Allergy Working Group Meeting ERS 2017 Milan, 9th September 2017

Agenda Working group progress update Priorities for future research Review potential studies Are they still relevant, feasible, valid and a priority Other research ideas Setting priorities Additional items

Attendees ? Peter Hellings (chair) A Azuma S Turner A Niimi

Progress update Published studies Manise M, Bakayoko B, Schleich F, Corhay JL, Louis R. 2016. IgE mediated sensitization to aeroallergens in an asthmatic cohort: relationship with inflammatory phenotypes and disease severity. The International Journal of Clinical Practice. 70 (7): 596-605

Active study update: Quantify the burden of acute versus chronic rhinosinusitis in routine clinical practice (REG_P001) Objective Methodology Quantify the burden of rhinitis and rhinosinusitus and characterize related management approaches in UK primary care assess the incidence of acute and chronic rhinosinusitis and rhinitis in current clinical practice Assess the number of consultations for rhinitis and rhinosinusitis and that result in a prescription of an antibiotic, steroid or antihistamine   Design: Retrospective cohort using OPCRD Population: Consultations coded for rhinitis and rhinosinusitis symptoms resulting in prescriptions for antibiotics, oral steroids and/or antihistamines in the last 5 years.

Antibiotics prescribed Results Antibiotics prescribed 19% 71%

Paper in draft format (Prof. Fokkens) Conclusions In the OPCRD, acute rhinosinusitis consultations make up 35% of all primary care consultations for rhinitis and rhinosinusitis Interestingly, almost three-quarters of patients (71%) consulting for acute rhinosinusitis and 58% of patients with chronic rhinosinusitis receive an antibiotic prescription Paper in draft format (Prof. Fokkens)

Australian Survey of Allergic Rhinitis Sufferers (REG-RES1615) Aim To build and disseminate a comprehensive picture of the burden and unmet need of allergic rhinitis patients in Australia.   Methodology Design: Online survey with discrete choice experiment with patients recruited through specialist recruitment agency Inclusion criteria: Self-reported diagnosis of allergic rhinitis by a medical professional. 18 years of age or older Currently resident in Australia Able to give informed consent Able to complete the protocol requirements

Australian Survey of Allergic Rhinitis Sufferers (REG-RES1615) In total 1151 participants completed the survey, of those 621 (54%) were symptomatic on the day of completing the survey. Most of the sample (N=1016, 88%) used medication to treat their AR Most participants (80%) use more than one medication Two thirds of participants see a doctor or specialist for their AR Only 13% of participants had received immunotherapy for their AR, this was most commonly for grass pollen (66%) or dust mite (62%) allergies

Australian Survey of Allergic Rhinitis Sufferers (REG-RES1615) In discrete choice analysis, participants showed a strong preference for: a treatment that provides complete symptom relief compared to mild symptom relief (OR:12.069; 95% CIs: 10.674 - 13.646; WTP: $73.63) a treatment that provides moderate symptom relief compared to mild symptom relief (OR:2.584; 95% CIs: 2.431 - 2.747; WTP: $28.07) a treatment that is taken once a day compared to three times a day (OR: 0.643; CIs: 0.607 – 0.681: WTP: -$13.06) administration attribute (tablets and nasal spray compared to nasal spray alone) was not a significant predictor of choice

Future interests Two projects with short proposals Four other potential project ideas

Evaluate the burden of allergic disease study from the multi-stakeholder (primary case, secondary care, pharmacy) perspectives (REG_P016) Working title Rationale Burden of allergic diseases A substantial proportion of patients with allergic disease do not present in primary care; instead purchase OTC therapies from the pharmacy. To understand the true burden of allergic disease there is a need to evaluate the burden of allergic disease presenting in the pharmacy setting as well as in clinical practice. Objective Improve understanding of the true burden of allergic disease Gain evidence to inform improved consumer guidance in the future   Proposed methodology Design: Questionnaire based study within the pharmacy setting with digital data collection Proposed by Dermot Ryan; 2016

Evaluate the prevalence and clinical implications of comorbid nasal and bronchial hyper responsiveness in patients managed in a range of settings (primary care, specialist/secondary care, pharmacy) (REG_P017) Working title Rationale Characterising the factors associated with oral steroid use by patients with asthma in primary care. Suboptimal asthma medication use is fundamental in poor asthma control. To date we do not know whether people with asthma make decisions not only about whether they will take their medications, but which medications they chose to take when they experience poor asthma control. By identifying the factors associated with oral steroid use, we may be able to distinguish patients with severe asthma from those with less severe asthma who have inappropriate asthma management practices. Objective To characterise people with asthma in primary care prescribed at least one course of oral steroids in the preceding 12 months based on their medication profile and asthma management practices. To identify the patient-related factors associated with oral steroid use. Some overlap with other groups. Is this best in allergy group? Proposed methodology Design: This will be a retrospective, real-world, cross-sectional observational study using data extracted from the OPCRD Population: Adult (18-70 years) asthma patients Exclusion criteria: People with a diagnosis of COPD Proposed by Sinthia Bosnic-Anticevich; 2016

Potential projects with no proposals REG_P018: Real-world effectiveness of allergen immunotherapy Link between severe asthma and allergic/nasal symptoms REG to look at questions on ISAR dataset, and in OPCRD. EUFOREA App: Potential validation study through REG allergy working group. Overlap with Technologies and Asthma working groups. REG project to validate EUFOREA clinical project on reasons for uncontrolled disease.

Other research ideas?

Setting priorities Are these projects still: Relevant? Feasible? Valid? A priority? How do we set priorities in allergy research? How to we ensure these priorities are pursued? What are the two most important projects to push forwards?

Any other business?