The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis

Morita-Baylis-Hillman adduct 2-(3-hydroxy-1-methyl-2-oxoindolin-3-il) acrylonitrile (CISACN) ameliorates the pulmonary allergic inflammation in CARAS model by increasing IFN-γ/IL-4 ratio towards the Th1 immune response

Combined allergic rhinitis and asthma syndrome (CARAS) is an airway-type 2 immune response with a profuse inflammatory process widely affecting the world population. Due to the compromise of quality of life and the lack of specific pharmacotherapy, the search for new molecules becomes relevant. This study aimed to evaluate the effectiveness of the Morita-Bailys-Hillman adduct (CISACN) treatment in the CARAS experimental model. Female BALB/c mice were ovalbumin (OVA) -sensitized and -challenged and treated with CISACN. The treatment decreased the eosinophil migration to the nasal and lung cavities and tissues and the goblet cell hyperplasia/hypertrophy, attenuated airway hyperactivity by reducing the hyperplasia/hypertrophy of the smooth muscle and the extracellular matrix's thickness. Also, the treatment reduced the clinical signs of rhinitis as nasal rubbing and sneezing in a histamine-induced nasal hyperreactivity assay. The immunomodulatory effect of CISACN was by reducing OVA-specific IgE serum level, and IL-33, IL-4, IL-13, and TGF-β production, dependent on IFN-γ increase. Furthermore, the effect of CISACN on lung granulocytes was by decreasing the p-p38MAPK/p65NF-κB signaling pathway. Indeed, CISACN reduced the p38MAPK and p65NF-κB activation. These data demonstrated the anti-inflammatory and immunomodulatory effects of the CISACN with scientific support to become a pharmacological tool to treat airway inflammatory diseases.

Asthma and rhinitis control in adolescents and young adults: A real-world MASK-air study

BACKGROUND

In allergic rhinitis and asthma, adolescents and young adult patients are likely to differ from older patients. We compared adolescents, young adults and adults on symptoms, control levels, and medication adherence.

METHODS

In a cross-sectional study (2015-2022), we assessed European users of the MASK-air mHealth app of three age groups: adolescents (13-18 years), young adults (18-26 years), and adults (>26 years). We compared them on their reported rhinitis and asthma symptoms, use and adherence to rhinitis and asthma treatment and app adherence. Allergy symptoms and control were assessed by means of visual analogue scales (VASs) on rhinitis or asthma, the combined symptom-medication score (CSMS), and the electronic daily control score for asthma (e-DASTHMA). We built multivariable regression models to compare symptoms or medication accounting for potential differences in demographic characteristics and baseline severity.

RESULTS

We assessed 965 adolescent users (15,252 days), 4595 young adults (58,161 days), and 15,154 adult users (258,796 days). Users of all three age groups displayed similar app adherence. In multivariable models, age groups were not found to significantly differ in their adherence to rhinitis or asthma medication. These models also found that adolescents reported lower VAS on global allergy, ocular, and asthma symptoms (as well as lower CSMS) than young adults and adults.

CONCLUSIONS

Adolescents reported a better rhinitis and asthma control than young adults and adults, even though similar medication adherence levels were observed across age groups. These results pave the way for future studies on understanding how adolescents control their allergic diseases.

Impact of Kayumidas© app on subjective symptoms and treatment adherence in allergic Rhinoconjunctivitis: Prospective Single-Arm interventional pilot study

INTRODUCTION

In the spring of 2021, a physician-supervised application (app) "Kayumidas© - Itchy Eye Alert" was released for allergy sufferers, which implements a function to predict pollen dispersal status for each user based on weather forecasts and notify users of the results. This app provides push notifications of warning levels of itchiness and other symptoms, countermeasures, and the time to use medication. However, no evaluation has been conducted to determine whether the use of app improves compliance with treatment. This study aimed to verify whether the use of a smartphone app is effective in relieving the symptoms of allergic conjunctivitis and rhinitis and how it changes patients' eye drop behavior.

METHODS

This was an investigator-initiated, observational, prospective cohort study that was conducted between February 2022 and May 2022. In 62 patients diagnosed with allergic conjunctivitis, the scores of nine subjective eye and nose symptoms (1-4) and eye itchiness (1-7) before and after using the app were compared using a questionnaire. The adherence scores for eye drops (1-4) were also investigated using a questionnaire.

RESULTS

The scores for all five ocular subjective symptoms and all four nasal subjective symptoms improved significantly after app use (p < 0.01). Both itching scores (4.1 ± 1.1 vs. 1.6 ± 0.5, p < 0.01) and eye drop compliance scores (2.0 ± 0.7 vs. 3.9 ± 0.3, p < 0.01) improved significantly after app use.

CONCLUSION

The use of the Kayumidas© app improved adherence to eye drops and the subjective symptoms of allergic conjunctivitis and rhinitis. Thus, app use effectively improves symptoms by changing behavior and improving self-care awareness regarding treatment in patients with allergic diseases.

Digitally-enabled, patient-centred care in rhinitis and asthma multimorbidity: The ARIA-MASK-air® approach

MASK-air^® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air^® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air^® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air^® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air^® results should lead to change management in rhinitis and asthma.