Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

Bousquet J. Melén E. Haahtela T. Koppelman G.H. Togias A. Valenta R. Akdis C.A. Czarlewski W. Rothenberg M. Valiulis A. Wickman M. Akdis M. Aguilar D. Bedbrook A. Bindslev-Jensen C. Bosnic-Anticevich S. Boulet L.P. Brightling C.E. Brussino L. Burte E. Bustamante M. Canonica G.W. Cecchi L. Celedon J.C. Chaves Loureiro C. Costa E. Cruz A.A. Erhola M. Gemicioglu B. Fokkens W.J. Garcia-Aymerich J. Guerra S. Heinrich J. Ivancevich J.C. Keil T. Klimek L. Kuna P. Kupczyk M. Kvedariene V. Larenas-Linnemann D.E. Lemonnier N. Lodrup Carlsen K.C. Louis R. Makela M. Makris M. Maurer M. Momas I. Morais-Almeida M. Mullol J. Naclerio R.N. Nadeau K. Nadif R. Niedoszytko M. Okamoto Y. Ollert M. Papadopoulos N.G. Passalacqua G. Patella V. Pawankar R. Pham-Thi N. Pfaar O. Regateiro F.S. Ring J. Rouadi P.W. Samolinski B. Sastre J. Savouré M. Scichilone N. Shamji M.H. Sheikh A. Siroux V. Sousa-Pinto B. Standl M. Sunyer J. Taborda-Barata L. Toppila-Salmi S. Torres M.J. Tsiligianni I. Valovirta E. Vandenplas O. Ventura M.T. Weiss S. Yorgancioglu A. Zhang L. Abdul Latiff A.H. Aberer W. Agache I. Al-Ahmad M. Alobid I. Ansotegui I.J. Arshad S.H. Asayag E. Barbara C. Baharudin A. Battur L. Bennoor K.S. Berghea E.C. Bergmann K.C. Bernstein D. Bewick M. Blain H. Bonini M. Braido F. Buhl R. Bumbacea R.S. Bush A. Calderon M. Calvo-Gil M. Camargos P. Caraballo L. Cardona V. Carr W. Carreiro-Martins P. Casale T. Cepeda Sarabia A.M. Chandrasekharan R. Charpin D. Chen Y.Z. Cherrez-Ojeda I. Chivato T. Chkhartishvili E. Christoff G. Chu D.K. Cingi C. Correia de Sousa J. Corrigan C. Custovic A. D’Amato G. Del Giacco S. De Blay F. Devillier P. Didier A. do Ceu Teixeira M. Dokic D. Douagui H. Doulaptsi M. Durham S. Dykewicz M. Eiwegger T. El-Sayed Z.A. Emuzyte R. Fiocchi A. Fyhrquist N. Gomez R.M. Gotua M. Guzman M.A. Hagemann J. Hamamah S. Halken S. Halpin D.M.G. Hofmann M. Hossny E. Hrubiško M. Irani C. Ispayeva Z. Jares E. Jartti T. Jassem E. Julge K. Just J. Jutel M. Kaidashev I. Kalayci O. Kalyoncu A.F. Kardas P. Kirenga B. Kraxner H. Kull I. Kulus M. La Grutta S. Lau S. Le Tuyet Thi L. Levin M. Lipworth B. Lourenço O. Mahboub B. Martinez-Infante E. Matricardi P. Miculinic N. Migueres N. Mihaltan F. Mohammad Y. Moniuszko M. Montefort S. Neffen H. Nekam K. Nunes E. Nyembue Tshipukane D. O’Hehir R. Ogulur I. Ohta K. Okubo K. Ouedraogo S. Olze H. Pali-Schöll I. Palomares O. Palosuo K. Panaitescu C. Panzner P. Park H.S. Pitsios C. Plavec D. Popov T.A. Puggioni F. Quirce S. Recto M. Repka-Ramirez M.S. Robalo Cordeiro C. Roche N. Rodriguez-Gonzalez M. Romantowski J. Rosario Filho N. Rottem M. Sagara H. Serpa F.S. Sayah Z. Scheire S. Schmid-Grendelmeier P. Sisul J.C. Sole D. Soto-Martinez M. Sova M. Sperl A. Spranger O. Stelmach R. Suppli Ulrik C. Thomas M. To T. Todo-Bom A. Tomazic P.V. Urrutia-Pereira M. Valentin-Rostan M. Van Ganse E. van Hage M. Vasankari T. Vichyanond P. Viegi G. Wallace D. Wang D.Y. Williams S. Worm M. Yiallouros P. Yusuf O. Zaitoun F. Zernotti M. Zidarn M. Zuberbier J. Fonseca J.A. Zuberbier T. Anto J.M.
May 2023 John Wiley and Sons Inc

Allergy: European Journal of Allergy and Clinical Immunology
2023 #78 Issue 5 1169 - 1203 pp.

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.

asthma , IL-33 , multimorbidity , rhinitis , Toll-like receptors

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Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
University Hospital Montpellier, Montpellier, France
Inserm, Equipe d’Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen, Beatrix Childrens Hospital, University of Groningen, Groningen, Netherlands
Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States
Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
Medical Consulting Czarlewski, Levallois, France
MASK-air, Montpellier, France
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States
Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania
Medical Faculty of Vilnius University, Vilnius, Lithuania
Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden
6AM Data Mining, Barcelona, Spain
ARIA, Montpellier, France
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
Odense Research Center for Anaphylaxis « ORCA », Odense, Denmark
Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
Sydney Local Health District, Sydney, NSW, Australia
Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, United Kingdom
Department of Medical Sciences, University of Torino, Torino, Italy
Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
Université Paris-Saclay, UVSQ, UnivParis-Sud, Villejuif, France
Universitat Pompeu Fabra (UPF), Barcelona, Spain
ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Personalized medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
Division of Pediatric Pulmonary Medicine, UPMC Childrens Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Bahia, Salvador, Brazil
Pirkanmaa Welfare district, Tampere, Finland
Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
Ludwig Maximilians University Munich, University Hospital Munich, Instituteand Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
Center for Rhinology and Allergology, Wiesbaden, Germany
Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, La Tronche, Site Santé, France
Department of Paediatrics, Oslo University Hospital, Oslo, Norway
Department of Pulmonary Medicine, CHU Liège, Liège, Belgium
GIGA I3 Research Group, University of Liège, Liège, Belgium
Allergy Unit D Kalogeromitros, 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
Department of Public Health and Health Products, Paris Descartes University-Sorbonne Paris Cité, Paris, EA 4064, France
Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
ENT Department, Rhinology Unit & Smell Clinic, Hospital Clínic, Barcelona, Spain
Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
Chiba Rosai Hospital, Chiba, Japan
Chiba University Hospital, Chiba, Japan
Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
Allergy and Respiratory Diseases, IRCCS Policlinico San Martino - University of Genoa, Genoa, Italy
Division of Allergy and Clinical Immunology, Department of Medicine, Santa Maria della Speranza Hospital, Salerno, Battipaglia, Italy
Agency of Health ASL, Salerno, Italy
Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
Department of Pediatrics, Nippon Medical School, Tokyo, Japan
Ecole Polytechnique de Palaiseau, Palaiseau, France
IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France
Université Paris Cité, Paris, France
Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
French Environment and Energy Management Agency, Angers, France
PROMISE Department, University of Palermo, Palermo, Italy
National Heart and Lung Institute, Imperial College, London, United Kingdom
NIHR Imperial Biomedical Research Centre, London, United Kingdom
Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
CINTESIS@RISE– Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
German Center of Lung Research (DZL), Munich, Germany
IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain
International Primary Care Respiratory Group IPCRG, Aberdeen, United Kingdom
Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland
Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium
Université Catholique de Louvain, Yvoir, Belgium
Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
Harvard Medical School and Channing Division of Network Medicine, Boston, United States
Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Department of Dermatology, Medical University of Graz, Graz, Austria
Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
Institut dInvestigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Centro Médico Teknon, Barcelona, Spain
Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
Argentine Society of Allergy and Immunopathology, Buenos Aires, Argentina
Portuguese National Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia
Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
University of Central Lancashire Medical School, Preston, United Kingdom
Department of Geriatrics, Montpellier University Hospital, MUSE, Montpellier, France
Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy
Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli – IRCCS, Rome, Italy
National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom
Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
Department of Allergy, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
Imperial College and Royal Brompton Hospital, London, United Kingdom
Imperial College and National Heart and Lung Institute, London, United Kingdom
Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile
Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
Allergy Section, Department of Internal Medicine, Hospital Vall dHebron, Barcelona, Spain
ARADyAL Research Network, Barcelona, Spain
Allergy & Asthma Associates of Southern California, A Medical Group, Southern California Research, Mission Viejo, CA, United States
NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
Division of Allergy/Immunology, University of South Florida, Tampa, FL, United States
Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia
SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Colombia
Department of ENT, Badr al Samaa Hospital, Salalah, Oman
Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
The Capital Institute of Pediatrics, Chaoyang district, Beijing, China
Universidad Espíritu Santo, Samborondón, Ecuador
Respiralab Research Group, Guayas, Guayaquil, Ecuador
School of Medicine, University CEU San Pablo, Madrid, Spain
David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia
Faculty of Public Health, Medical University – Sofia, Sofia, Bulgaria
Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey
School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Kings College London, London, United Kingdom
National Heart and Lung Institute, Imperial College London, London, United Kingdom
Division of Respiratory and Allergic Diseases, Hospital A Cardarelli, University of Naples Federico II, Naples, Italy
Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital Duilio Casula, University of Cagliari, Cagliari, Italy
Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France
Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France
Dr Agostinho Neto University hospital, Praia, Cape Verde
Immunology, Faculty of Medicine, Cabo Verde University, Praia, Cape Verde
Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, North Macedonia
Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete, Greece
Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, United States
The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, ON, Canada
Pediatric Allergy, Immunology and Rheumatology Unit, Childrens Hospital, Ain Shams University, Cairo, Egypt
Clinic of Childrens Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Allergy, Bambino Gesù Childrens Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
School of Health Sciences, Catholic University of Salta, Salta, Argentina
Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
Biology of Reproduction department, INSERM 1203, University hospital, Montpellier, France
Hans Christian Andersen Childrens Hospital, Odense University Hospital, Odense, Denmark
University of Exeter Medical School, College of Medicine and Health, University of Exeter, Devon, Exeter, United Kingdom
Berlin Institute of Health, Berlin, Germany
Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina
EDEGO Research Unit, University of Oulu, Oulu, Finland
Department of Pneumology, Medical University of Gdańsk, Gdansk, Poland
Tartu University Institute of Clinical Medicine, Childrens Clinic, Tartu, Estonia
Sorbonne université, Hôpital américain de Paris, Neuilly, France
Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland
ALL-MED Medical Research Institute, Wroclaw, Poland
Poltava State Medical University, Poltava, Ukraine
Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Hacettepe University, Ankara, Turkey
Department of Family Medicine, Medical University of Lodz, Lodz, Poland
Makerere University Lung Institute, Kampala, Uganda
Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
Institute of Translational Pharmacology, National Research Council, Palermo, Italy
Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany
University of Medicine and Pharmacy, Hochiminh City, Viet Nam
Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
Department of Pulmonary Medicine, Rashid Hospital, Dubai, United Arab Emirates
Hospital San Luca, Oaxaca, Mexico
Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
Croatian Pulmonary Society, Zagreb, Croatia
National Institute of Pneumology M Nasta, Bucharest, Romania
National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syrian Arab Republic
Syrian Private University, Damascus, Syrian Arab Republic
Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland
Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
Hungarian Allergy Association, Budapest, Hungary
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
Japan Anti-Tuberculosis Association (JATA), Fukujuji Hospital, Tokyo, Japan
Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria
Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
OncoGen Center, County Clinical Emergency Hospital Pius Branzeu, and University of Medicine and Pharmacy V Babes, Timisoara, Romania
Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
Medical School, University of Cyprus, Nicosia, Cyprus
Srebrnjak Childrens Hospital, Zagreb, Croatia
Medical Faculty, University JJ Strossmayer of Osijek, Osijek, Croatia
Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
Personalized medicine Asthma & Allergy, Rozzano, IRCCS Humanitas Research Center, Milan, Italy
Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
Division of Adult and Pediatric Allergy and Immunology, University of the Philippines- Philippines General Hospital, Manila, Philippines
Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay
Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Pneumologie, AP-HP Centre, Université de Paris Cité, Hôpital Cochin, Paris, France
UMR 1016, Institut Cochin, Paris, France
Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico
Department of Pediatrics, Federal University of Parana, Curitiba, Brazil
Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
SMAIC Société Marocaine d’ Allergologie et Immunologie Clinique, Rabat, Morocco
Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
Allergy & Asthma, Clinica SISUL, FACAAI, SPAAI, Asuncion, Paraguay
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria
Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
University of Southampton, Southampton, United Kingdom
The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Department of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Graz, Austria
Universidade Federal dos Pampa, Uruguaiana, Brazil
Allergist, Montevideo, Uruguay
Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France
Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
FILHA, Finnish Lung Health Association, Helsinki, Finland
Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
International Primary Care Respiratory Group IPCRG, Aberdeen, United Kingdom
Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
The Allergy and Asthma Institute, Islamabad, Pakistan
Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, United Arab Emirates
Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Villa Maria, Argentina
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

Institute of Allergology
Allergology and Immunology
University Hospital Montpellier
Inserm
Department of Clinical Science and Education
Sach´s Children and Youth Hospital
Skin and Allergy Hospital
Department of Pediatric Pulmonology and Pediatric Allergology
Division of Allergy
Division of Immunopathology
Swiss Institute of Allergy and Asthma Research (SIAF)
Medical Consulting Czarlewski
MASK-air
Division of Allergy and Immunology
Institute of Clinical Medicine and Institute of Health Sciences
Medical Faculty of Vilnius University
Institute of Environmental medicine
6AM Data Mining
ARIA
Department of Dermatology and Allergy Centre
Odense Research Center for Anaphylaxis « ORCA »
Quality Use of Respiratory Medicines Group
Sydney Local Health District
Sydney Pharmacy School
Quebec Heart and Lung Institute
Institute of Lung Health
Department of Medical Sciences
Allergy and Clinical Immunology Unit
Université Paris-Saclay
Universitat Pompeu Fabra (UPF)
ISGlobal
CIBER Epidemiología y Salud Pública (CIBERESP)
Department of Biomedical Sciences
Personalized medicine
SOS Allergology and Clinical Immunology
Division of Pediatric Pulmonary Medicine
Pneumology Unit
UCIBIO
Fundaçao ProAR
Pirkanmaa Welfare district
Department of Pulmonary Diseases
Department of Otorhinolaryngology
Asthma and Airway Disease Research Center
Ludwig Maximilians University Munich
Servicio de Alergia e Immunologia
Institute of Social Medicine
Institute for Clinical Epidemiology and Biometry
State Institute of Health
Department of Otolaryngology
Center for Rhinology and Allergology
Division of Internal Medicine
Institute of Clinical Medicine
Institute of Biomedical Sciences
Center of Excellence in Asthma and Allergy
Institute for Advanced Biosciences
Department of Paediatrics
Department of Pulmonary Medicine
GIGA I3 Research Group
Allergy Unit D Kalogeromitros
Department of Public Health and Health Products
Paris Municipal Department of Social Action
Allergy Center
ENT Department
Clinical & Experimental Respiratory Immunoallergy
Department of Otolaryngology - Head and Neck Surgery
Sean N. Parker Center for Allergy and Asthma Research
Department of Allergology
Chiba Rosai Hospital
Chiba University Hospital
Department of Infection and Immunity
Allergy Department
Allergy and Respiratory Diseases
Division of Allergy and Clinical Immunology
Agency of Health ASL
Postgraduate Programme in Allergy and Clinical Immunology
Department of Pediatrics
Ecole Polytechnique de Palaiseau
IRBA (Institut de Recherche Bio-Médicale des Armées)
Université Paris Cité
Section of Rhinology and Allergy
Allergy and Clinical Immunology Unit
Coimbra Institute for Clinical and Biomedical Research (ICBR)
Institute of Immunology
Department of Dermatology and Allergy Biederstein
Christine Kühne Center for Allergy Research and Education (CK-Care)
Department of Otolaryngology-Head and Neck Surgery
Department of Otorhinolaryngology-Head and Neck Surgery
Department of Prevention of Environmental Hazards
Allergy Service
French Environment and Energy Management Agency
PROMISE Department
National Heart and Lung Institute
NIHR Imperial Biomedical Research Centre
Usher Institute
INSERM
MEDCIDS - Department of Community Medicine
CINTESIS@RISE– Health Research Network
Institute of Epidemiology
German Center of Lung Research (DZL)
IMIM (Hospital del Mar Medical Research Institute)
Department of Immunoallergology
UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre
Allergy Unit
International Primary Care Respiratory Group IPCRG
Health Planning Unit
Department of Lung Diseases and Clinical Allergology
Department of Chest Medicine
Université Catholique de Louvain
Unit of Geriatric Immunoallergology
Institute of Sciences of Food Production
Harvard Medical School and Channing Division of Network Medicine
Department of Pulmonary Diseases
Department of Otolaryngology Head and Neck Surgery
Allergy & Immunology Centre
Department of Dermatology
Faculty of Medicine
Microbiology Department
Institut dInvestigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
Centro Médico Teknon
Department of Allergy and Immunology
Clinical and Experimental Sciences
David Hide Asthma and Allergy Research Centre
Argentine Society of Allergy and Immunopathology
Portuguese National Programme for Respiratory Diseases
Department of Otorhinolaryngology
Mongolian Association of Hospital Managers
Department of Respiratory Medicine
Department of Pediatrics
Division of Immunology
University of Central Lancashire Medical School
Department of Geriatrics
Department of Cardiovascular and Respiratory Sciences
Department of Neurological
National Heart and Lung Institute (NHLI)
Respiratory Clinic
IRCCS Ospedale Policlinico San Martino
Department of Pulmonary Medicine
Department of Allergy
Imperial College and Royal Brompton Hospital
Imperial College and National Heart and Lung Institute
Pediatrics Department
Department of Pediatrics
Institute for Immunological Research
Allergy Section
ARADyAL Research Network
Allergy & Asthma Associates of Southern California
NOVA Medical School/Comprehensive Health Research Centre (CHRC)
Serviço de Imunoalergologia
Division of Allergy/Immunology
Allergy and Immunology Laboratory
SLaai
Department of ENT
Clinique des Bronches
The Capital Institute of Pediatrics
Universidad Espíritu Santo
Respiralab Research Group
School of Medicine
David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School
Faculty of Public Health
Department of Health Research Methods
Medical Faculty
School of Medicine
Division of Asthma
National Heart and Lung Institute
Division of Respiratory and Allergic Diseases
Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology
Allergy Division
Federation of Translational Medicine
VIM Suresnes
Department of Respiratory Diseases
Dr Agostinho Neto University hospital
Immunology
Medical Faculty Skopje
Service de Pneumo-Allergologie
Department of Otorhinolaryngology Head and Neck Surgery
Allergy and Clinical Immunology
Section of Allergy and Immunology
The Hospital for Sick Children
Pediatric Allergy
Clinic of Childrens Diseases
Allergy
School of Health Sciences
Center of Allergy and Immunology
Immunology and Allergy Division
Biology of Reproduction department
Hans Christian Andersen Childrens Hospital
University of Exeter Medical School
Berlin Institute of Health
Department of Clinical Immunology and Allergy
Department of Internal Medicine and Infectious Diseases
Kazakhstan Association of Allergology and Clinical Immunology
Servicio de Alergia
EDEGO Research Unit
Department of Pneumology
Tartu University Institute of Clinical Medicine
Sorbonne université
Department of Clinical Immunology
ALL-MED Medical Research Institute
Poltava State Medical University
Pediatric Allergy and Asthma Unit
School of Medicine
Department of Family Medicine
Makerere University Lung Institute
Department of Otorhinolaryngology
Department of Pediatric Respiratory Diseases and Allergology
Institute of Translational Pharmacology
Department of Paediatric Respiratory Medicine
University of Medicine and Pharmacy
Division Paediatric Allergology
Scottish Centre for Respiratory Research
Faculty of Health Sciences and CICS – UBI
Department of Pulmonary Medicine
Hospital San Luca
Pediatric Pulmonology
Croatian Pulmonary Society
National Institute of Pneumology M Nasta
National Center for Research in Chronic Respiratory Diseases
Syrian Private University
Department of Regenerative Medicine and Immune Regulation
Department of Medicine
Center of Allergy
Hungarian Allergy Association
Faculty of Medicine
ENT Department
Allergy
Japan Anti-Tuberculosis Association (JATA)
Department of Otolaryngology
Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle
Department of Comparative Medicine
Department of Biochemistry and Molecular Biology
Department of Dermatology
OncoGen Center
Department of Immunology and Allergology
Department of Allergy and Clinical Immunology
Medical School
Srebrnjak Childrens Hospital
Medical Faculty
Clinic of Occupational Diseases
Personalized medicine Asthma & Allergy
Department of Allergy
Division of Adult and Pediatric Allergy and Immunology
Division of Allergy
Pneumology Unit
Pneumologie
UMR 1016
Pediatric Allergy and Clinical Immunology
Department of Pediatrics
Division of Allergy
Department of Medicine
Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória
SMAIC Société Marocaine d’ Allergologie et Immunologie Clinique
Pharmaceutical Care Unit
Allergy Unit
Allergy & Asthma
Division of Allergy
Division of Respiratory Medicine
Department of Respiratory Medicine and Tuberculosis
Global Allergy and Airways Patient Platform GAAPP
Pulmonary Division
Department of Respiratory Medicine
Institute of Clinical Medicine
University of Southampton
The Hospital for Sick Children
Imunoalergologia
Department of General ORL
Universidade Federal dos Pampa
Allergist
Research on Healthcare Performance (RESHAPE)
Division of Immunology and Allergy
Department of Clinical Immunology and Transfusion Medicine
FILHA
Department of Clinical Medicine
Division of Allergy and Immunology
Pulmonary Environmental Epidemiology Unit
College of Allopathic Medicine
Department of Otolaryngology
International Primary Care Respiratory Group IPCRG
Division of Allergy and Immunology Department of Dermatology
The Allergy and Asthma Institute
Lebanese-American University
Universidad Católica de Córdoba
University Clinic of Respiratory and Allergic Diseases
Faculty of Medicine

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