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Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper.

Jean Bousquet 1, 2, * Josep Anto 3, 4, 5, 6 Pascal Demoly 7, 8 Holger Schünemann 9 Alkis Togias 10 Mübeccel Akdis 11 Charles Auffray 12 Claus Bachert 13 Thomas Bieber 14 Philippe Bousquet 1 Kai-Håkon Carlsen 15 Thomas Casale 16 Alavaro Cruz 17 Thomas Keil 18 Karin Lodrup Carlsen 15 Marcus Maurer 19 K. Ohta 20 N. G. Papadopoulos 21 M. Roman Rodriguez 22 B. Samolinski 23 I. Agache 24 A. Andrianarisoa 25 Isabella Annesi-Maesano 26 F. Ballester 27 C. E. Baena-Cagnani 28, 29 X. Basagaña 3, 4, 5 E. D. Bateman 30 E. H. Bel 31 A. Bedbrook 7 B. Beghé 32 M. Beji 33 Ali Ben Kheder 34 M. Benet 3, 4, 5 Kazi Saifuddin Bennoor 35 K. C. Bergmann 19 Fouad Berrissoul 36 Carsten Bindslev Jensen 37 Eugene Bleecker 38 S. Bonini 39 A. L. Boner 40 L. P. Boulet 41 Christopher Brightling 42 Jan Brozek 9 Andrew Bush 43 W. W. Busse 44 Paulo Augusto Moreira Camargos 45 Giorgio Walter Canonica 46 Warner Carr 47 Alfredo Cesario 48, 49 Y. Z. Chen 50 A. M. Chiriac 1 David Costa 51 Latonia Cox 52 Adnan Custovic 53 Ronald Dahl 54 Ulf Darsow 55 Toufik Didi 56 Habib Douagui 57 Ruta Dubakiene 58 Abdellah El-Meziane 59 Joao Fonseca 60 W. J. Fokkens 61 E. Fthenou 62 Amiran Gamkrelidze 63 J. Garcia-Aymerich 3, 4, 5, 6 Roy Gerth van Wijk 64 E. Gimeno-Santos 3 Stefano Guerra 3, 4, 5, 65 Tari Haahtela 66 H. Haddad 67 Peter Hellings 68 B. Hellquist-Dahl 54 C. Hohmann 18 Peter Howarth 69 J. O. Hourihane 70 Marc Humbert 71 Bénédicte Jacquemin 2 Jocelyne Just 72 Omer Kalayci 73 Michael Kaliner 74 Francine Kauffmann 2 Marjan Kerkhof 75 G. Khayat 76 Bernard Koffi N'Goran 77 M. Kogevinas 3, 4, 5 Gerard Koppelman 78 Marek Kowalski 79 Inger Kull 80, 81 Piotr Kuna 82 Désirée Larenas 83 I. Lavi 3 Lan Thi Tuyet Le 84 Phil Lieberman 85 Brian Lipworth 86 Bassam Mahboub 87 M. J. Makela 66 Francis Martin 88 Fernando Martinez 89 Gailen Marshall 90 A. Mazon 27 Erik Melen 91 Eli Meltzer 92 F. Mihaltan 93 Yousser Mohammad 94 Azzeddine Mohammadi 95 Isabelle Momas 96 Mario Morais-Almeida 97 Joaquim Mullol 98 Antonella Muraro 99 Robert Naclerio 100 Salim Nafti 101 Leyla Namazova-Baranova 102 Martijn Nawijn 103 Tshipukane Nyembue 104 Sam Oddie 105 Robyn O'Hehir 106 Yoshitaka Okamoto 107 M. P. Orru 108 Cevdet Ozdemir 109 G. S. Ouedraogo 110 Susanna Palkonen 111 Petr Panzner 112 G. Passalacqua 46 Ruby Pawankar 113 Bernard Pigearias 114 Isabelle Pin 115 M. Pinart 3 Christophe Pison 116 Ted Popov 117 Daniela Porta 118 Dirkje Postma 78 David Price 119 Klaus Rabe 120 Julia Ratomaharo 121 S. Reitamo 65 Djamel Rezagui 122 Johannes Ring 123 R. Roberts 124 Joseph Roca 125 B. Rogala 126 Antonino Romano 127 José Rosado-Pinto 128 Dermot Ryan 129, 130 Mario Sanchez-Borges 131 Glenis Scadding 132 Aziz Sheikh 133 Frances Estelle Reed Simons 134 Valérie Siroux 115 Peter Schmid-Grendelmeier 135 H. A. Smit 136 Talant Sooronbaev 137 Renato Stein 3, 138 P. J. Sterk 31, 121 J. Sunyer 3, 4, 5, 6 Ingrid Terreehorst 139 Elina Toskala 140 Yves Tremblay 141 Rudolf Valenta 142 Dominique Valeyre 143 Olivier Vandenplas 144 Chris van Weel 145 M. Vassilaki 62 R. Varraso 71, 2 Giovanni Viegi 146, 147 de Yun Wang 148 Magnus Wickman 149 Dennis Williams 150 Stefan Wöhrl 151 J. Wright 105 Arzu Yorgancioglu 152 Osman Yusuf 153 H. J. Zar 154 M. E. Zernotti 28 Mihaela Zidarn 155 N. Zhong 156 Torsten Zuberbier 19, 157
* Corresponding author
1 Hôpital Arnaud de Villeneuve [CHRU Montpellier]
2 CESP - Centre de recherche en épidémiologie et santé des populations
3 IMIM-Hospital del Mar
4 CREAL - Center for Research in Environmental Epidemiology
5 CIBER Epidemiologia y Salud Publica
6 Universitat Pompeu Fabra [Barcelona]
7 WHO Collaborating Center for Asthma and Rhinitis
8 Pharmacoepidemiologie et évaluation de l'impact des produits de santé sur les populations
9 Department of Clinical Epidemiology and Biostatistics and Medicine
10 NIAID-NIH - National Institute of Allergy and Infectious Diseases [Bethesda]
11 SIAF - Swiss Institute of Allergy and Asthma Research
12 Génomique fonctionnelle et biologie systémique pour la santé
13 URL - Upper Airway Research Laboratory
14 Department of Dermatology and Allergy
15 Department of Paediatrics
16 Division of Allergy and Immunology, Department of Medicine
17 ProAR - FMB
18 Epidemiology and Health Economics
19 Department of Dermatology
20 Division of Respiratory Medicine and Allergology
21 Allergy Department
22 Son Pisa Primary Care Centre
23 Department of Prevention of Environmental Hazards and Allergology
24 Department of Allergy and Clinical Immunology
25 Public Hospital Medical Service
26 ESIM - Epidémiologie des maladies infectieuses et modélisation
27 CSISP - Center for Public Health Research
28 Respiratory Medicine
29 Faculty of Medicine
30 Health Sciences Faculty
31 Department of Pulmonology
32 Divisions of Human Genetics Infection, Inflammation and Repair
33 Service de Pneumologie Allergologie
34 Service de Pneumologie
35 National Asthma Centre
36 Pneumologie / Anesthésie - réanimation / Oxygénothérapie
37 Department of Dermatology and Allergy Center
38 Center for Genomics and Personalized Medicine
39 Institute of Neurobiology and Molecular Medicine
40 Department of Paediatrics
41 Institut de cardiologie et de pneumologie
42 Department of Respiratory Medicine and Thoracic Surgery
43 Department of Paediatric Respiratory Medicine
44 Department of Medicine
45 Department of Pediatrics
46 Allergy & Respiratory Diseases
47 Allergy & Asthma Associates
48 Deputy Scientific Director
49 Department of Thoracic Surgery
50 National Cooperative Group of Pediatric Research on Asthma
51 Service des Premiers Soins
52 Osteopathic College of Medicine
53 Respiratory Research Group
54 Department of Respiratory Diseases
55 Department of Dermatology and Allergy Biederstein
56 Service de pneumologie
57 Service de pneumo-allergologie
58 Allergy Centre
59 Société Marocaine des Maladies Respiratoires
60 Allergy Division
61 Department of Otorhinolaryngology
62 Department of Social Medicine
63 Health Care
64 Section of Allergology
65 Epidemiology and Biostatistics Division
66 Department of Dermatology
67 Service de pneumologie
68 Department of Otorhinolaryngology, Head, and Neck Surgery
69 Engineering and the Environment
70 Paediatrics and Child Health
71 Service de Pneumologie
72 Centre de l'Asthme et des Allergies [CHU Trousseau]
73 Pediatric Allergy and Asthma Unit
74 Institute for Asthma and Allergy
75 Department of Epidemiology
76 Service de Pneumologie
77 Service des Maladies Respiratoires
78 Pediatric Pulmonology, Allergology & Epidemiology
79 Department of Clinical Immunology and Allergy
80 Centre for Allergy Research
81 Department of Clinical Science and Education
82 Division of Internal Medicine, Asthma and Allergy
83 Allergy Department
84 Physiology Department
85 Division of Allergy Immunology
86 university of dundee asthma - allergic rhinitis - COPD - beta-2-adrenoceptor
87 Pulmonary and allergy unit
88 AFVP - Association Franco-Vietnamienne de Pneumologie
89 Arizona Respiratory Center
90 Department of Medicine, Clinical Immunology and Allergy
91 Institute of Environmental Medicine
92 Allergy & Asthma Medical Group & Research Center
93 Pneumology Department
94 Department of Internal Medicine
95 AFMAPATH - Association Franco-Marocaine de Pathologie Thoracique
96 EA 4064 - Epidémiologie Environnementale : Impact Sanitaire des Pollutions
97 Immunoallergy Department
98 Rhinology Unit & Smell Clinic
99 Allergy Unit
100 OHNS - Section of Otolaryngology-Head & Neck Surgery
101 Clinique des maladies respiratoires
102 Scientific Center for Children's Health
103 Laboratory of Allergology and Pulmonary Diseases
104 ENT Department
105 Bradford Neonatology
106 Department of Allergy, Immunology and Respiratory Medicine
107 Department of Otorhinolaryngology
108 Asthme Rhinite allergique
109 Division of Pediatric Allergy and Immunology
110 Pédiatrie
111 EFA - European Federation of Allergy
112 Department of Allergology and Clinical Immunology
113 Immunopharmacology
114 Laboratoire du Sommeil et de l'Effort
115 INSERM U823 - Institut d'oncologie/développement Albert Bonniot de Grenoble
116 LBFA [1990-2015] - Laboratoire de bioénergétique fondamentale et appliquée [1990-2015]
117 Clinic of Allergy and Asthma
118 Department of Epidemiology
119 Primary Care Respiratory Medicine
120 Department of Pulmonary Medicine
121 Pneumalgia
122 AFAP - Association Franco-Algérienne de Pneumologie
123 Department of Dermatology and Allergy
124 Allergy Department
125 Department of Pneumology
126 Allergology and Clinical Immunology
127 UCSC-Allergy Unit
128 Immunoallergy Department
129 Medical Centre
130 Research Fellow
131 Department of Allergy and Clinical Immunology
132 Department of Pharmacology
133 Primary Care Research & Development
134 Section of Allergy & Clinical Immunology
135 Allergy Unit - Department of Dermatology
136 Julius Center for Health Sciences and Primary Care
137 National Centre of Cardiology and Internal Medicine
138 School of Medicine
139 Department of ENT and Pediatrics
140 Department of Otorhinolaryngology
141 Department of Obstetrics and Gynaecology
142 Christian Doppler Laboratory for Allergy Research
143 Service de Pneumologie
144 Department of Chest Medicine
145 Department of Primary and Community Care
146 Epidemiology Unit
147 Pulmonary Environmental Epidemiology Unit
148 Department of Otolaryngology
149 Institute of Environmental Medicine
150 GLP Analytical Facility
151 DIAID - Department of Dermatology Division of Immunology, Allergy and Infectious Diseases
152 Department of Pulmonology
153 Allergy and Asthma Clinics
154 Department of Paediatrics and Child Health
155 Respiratory and Allergic Diseases
156 State Key Laboratory of Respiratory Diseases
157 GA2LEN - Secretary General of the Global Allergy and Asthma European Network
Abstract : Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
Keywords : IgE allergy severity control risk asthma rhinitis rhinosinusitis urticaria atopic dermatitis
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Jean Bousquet, Josep Anto, Pascal Demoly, Holger Schünemann, Alkis Togias, et al.. Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper.. International Archives of Allergy and Immunology, Karger, 2012, 158 (3), pp.216-31. ⟨10.1159/000332924⟩. ⟨inserm-00788048⟩

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