Rhinitis and asthma represent hot topics for Allergy
Authors: J. Bousquet, T. Bieber, W. Fokkens, M. L. Kowalski, M. Humbert, B. Niggemann, H.‐U. Simon
Journal: Allergy (2008)

Rhinitis and asthma represent hot topics and there are still more questions than answers (1). We urgently need a common international approach, in particular for severe diseases (2). In this issue of the journal, Cooper et al. (3) report on asthma in Latin America and show that this is a public health challenge with interesting research opportunities. The global map of the prevalence of symptoms of rhinoconjunctivitis in children is reported in this issue of the journal by the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three (4). Interesting results are found since elevated prevalence rates are found around the world and not only in developed countries. Important research questions in allergy and related diseases is a new series of the Journal attempting to identify topics of interest for future programs (5). Among the first question published, nonallergic rhinitis (6) appears to be of great relevance due to the very large number of patients (probably hundreds of million around the world) (7, 8), the difficulty to understand the mechanisms (9–18), the importance of occupational agents (19), the links with lower airway disease (20–22), under diagnosis (23), and the lack of adequate treatment. It is important to differentiate nonallergic rhinitis from chronic rhinosinusitis (24). It is possible that the stress response is dysregulated in nonallergic rhinitis as it has been proposed in a challenging hypothesis in asthma (25). Novel therapeutic approaches are needed for the control of nonallergic patients. In this issue of the journal it has been reported that topical corticosteroids down-regulate COX-1 positive cells in nasal polyps (26). The relationship between chronic rhinosinusitis and asthma is still unclear and it is important to find predictors of bronchial hyperresponsiveness in patients with chronic rhinosinusitis (27). Airway remodeling is another important topic and it is needed to differentiate persistence vs progression (28–30). The treatment of severe asthma by anti-IgE is still a hot topic (31–33) including the cost-effectiveness of expensive interventions (34). In the present issue, Humbert et al. (35) show that patients who achieve greatest benefit for their asthma experience with omalizumab therapy also experience greatest benefit for rhinitis. This is the first time that such links are found. The socioeconomic burden of allergic diseases and asthma need to be re-emphasized (36) and Simoens et al. (37) present recent data on the pharmacoeconomics of allergic rhinitis in this issue of the journal. 2008 was the year of the Olympic games, and Allergy published a series (38–42) on the subject with a key paper from China proposing the methods to be used to prevent air pollution during the period of the games in Beijing (42). An important meeting with the International Olympic Committee was reported in another journal (43). Air pollution (44) as well as with climate changes represent an important issue for the future of allergic diseases and more studies are needed to appreciate their importance (45, 46). Ozone changes are associated with some inflammatory mechanisms of allergic diseases, but it had not been reported before that they are also involved in total IgE levels (47). Guidelines are part of our daily practice. The journal has published in 2008 important guidelines on paediatric asthma (48) and allergic rhinitis (ARIA) (49). These guidelines were based on a simple evidence-based system which needs to be improved in order to include safety, patient's views and costs (50). Other practice parameters have been published in rhinitis in 2008 (51). There is a need for guidelines harmonization and for clear-cut methodology for guideline development (52). They should be carefully developed and should follow a precise methodology in order to be widely applicable and avoid harm for patients (53). Moreover, these guidelines are usually source documents which need to be summarized in pocket guides for primary care physicians (49, 54), the cornerstone of rhinitis and asthma diagnosis and treatment (55, 56). The primary prevention of asthma and allergy is essential (57–60) and the journal is proud that the first national prevention program, the Finnish program, has been published in June (61). The tertiary prevention of asthma is still a matter of debate. The most recent Cochrane meta-analysis concerning house dust mite prevention has been published in June (62). It has raised a very interesting debate published in this issue of the journal (63–65). The European Union networks and programs need to be publicized and we are proud to publish studies and positions from GA2LEN (38, 39, 66–69), INDEX (70), CREATE (71) and EUROPREVALL (72).