Author
J. M. Klossek
Bio: J. M. Klossek is an academic researcher from University of Poitiers. The author has contributed to research in topics: Visual analogue scale & Asthma. The author has an hindex of 8, co-authored 9 publications receiving 4011 citations.
Papers
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Federal University of Bahia1, McMaster University2, University of Amsterdam3, National Institutes of Health4, Charité5, Catholic University of Cordoba6, University of Genoa7, Radboud University Nijmegen8, Transilvania University of Brașov9, Ghent University10, University of Tennessee Health Science Center11, University of Naples Federico II12, Laval University13, Universidade Federal de Minas Gerais14, University of Oslo15, University of Manchester16, Aarhus University17, Imperial College London18, Erasmus University Rotterdam19, George Washington University20, Seoul National University21, Medical University of Łódź22, Hai phong University Of Medicine and Pharmacy23, Université de Montréal24, Guangzhou Medical University25, University of South Florida26, University of California, San Diego27, University of California28, University of Chicago29, Monash University30, Teikyo University31, National and Kapodistrian University of Athens32, Nippon Medical School33, Sofia Medical University34, Leiden University35, Leiden University Medical Center36, University College London37, University of Manitoba38, University of Helsinki39, Finnish Institute of Occupational Health40, National University of Singapore41, Karolinska Institutet42, University of Minnesota43, Celal Bayar University44, University of Cape Town45, Pierre-and-Marie-Curie University46, Tunis University47, University of Ghana48, University of Wisconsin-Madison49, University of British Columbia50, Georgia Regents University51, Vilnius University52, University of Washington53, University of Dundee54, University of Poitiers55, University of Mississippi56, Federal University of São Paulo57, German Red Cross58, Jagiellonian University Medical College59, Chiba University60, American Pharmacists Association61, University of Aberdeen62, University of Nevada, Reno63, University of North Carolina at Chapel Hill64
TL;DR: The ARIA guidelines for the management of allergic rhinitis and asthma are similar in both the 1999 ARIA workshop report and the 2008 Update as discussed by the authors, but the GRADE approach is not yet available.
Abstract: Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.
In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.
This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.
The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.
Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.
The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.
3,769 citations
TL;DR: In this paper, the authors used a visual analog scale (VAS) for global rhinitis symptoms to assess the disease severity according to the guidelines of the ARIA guidelines.
Abstract: Background: The allergic rhinitis and its impact on asthma (ARIA) guidelines provide a new classification of allergic rhinitis, but a quantitative analysis for severity assessment is lacking
Objective: To study whether a visual analog scale (VAS) for global rhinitis symptoms could be used to assess the disease severity according to ARIA
Methods: Three thousand fifty-two allergic rhinitis patients seen in primary care were tested Fifty three per cent had an objective diagnosis of allergy and 58% of the patients were treated Patients were categorized according to ARIA guidelines The severity of nasal symptoms was assessed using a VAS Quality of life was measured using the rhinoconjunctivitis quality of life questionnaire (RQLQ)
Results: Severity had more impact on VAS levels than duration: mild intermittent rhinitis (35, 24–50 cm), mild persistent rhinitis (45, 32–56 cm), moderate/severe intermittent rhinitis (67, 53–77 cm) and moderate/severe persistent rhinitis (72, 61–82 cm) The receiver operating characteristic curve results showed that patients with a VAS of under 5 cm could be classified as ‘mild’ rhinitis (negative predictive value: 935%) and those with a VAS of over 6 cm as ‘moderate/severe’ rhinitis (positive predictive value: 736%) Receiver operating characteristic curves and a logistic regression showed that current treatment and allergy diagnosis have no effect on the assessment of rhinitis severity using VAS Visual analog scale and the RQLQ global score were significantly correlated (ρ = 046; P < 00001)
Conclusion: A simple and quantitative method (VAS) can be used for the quantitative evaluation of severity of allergic rhinitis
355 citations
McMaster University1, Charité2, Ghent University3, University of Genoa4, Creighton University5, Erasmus University Rotterdam6, Teikyo University7, University of Cape Town8, Imperial College London9, Federal University of Bahia10, Georgia Regents University11, University of South Florida12, National Institutes of Health13, Seconda Università degli Studi di Napoli14, Laval University15, Universidade Federal de Minas Gerais16, University of Oslo17, Leiden University18, University of Porto19, University of Amsterdam20, University of Helsinki21, Hacettepe University22, Medical University of Łódź23, Guangzhou Medical University24, Tishreen University25, University of Barcelona26, University of Chicago27, Monash University28, National and Kapodistrian University of Athens29, Nippon Medical School30, University of Aberdeen31, Medical University of Warsaw32, University of Manitoba33, Celal Bayar University34, Transilvania University of Brașov35, French Institute of Health and Medical Research36, University of Modena and Reggio Emilia37, University of Tennessee Health Science Center38, University of Ghana39, University of Wisconsin-Madison40, University of British Columbia41, University of Montpellier42, University of Manchester43, Aarhus University44, Vilnius University45, University of Washington46, University of Paris-Sud47, University of St Andrews48, Washington University in St. Louis49, Seoul National University50, University of Poitiers51, Université de Montréal52, University of Dundee53, University of Sharjah54, University of Mississippi55, Boston Children's Hospital56, University of California, San Diego57, Federal University of São Paulo58, German Red Cross59, Jagiellonian University60, Chiba University61, American Pharmacists Association62, Sofia Medical University63, University of Nevada, Reno64, Finnish Institute of Occupational Health65, Catholic University of Leuven66, Radboud University Nijmegen67, University of Rostock68, National University of Singapore69, Karolinska Institutet70, University of North Carolina at Chapel Hill71, University of Minnesota72, Catholic University of Cordoba73
TL;DR: Development and implementation of guidelines in allergic rhinitis – an ARIA‐GA2LEN paper.
Abstract: The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.
96 citations
TL;DR: Grass pollen count aggravated SAR in terms of symptoms in a large nationwide sample of patients whose SAR was diagnosed by a physician and confirmed by skin prick test positivity or specific immunolglobulin E to common aeroallergens.
Abstract: Background: Little is known about the relation between allergic rhinitis severity and airborne pollen in combination with air pollutants. Objective: To model the risk of suffering from severe seasonal allergic rhinitis (SAR) as a function of both pollen count and air pollution levels in a large nationwide sample of patients whose SAR was diagnosed by a physician and confirmed by skin prick test positivity or specific immunolglobulin E to common aeroallergens. Methods: The severity of SAR symptoms was estimated with the Symptomatic Global Score (SGS) among 36,397 patients suffering from an untreated and uncomplicated SAR between May and August 2004 in metropolitan France. Patients who had an SGS in the upper third quartile were classified as suffering from severe SAR. A multilevel model relating SAR severity, pollen and air pollution was used to take into account the hierarchical data structure. Results: 18.9% of the 17,567 urban patients retained for the analysis suffered from severe rhinitis. At the Lag0 (day of the visit), a rise of 60 grass pollen grains/m3 increased the risk of suffering from a severe SAR form by 8% in the multileveled model after adjusting for potential confounders and air pollution levels. Results were also confirmed in the subsample of individuals with documented sensitization to grass pollen. Conclusion: Grass pollen count aggravated SAR in terms of symptoms in our nationwide sample. These findings confirm the need for proper treatment and preventive measures in SAR patients sensitized to grass pollen.
45 citations
TL;DR: This survey confirms the impact of ocular symptoms on AR patients’ lives and suggests that they are still neglected and undertreated.
Abstract: Background: Ocular symptoms remain widely neglected while they concern the majority of subjects with allergic rhinitis (AR) and impair their daily activities. We describe the charac
34 citations
Cited by
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Federal University of Bahia1, McMaster University2, University of Amsterdam3, National Institutes of Health4, Charité5, Catholic University of Cordoba6, University of Genoa7, Radboud University Nijmegen8, Transilvania University of Brașov9, Ghent University10, University of Tennessee Health Science Center11, University of Naples Federico II12, Laval University13, Universidade Federal de Minas Gerais14, University of Oslo15, University of Manchester16, Aarhus University17, Imperial College London18, Erasmus University Rotterdam19, George Washington University20, Seoul National University21, Medical University of Łódź22, Hai phong University Of Medicine and Pharmacy23, Université de Montréal24, Guangzhou Medical University25, University of South Florida26, University of California, San Diego27, University of California28, University of Chicago29, Monash University30, Teikyo University31, National and Kapodistrian University of Athens32, Nippon Medical School33, Sofia Medical University34, Leiden University35, Leiden University Medical Center36, University College London37, University of Manitoba38, University of Helsinki39, Finnish Institute of Occupational Health40, National University of Singapore41, Karolinska Institutet42, University of Minnesota43, Celal Bayar University44, University of Cape Town45, Pierre-and-Marie-Curie University46, Tunis University47, University of Ghana48, University of Wisconsin-Madison49, University of British Columbia50, Georgia Regents University51, Vilnius University52, University of Washington53, University of Dundee54, University of Poitiers55, University of Mississippi56, Federal University of São Paulo57, German Red Cross58, Jagiellonian University Medical College59, Chiba University60, American Pharmacists Association61, University of Aberdeen62, University of Nevada, Reno63, University of North Carolina at Chapel Hill64
TL;DR: The ARIA guidelines for the management of allergic rhinitis and asthma are similar in both the 1999 ARIA workshop report and the 2008 Update as discussed by the authors, but the GRADE approach is not yet available.
Abstract: Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.
In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.
This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.
The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.
Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.
The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.
3,769 citations
TL;DR: These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children and patients are encouraged to use these recommendations in their daily practice and to support their decisions.
Abstract: Background: Allergic rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally. Objective: To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of allergic rhinitis on the basis of current best evidence. Methods: The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group. Results: This article presents recommendations about the prevention of allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with allergic rhinitis as well as patients with both allergic rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals. Conclusion: These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.
1,398 citations
Charité1, Medical University of Graz2, University of Southern Denmark3, Medical University of Silesia4, University of Genoa5, Federal University of São Paulo6, Autonomous University of Barcelona7, University of Coimbra8, St. John's University9, Hiroshima University10, Medical University of South Carolina11, Hannover Medical School12, Hospital Kuala Lumpur13, Johns Hopkins University14, University of Zurich15, University of Manitoba16, University of Mainz17, University of Toronto18, Technion – Israel Institute of Technology19, University of Bari20, Peking University21
TL;DR: This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms, and outlines evidence-based diagnostic and therapeutic approaches for the different subtypes ofUrticaria.
Abstract: This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
1,150 citations
McMaster University1, University of Montpellier2, Transylvania University3, Ghent University Hospital4, University of Sydney5, Humanitas University6, University of South Florida7, Leiden University Medical Center8, RMIT University9, Federal University of Bahia10, Pierre-and-Marie-Curie University11, Saint Louis University12, University of Porto13, Katholieke Universiteit Leuven14, Medical University of Łódź15, University of Tartu16, Oslo University Hospital17, Royal College of Surgeons in Ireland18, University of California, San Diego19, University of Barcelona20, University of Padua21, Monash University22, Charles University in Prague23, University of Manchester24, Ajou University25, University of Genoa26, Nippon Medical School27, University of Aberdeen28, University of Edinburgh29, Kerman Medical University30, Medical University of Warsaw31, National Institutes of Health32, Vilnius University33, University of Turku34, Nova Southeastern University35, Boston Children's Hospital36, Beijing Tongren Hospital37, Charité38
TL;DR: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR, addressing the relative merits of using oral H1‐antihistamines, intranasal H1-antihistsamines, IntranasAL corticosteroids, and leukotriene receptor antagonists either alone or in combination.
Abstract: Background Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. Objective We sought to provide a targeted update of the ARIA guidelines. Methods The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. Results The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. Conclusions Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.
1,098 citations
Humboldt University of Berlin1, Medical University of Graz2, Hospital Kuala Lumpur3, University of Zurich4, University of Cincinnati5, University of Southern Denmark6, Medical University of Silesia7, Humanitas University8, Charité9, Penn State Milton S. Hershey Medical Center10, Federal University of São Paulo11, Autonomous University of Barcelona12, St Thomas' Hospital13, Laval University14, Hiroshima University15, Medical University of South Carolina16, Hannover Medical School17, Campbelltown Hospital18, Mahidol University19, Royal Free Hospital20, University of Bari21, University Medical Center Groningen22, Johns Hopkins University23, University of Toronto24, Technion – Israel Institute of Technology25, Aarhus University Hospital26, Peking University27
TL;DR: In this paper, an evidence-and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group.
Abstract: This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Sectionof the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
819 citations