roche, Luís Taborda‐Barata, Charlotte Suppli Ulrik, Marylin Valentin Rostan, Giovanni Viegi, Luo Zhang, Tari Haahtela, Iván Chérrez-Ojeda, Juan Carlos Ivancevich, Nikolaï Khaltaev, Arzu Yorgancıoğlu, Baharudin Abdullah, Mona Al‐Ahmad, Maryam Al‐Nesf, Rita Amaral, Julijana Asllani, Karl‐Christian Bergmann, Jonathan A. Bernstein, Michael S. Blaiss, Fulvio Braido, Paulo Augusto Moreira Camargos, Pedro Martins, Thomas B. Casale, Lorenzo Cecchi, Alessandro Fiocchi, Antonio Francesco Maria Giuliano, George Christoff, Ieva Cirule, Jaime Correia de Sousa, Elı́sio Costa, Stefano R. Del Giacco, Philippe Devillier, Dejan Dokic, Elham Hossny, Tomohisa Iinuma, Carla Irani, Zhanat Ispayeva, Kaja Julge, Ігор Петрович Кайдашев, Kazi S. Bennoor, Helga Kraxner, Inger Kull, Marek Kulus, Maciej Kupczyk, А.И. Курченко, Stefania La Grutta, Neven Mičulinić, Lan Le Thi Tuyet, Μichael Μakris, Branislava Milenković, Sang Min Lee, Stephen Montefort, André Moreira, Joaquim Mullol
Abstract
BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management. METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs. RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH. CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.