Asia Pac Allergy.  2016 Jan;6(1):56-66. 10.5415/apallergy.2016.6.1.56.

Role of bilastine in the management of allergic rhinitis and urticaria: an Asia-Pacific consensus statement

• Mösges R
• Lee DL
• Abong J
• Siasoco B
• Chow SK
• Leong JL
• Singh H
• Kuljit S
• Campomanes B

• KMID: 2396971
• DOI: http://doi.org/10.5415/apallergy.2016.6.1.56

Abstract

The prevalence of allergic diseases is increasing globally, most particularly in middle- to low-income countries. This article examines the burden of allergic rhinitis and chronic urticaria in the Asia-Pacific region, unmet clinical needs, and the potential role of bilastine in the management of these conditions. An International Advisory Group meeting was convened in association with the Asian Pacific Society of Respirology Annual Congress in November 2014, followed by a literature review, and consensus-based outcomes from the meeting and literature review are described. Regional estimates of the prevalence of allergic rhinitis range from 10% to 50%, while little is known regarding the burden of urticaria in the Asia-Pacific region. A survey of allergy patients in the region identified fast, complete, and long-lasting symptom relief as the medication attributes most important to patients. International treatment guidelines for allergic rhinitis and urticaria advocate the first-line use of second-generation, no-sedating H1-antihistamines, such as bilastine, over their first-generation counterparts and a range of these agents are available to Asia-Pacific patients. The newer agents possess many of the properties of an "ideal" antihistamine (once daily administration, rapid and complete symptom relief, limited potential for drug-drug interactions, minimal side effects). The burgeoning prevalence of allergic diseases in the Asia-Pacific region and the uncontrolled symptoms that these patients experience demand a new antihistamine that offers the highest number of positive features according to the international guidelines.

Keyword

Rhinitis, Allergic; Urticaria; Histamine Antagonists; Asia; Consensus; Bilastine

MeSH Terms

Asia
Asian Continental Ancestry Group
Consensus*
Group Processes
Histamine Antagonists
Humans
Hypersensitivity
Prevalence
Rhinitis, Allergic*
Urticaria*
Histamine Antagonists

Reference

1. Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. WAO white book on allergy: update 2013. Milwaukee (WI): World Allergy Organization;2013.

2. Bjorksten B, Clayton T, Ellwood P, Stewart A, Strachan D. ISAAC Phase III Study Group. Worldwide time trends for symptoms of rhinitis and conjunctivitis: Phase III of the International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol. 2008; 19:110–124.

3. Park HS, Choi GS, Cho JS, Kim YY. Epidemiology and current status of allergic rhinitis, asthma, and associated allergic diseases in Korea: ARIA Asia-Pacific workshop report. Asian Pac J Allergy Immunol. 2009; 27:167–171.

4. Wu WF, Wan KS, Wang SJ, Yang W, Liu WL. Prevalence, severity, and time trends of allergic conditions in 6-to-7-year-old schoolchildren in Taipei. J Investig Allergol Clin Immunol. 2011; 21:556–562.

5. Zhao J, Bai J, Shen K, Xiang L, Huang S, Chen A, Huang Y, Wang J, Ye R. Self-reported prevalence of childhood allergic diseases in three cities of China: a multicenter study. BMC Public Health. 2010; 10:551.

6. Hong Q, Bai C, Wang X. Characteristics of Chinese patients with cough in primary care centre. J Transl Med. 2011; 9:149.

7. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004; 24:758–764.

8. Chang JW, Lin CY, Chen WL, Chen CT. Higher incidence of Dermatophagoides pteronyssinus allergy in children of Taipei city than in children of rural areas. J Microbiol Immunol Infect. 2006; 39:316–320.

9. Lam HT, Van Tuong N, Ekerljung L, Ronmark E, Lundback B. Allergic rhinitis in northern vietnam: increased risk of urban living according to a large population survey. Clin Transl Allergy. 2011; 1:7.

10. Ma Y, Zhao J, Han ZR, Chen Y, Leung TF, Wong GW. Very low prevalence of asthma and allergies in schoolchildren from rural Beijing, China. Pediatr Pulmonol. 2009; 44:793–799.

11. Sriyaraj K, Priest N, Shutes B. Environmental factors influencing the prevalence of respiratory diseases and allergies among schoolchildren in Chiang Mai, Thailand. Int J Environ Health Res. 2008; 18:129–148.

12. Devalia JL, Rusznak C, Davies RJ. Allergen/irritant interaction: its role in sensitization and allergic disease. Allergy. 1998; 53:335–345.

13. D'Amato G, Cecchi L, D'Amato M, Liccardi G. Urban air pollution and climate change as environmental risk factors of respiratory allergy: an update. J Investig Allergol Clin Immunol. 2010; 20:95–102.

14. Annesi-Maesano I, Beyer A, Marmouz F, Mathelier-Fusade P, Vervloet D, Bauchau V. Concurrent allergic diseases: a cross-sectional study in a French population. Allergy. 2006; 61:390–391.

15. Zazzali JL, Broder MS, Chang E, Chiu MW, Hogan DJ. Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2012; 108:98–102.

16. Blaiss MS, Montanaro A. Allergic rhinitis and chronic urticaria: management of histamine-induced disorders. Prim Issue. 2009; 11:24–34.

17. Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma. A population-based study of young adults. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1391–1396.

18. Pherwani AV, Bansode G, Gadhia S. The impact of chronic urticaria on the quality of life in Indian patients. Indian J Dermatol. 2012; 57:110–113.

19. Liu JB, Yao MZ, Si AL, Xiong LK, Zhou H. Life quality of Chinese patients with chronic urticaria as assessed by the dermatology life quality index. J Eur Acad Dermatol Venereol. 2012; 26:1252–1257.

20. Kang MJ, Kim HS, Kim HO, Park YM. The impact of chronic idiopathic urticaria on quality of life in korean patients. Ann Dermatol. 2009; 21:226–229.

21. Katelaris CH, Lai CK, Rhee CS, Lee SH, Yun WD, Lim-Varona L, Quang VT, Hwang J, Singh H, Kim J, Boyle JM, Dhong HJ, Narayanan P, Vicente G, Blaiss M, Sacks R. Nasal allergies in the Asian-Pacific population: results from the Allergies in Asia-Pacific Survey. Am J Rhinol Allergy. 2011; 25:Suppl 1. S3–S15.

22. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schunemann HJ. Global Allergy and Asthma European Network. Grading of Recommendations Assessment, Development and Evaluation Working Group. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:466–476.

23. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Gimenez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sanchez-Borges M, Schmid-Grendelmeier P, Simons FE, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. European Academy of Allergy and Clinical Immunology. Global Allergy and Asthma European Network. European Dermatology Forum. World Allergy Organization. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69:868–887.

24. Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, Park YM, Lee SY, Han M, Kim WK. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide cross-sectional survey using complex sampling design. J Korean Med Assoc. 2011; 54:769–778.

25. Li F, Zhou Y, Li S, Jiang F, Jin X, Yan C, Tian Y, Zhang Y, Tong S, Shen X. Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: a multicenter study. BMC Public Health. 2011; 11:437.

26. Seong HU, Cho SD, Park SY, Yang JM, Lim DH, Kim JH, Son BK. Nationwide survey on the prevalence of allergic diseases according to region and age. Pediatr Allergy Respir Dis. 2012; 22:224–231.

27. Shen J, Ke X, Hong S, Zeng Q, Liang C, Li T, Tang A. Epidemiological features of allergic rhinitis in four major cities in Western China. J Huazhong Univ Sci Technolog Med Sci. 2011; 31:433–440.

28. Teeratakulpisarn J, Pairojkul S, Heng S. Survey of the prevalence of asthma, allergic rhinitis and eczema in schoolchildren from Khon Kaen, Northeast Thailand. an ISAAC study International Study of Asthma and Allergies in Childhood. Asian Pac J Allergy Immunol. 2000; 18:187–194.

29. Teeratakulpisarn J, Wiangnon S, Kosalaraksa P, Heng S. Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III. Asian Pac J Allergy Immunol. 2004; 22:175–181.

30. Uthaisangsook S. Prevalence of asthma, rhinitis, and eczema in the university population of Phitsanulok, Thailand. Asian Pac J Allergy Immunol. 2007; 25:127–132.

31. Wang ZH, Lin WS, Li SY, Zhao SC, Wang L, Yang ZG, Chen J, Zhang ZF, Yu JZ. Research on prevalence and related factors in allergic rhinitis. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011; 46:225–231.

32. Zhao J, Bai J, Shen KL, Xiang L, Huang Y, Huang S, Chen AH, Wang JS, Ye RW. Questionnaire-based survey of allergic diseases among children aged 0 - 14 years in the downtown of Beijing, Chongqing and Guangzhou. Zhonghua Er Ke Za Zhi. 2011; 49:740–744.

33. Meltzer EO, Blaiss MS, Naclerio RM, Stoloff SW, Derebery MJ, Nelson HS, Boyle JM, Wingertzahn MA. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc. 2012; 33:Suppl 1. S113–S141.

34. Andiappan AK, Puan KJ, Lee B, Nardin A, Poidinger M, Connolly J, Chew FT, Wang DY, Rotzschke O. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy. 2014; 69:501–509.

35. Lam HT, Ekerljung L, Bjerg A, Van T Tng N, Lundbäck B, Ronmark E. Sensitization to airborne allergens among adults and its impact on allergic symptoms: a population survey in northern Vietnam. Clin Transl Allergy. 2014; 4:6.

36. Prasarnphanich T, Sindhurat S. Sensitization to common indoor allergens and its association with allergic diseases in Thai female high-school students. Pediatr Allergy Immunol. 2005; 16:402–407.

37. Sun BQ, Zheng PY, Zhang XW, Huang HM, Chen DH, Zeng GQ. Prevalence of allergen sensitization among patients with allergic diseases in Guangzhou, Southern China: a four-year observational study. Multidiscip Respir Med. 2014; 9:2.

38. Pawankar R, Bunnag C, Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA update 2008. World Allergy Organ J. 2012; 5:Suppl 3. S212–S217.

39. Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007; 62:Suppl 85. 17–25.

40. Blaiss MS. Allergic rhinitis: direct and indirect costs. Allergy Asthma Proc. 2010; 31:375–380.

41. Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc. 2007; 28:3–9.

42. Ngamphaiboon J, Kongnakorn T, Detzel P, Sirisomboonwong K, Wasiak R. Direct medical costs associated with atopic diseases among young children in Thailand. J Med Econ. 2012; 15:1025–1035.

43. Stull DE, Gavriel S. Use of, satisfaction with, and willingness to switch prescription and over-the-counter treatments for chronic urticaria: an online survey. Patient. 2009; 2:151–157.

44. Staubach P, Dechene M, Metz M, Magerl M, Siebenhaar F, Weller K, Zezula P, Eckhardt-Henn A, Maurer M. High prevalence of mental disorders and emotional distress in patients with chronic spontaneous urticaria. Acta Derm Venereol. 2011; 91:557–561.

45. Yun J, Katelaris CH, Weerasinghe A, Adikari DB, Ratnayake C. Impact of chronic urticaria on the quality of life in Australian and Sri Lankan populations. Asia Pac Allergy. 2011; 1:25–29.

46. Baiardini I, Braido F, Bindslev-Jensen C, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, Gimenez-Arnau A, Godse K, Grattan C, Grob JJ, La Grutta S, Kalogeromitros D, Kocaturk E, Lombardi C, Mota-Pinto A, Ridolo E, Saini SS, Sanchez-Borges M, Senna GE, Terreehorst I, Todo Bom A, Toubi E, Bousquet J, Zuberbier T, Maurer M. Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA(2) LEN taskforce position paper. Allergy. 2011; 66:840–844.

47. Chow SK. Management of chronic urticaria in Asia: 2010 AADV consensus guidelines. Asia Pac Allergy. 2012; 2:149–160.

48. Church DS, Church MK. Pharmacology of antihistamines. World Allergy Organ J. 2011; 4:3 Suppl. S22–S27.

49. Bousquet J, Ansotegui I, Canonica GW, Zuberbier T, Baena-Cagnani CE, Bachert C, Cruz AA, González SN, Kuna P, Morais-Almeida M, Mullol J, Ryan DP, Sánchez-Borges M, Valiente R, Church MK. Establishing the place in therapy of bilastine in the treatment of allergic rhinitis according to ARIA: evidence review. Curr Med Res Opin. 2012; 28:131–139.

50. Bousquet J, Van Cauwenberge P, Bachert C, Canonica GW, Demoly P, Durham SR, Fokkens W, Lockey R, Meltzer EO, Mullol J, Naclerio RM, Price D, Simons FE, Vignola AM, Warner JO. European Academy of Allergy and Clinical Immunology (EAACI). Allergic Rhinitis and its Impact on Asthma (ARIA). Requirements for medications commonly used in the treatment of allergic rhinitis European Academy of Allergy and Clinical Immunology (EAACI), Allergic Rhinitis and its Impact on Asthma (ARIA). Allergy. 2003; 58:192–197.

51. Church MK. Comparative inhibition by bilastine and cetirizine of histamine-induced wheal and flare responses in humans. Inflamm Res. 2011; 60:1107–1112.

52. Horak F, Zieglmayer P, Zieglmayer R, Lemell P. The effects of bilastine compared with cetirizine, fexofenadine, and placebo on allergen-induced nasal and ocular symptoms in patients exposed to aeroallergen in the Vienna Challenge Chamber. Inflamm Res. 2010; 59:391–398.

53. Bachert C, Kuna P, Sanquer F, Ivan P, Dimitrov V, Gorina MM, van de Heyning P, Loureiro A. Bilastine International Working Group. Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patients. Allergy. 2009; 64:158–165.

54. Kuna P, Bachert C, Nowacki Z, van Cauwenberge P, Agache I, Fouquert L, Roger A, Sologuren A, Valiente R. Bilastine International Working Group. Efficacy and safety of bilastine 20 mg compared with cetirizine 10 mg and placebo for the symptomatic treatment of seasonal allergic rhinitis: a randomized, double-blind, parallel-group study. Clin Exp Allergy. 2009; 39:1338–1347.

55. Sastre J, Mullol J, Valero A, Valiente R. Bilastine Study Group. Efficacy and safety of bilastine 20 mg compared with cetirizine 10 mg and placebo in the treatment of perennial allergic rhinitis. Curr Med Res Opin. 2012; 28:121–130.

56. Zuberbier T, Oanta A, Bogacka E, Medina I, Wesel F, Uhl P, Antepara I, Jauregui I, Valiente R. Bilastine International Working Group. Comparison of the efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: a multi-centre, double-blind, randomized, placebo-controlled study. Allergy. 2010; 65:516–528.

57. Jauregui I, Bartra J, del Cuvillo A, Dávila I, Ferrer M, Montoro J, Mullol J, Sastre J, Valero A. Bilastine and quality of life. J Investig Allergol Clin Immunol. 2011; 21:Suppl 3. 16–23.

58. Bousquet J, Schünemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, Bonini S, Boulet LP, Bousquet PJ, Brozek JL, Canonica GW, Casale TB, Cruz AA, Fokkens WJ, Fonseca JA, van Wijk RG, Grouse L, Haahtela T, Khaltaev N, Kuna P, Lockey RF, Lodrup Carlsen KC, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Palkonen S, Papadopoulos NG, Passalacqua G, Pawankar R, Price D, Ryan D, Simons FE, Togias A, Williams D, Yorgancioglu A, Yusuf OM, Aberer W, Adachi M, Agache I, Aït-Khaled N, Akdis CA, Andrianarisoa A, Annesi-Maesano I, Ansotegui IJ, Baiardini I, Bateman ED, Bedbrook A, Beghe B, Beji M, Bel EH, Ben Kheder A, Bennoor KS, Bergmann KC, Berrissoul F, Bieber T, Bindslev Jensen C, Blaiss MS, Boner AL, Bouchard J, Braido F, Brightling CE, Bush A, Caballero F, Calderon MA, Calvo MA, Camargos PA, Caraballo LR, Carlsen KH, Carr W, Cepeda AM, Cesario A, Chavannes NH, Chen YZ, Chiriac AM, Chivato Pérez T, Chkhartishvili E, Ciprandi G, Costa DJ, Cox L, Custovic A, Dahl R, Darsow U, De Blay F, Deleanu D, Denburg JA, Devillier P, Didi T, Dokic D, Dolen WK, Douagui H, Dubakiene R, Durham SR, Dykewicz MS, El-Gamal Y, El-Meziane A, Emuzyte R, Fiocchi A, Fletcher M, Fukuda T, Gamkrelidze A, Gereda JE, González Diaz S, Gotua M, Guzmán MA, Hellings PW, Hellquist-Dahl B, Horak F, Hourihane JO, Howarth P, Humbert M, Ivancevich JC, Jackson C, Just J, Kalayci O, Kaliner MA, Kalyoncu AF, Keil T, Keith PK, Khayat G, Kim YY, Koffi N'goran B, Koppelman GH, Kowalski ML, Kull I, Kvedariene V, Larenas-Linnemann D, Le LT, Lemière C, Li J, Lieberman P, Lipworth B, Mahboub B, Makela MJ, Martin F, Marshall GD, Martinez FD, Masjedi MR, Maurer M, Mavale-Manuel S, Mazon A, Melen E, Meltzer EO, Mendez NH, Merk H, Mihaltan F, Mohammad Y, Morais-Almeida M, Muraro A, Nafti S, Namazova-Baranova L, Nekam K, Neou A, Niggemann B, Nizankowska-Mogilnicka E, Nyembue TD, Okamoto Y, Okubo K, Orru MP, Ouedraogo S, Ozdemir C, Panzner P, Pali-Schöll I, Park HS, Pigearias B, Pohl W, Popov TA, Postma DS, Potter P, Rabe KF, Ratomaharo J, Reitamo S, Ring J, Roberts R, Rogala B, Romano A, Roman Rodriguez M, Rosado-Pinto J, Rosenwasser L, Rottem M, Sanchez-Borges M, Scadding GK, Schmid-Grendelmeier P, Sheikh A, Sisul JC, Solé D, Sooronbaev T, Spicak V, Spranger O, Stein RT, Stoloff SW, Sunyer J, Szczeklik A, Todo-Bom A, Toskala E, Tremblay Y, Valenta R, Valero AL, Valeyre D, Valiulis A, Valovirta E, Van Cauwenberge P, Vandenplas O, van Weel C, Vichyanond P, Viegi G, Wang DY, Wickman M, Wöhrl S, Wright J, Yawn BP, Yiallouros PK, Zar HJ, Zernotti ME, Zhong N, Zidarn M, Zuberbier T, Burney PG, Johnston SL, Warner JO. World Health Organization Collaborating Center for Asthma and Rhinitis. Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012; 130:1049–1062.

59. Conen S, Theunissen EL, Van Oers AC, Valiente R, Ramaekers JG. Acute and subchronic effects of bilastine (20 and 40 mg) and hydroxyzine (50 mg) on actual driving performance in healthy volunteers. J Psychopharmacol. 2011; 25:1517–1523.

60. Farre M, Perez-Mana C, Papaseit E, Menoyo E, Perez M, Martin S, Bullich S, Rojas S, Herance JR, Trampal C, Labeaga L, Valiente R. Bilastine vs. hydroxyzine: occupation of brain histamine H1 -receptors evaluated by positron emission tomography in healthy volunteers. Br J Clin Pharmacol. 2014; 78:970–980.

61. García-Gea C, Martínez J, Ballester MR, Gich I, Valiente R, Antonijoan RM. Psychomotor and subjective effects of bilastine, hydroxyzine, and cetirizine, in combination with alcohol: a randomized, double-blind, crossover, and positive-controlled and placebo-controlled Phase I clinical trials. Hum Psychopharmacol. 2014; 29:120–132.

62. Tyl B, Kabbaj M, Azzam S, Sologuren A, Valiente R, Reinbolt E, Roupe K, Blanco N, Wheeler W. Lack of significant effect of bilastine administered at therapeutic and supratherapeutic doses and concomitantly with ketoconazole on ventricular repolarization: results of a thorough QT study (TQTS) with QT-concentration analysis. J Clin Pharmacol. 2012; 52:893–903.

63. Bousquet J, Lund VJ, van Cauwenberge P, Bremard-Oury C, Mounedji N, Stevens MT, El-Akkad T. Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial. Allergy. 2003; 58:733–741.

64. European Innovation Partnership on Active and Healthy Ageing, Action Plan B3. Mechanisms of the Development of Allergy, WP 10. Global Alliance against Chronic Respiratory Diseases. Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, Annesi-Maesano I, Anto JM, Bachert C, Baena-Cagnani CE, Bai C, Baigenzhin A, Barbara C, Barnes PJ, Bateman ED, Beck L, Bedbrook A, Bel EH, Benezet O, Bennoor KS, Benson M, Bernabeu-Wittel M, Bewick M, Bindslev-Jensen C, Blain H, Blasi F, Bonini M, Bonini S, Boulet LP, Bourdin A, Bourret R, Bousquet PJ, Brightling CE, Briggs A, Brozek J, Buhl R, Bush A, Caimmi D, Calderon M, Calverley P, Camargos PA, Camuzat T, Canonica GW, Carlsen KH, Casale TB, Cazzola M, Cepeda Sarabia AM, Cesario A, Chen YZ, Chkhartishvili E, Chavannes NH, Chiron R, Chuchalin A, Chung KF, Cox L, Crooks G, Crooks MG, Cruz AA, Custovic A, Dahl R, Dahlen SE, De Blay F, Dedeu T, Deleanu D, Demoly P, Devillier P, Didier A, Dinh-Xuan AT, Djukanovic R, Dokic D, Douagui H, Dubakiene R, Eglin S, Elliot F, Emuzyte R, Fabbri L, Fink Wagner A, Fletcher M, Fokkens WJ, Fonseca J, Franco A, Frith P, Furber A, Gaga M, Garcés J, Garcia-Aymerich J, Gamkrelidze A, Gonzales-Diaz S, Gouzi F, Guzmán MA, Haahtela T, Harrison D, Hayot M, Heaney LG, Heinrich J, Hellings PW, Hooper J, Humbert M, Hyland M, Iaccarino G, Jakovenko D, Jardim JR, Jeandel C, Jenkins C, Johnston SL, Jonquet O, Joos G, Jung KS, Kalayci O, Karunanithi S, Keil T, Khaltaev N, Kolek V, Kowalski ML, Kull I, Kuna P, Kvedariene V, Le LT, Lodrup Carlsen KC, Louis R, MacNee W, Mair A, Majer I, Manning P, de Manuel Keenoy E, Masjedi MR, Melen E, Melo-Gomes E, Menzies-Gow A, Mercier G, Mercier J, Michel JP, Miculinic N, Mihaltan F, Milenkovic B, Molimard M, Momas I, Montilla-Santana A, Morais-Almeida M, Morgan M, N'Diaye M, Nafti S, Nekam K, Neou A, Nicod L, O'Hehir R, Ohta K, Paggiaro P, Palkonen S, Palmer S, Papadopoulos NG, Papi A, Passalacqua G, Pavord I, Pigearias B, Plavec D, Postma DS, Price D, Rabe KF, Radier Pontal F, Redon J, Rennard S, Roberts J, Robine JM, Roca J, Roche N, Rodenas F, Roggeri A, Rolland C, Rosado-Pinto J, Ryan D, Samolinski B, Sanchez-Borges M, Schünemann HJ, Sheikh A, Shields M, Siafakas N, Sibille Y, Similowski T, Small I, Sola-Morales O, Sooronbaev T, Stelmach R, Sterk PJ, Stiris T, Sud P, Tellier V, To T, Todo-Bom A, Triggiani M, Valenta R, Valero AL, Valiulis A, Valovirta E, Van Ganse E, Vandenplas O, Vasankari T, Vestbo J, Vezzani G, Viegi G, Visier L, Vogelmeier C, Vontetsianos T, Wagstaff R, Wahn U, Wallaert B, Whalley B, Wickman M, Williams DM, Wilson N, Yawn BP, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zhong N, Zidarn M, Zuberbier T. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014; 44:304–323.

65. Katelaris CH, Sacks R, Theron PN. Allergic rhinoconjunctivitis in the Australian population: burden of disease and attitudes to intranasal corticosteroid treatment. Am J Rhinol Allergy. 2013; 27:506–509.

66. Maurer M, Weller K, Bindslev-Jensen C, Gimenez-Arnau A, Bousquet PJ, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CE, Greaves MW, Hide M, Kalogeromitros D, Kaplan AP, Saini SS, Zhu XJ, Zuberbier T. Unmet clinical needs in chronic spontaneous urticaria. A GA²LEN task force report. Allergy. 2011; 66:317–330.

67. Rondon C, Campo P, Togias A, Fokkens WJ, Durham SR, Powe DG, Mullol J, Blanca M. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012; 129:1460–1467.