Distinction between allergic rhinitis alone and allergic rhinitis + asthma in MASK-air® real-world studies; a ARIA-WAO task force review

Bernardo Sousa-Pinto MD, PhD, Rafael José Vieira MD, PhD, Ana Margarida Pereira PhD et al. World Allergy Organization Journal Volume 19, Issue 8, August 2026, 101435

Abstract

The recent ARIA-MeDALL hypothesis proposed in 2023 that allergic rhinitis (AR) alone and allergic rhinitis and asthma (A) multimorbidity (AR + A) represent 2 distinct diseases. To improve the knowledge on this topic, we have gathered data from real-world studies using MASK-air®. According to our analyses: (i) An “extreme allergy phenotype” [A + AR + C, Conjunctivitis] was confirmed and found to be more severe (symptoms and work productivity) than single diseases alone. (ii) Patients with AR + A required more rhinitis medications, and had more severe VAS levels for nasal and ocular symptoms than those with AR alone in all countries tested. (iii) In clusters with poorly controlled AR, the frequency of co-medicating with more than 1 rhinitis drug was higher in AR + A than in AR alone. 

Impact on work and VAS global depending
on the RCA multimorbidity

(iv) In the CONSTANCES general population cohort, a co-medication pattern (intranasal corticosteroid and oral H1-antihistamines) was associated with the presence of AR + A (vs AR alone). This co-medication pattern was associated in MASK-air® with a poorer AR control than monotherapy. (v) Patients with AR + A had different EQ-5D patterns than those with AR alone. (vi) Large differences were found between AR alone and AR + A in work impairment, resulting in higher weekly indirect costs in all OECD countries in AR + A by comparison to AR alone. Although mHealth studies are hypothesis-generating, and usually not reliable for testing or confirming hypotheses, our results are strongly in support of the nosologic distinction between A + AR and AR alone.

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