Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments

Bernardo Sousa-Pinto; Jean Bousquet; Rafael José Vieira; Holger J Schünemann; Torsten Zuberbier; Antonio Bognanni; Alkis Togias; Boleslaw Samolinski; Arunas Valiulis; Sian Williams; Anna Bedbrook; Wienczyslawa Czarlewski; Maria Jose Torres; Mohamed H Shamji; Mário Morais-Almeida; G Walter Canonica; Leticia de Las Vecillas; Mark S Dykewicz; Cristina Jacomelli; Ludger Klimek; Lucas Leemann; Olga Lourenço; Yuliia Palamarchuk; Nikolaos G Papadopoulos; Ana Margarida Pereira; Marine Savouré; Sanna K Toppila-Salmi; Maria Teresa Ventura; Juan José Yepes-Nuñez; Alvaro A Cruz; Giorgio Ciprandi; Bilun Gemicioglu; Mattia Giovannini; Brigita Gradauskiene; Tuomas Jartti; Miloš Jeseňák; Piotr Kuna; Violeta Kvedariene; Désirée E Larenas-Linnemann; Amir Ha Latiff; Yousser Mohammad; Ken Ohta; Padukudru A Mahesh; Isabella Pali-Schöll; Oliver Pfaar; Frederico S Regateiro; Nicolas Roche; Luís Taborda-Barata; Charlotte Suppli Ulrik; Marylin Valentin Rostan; Giovanni Viegi; Luo Zhang; Tari Haahtela; Ivan Cherrez-Ojeda; Juan Carlos Ivancevich; Nikolai Khaltaev; Arzu Yorgancioglu; Baharudin Abdullah; Mona Al-Ahmad; Maryam Ali Al-Nesf; Rita Amaral; Julijana Asllani; Karl-C Bergmann; Jonathan A Bernstein; Michael S Blaiss; Fulvio Braido; Paulo Camargos; Pedro Carreiro-Martins; Thomas Casale; Lorenzo Cecchi; Alessandro Fiocchi; Antonio F M Giuliano; George Christoff; Ieva Cirule; Jaime Correia de Sousa; Elisio M Costa; Stefano Del Giacco; Philippe Devillier; Dejan Dokic; Elham Hossny; Tomohisa Iinuma; Carla Irani; Zhanat Ispayeva; Kaja Julge; Igor Kaidashev; Kazi S Bennoor; Helga Kraxner; Inger Kull; Marek Kulus; Maciej Kupczyk; Andriy Kurchenko; Stefania La Grutta; Neven Miculinic; Lan Le Thi Tuyet; Michael Makris; Branislava Milenkovic; Sang Min Lee; Stephen Montefort; Andre Moreira; Joaquim Mullol; Rachel Nadif; Alla Nakonechna; Hugo E Neffen; Marek Niedoszytko; Dieudonné Nyembue; Robyn E O'Hehir; Ismail Ogulur; Yoshitaka Okamoto; Heidi Olze; Oscar Palomares; Petr Panzner; Vincenzo Patella; Ruby Pawankar; Constantinos Pitsios; Todor A Popov; Francesca Puggioni; Santiago Quirce; Agné Ramonaité; Marysia Recto; Maria Susana Repka-Ramirez; Graham Roberts; Karla Robles-Velasco; Menachem Rottem; Marianella Salapatas; Joaquin Sastre; Nicola Scichilone; Juan-Carlos Sisul; Dirceu Solé; Manuel E Soto-Martinez; Milan Sova; Pongsakorn Tantilipikorn; Ana Todo-Bom; Vladyslav Tsaryk; Ioanna Tsiligianni; Marilyn Urrutia-Pereira; Erkka Valovirta; Tuula Vasankari; Dana Wallace; De Yun Wang; Margitta Worm; Osman M Yusuf; Mihaela Zidarn; Sara Gil-Mata; Manuel Marques-Cruz; Bassam Mahboub; Ignacio J Ansotegui; Antonino Romano; Werner Aberer; Maria Cristina Artesani; Elena Azzolini; Bruno Barreto; Joan Bartra; Sven Becker; Bianca Beghe; Attilio Boner; Ewa Borowiack; Jacques Bouchard; Melisande Bourgoin-Heck; Luisa Brussino; Roland Buhl; José Antonio Castillo-Vizuete; Denis Charpin; Niels H Chavannes; Marta Chełmińska; Lei Cheng; Ekaterine Chkhartishvili; Seong H Cho; Herberto Jose Chong-Neto; Deepa Choudhury; Derek K Chu; Cemal Cingi; Enrico Compalati; Raquel Albuquerque Costa; Olga Mariana Cunha; Biljana Cvetkovski; Victoria Cardona-Dahl; Gennaro D'Amato; Janet Davies; Danilo Di Bona; Sandra N Gonzalez Diaz; Maria V Dimou; Maria Doulaptsi; Renato Ferreira-da-Silva; Radoslaw Gawlik; Mario Calvo-Gil; Ozlem Goksel; Maximiliano R Gómez; Maia Gotua; Christos Grigoreas; Ineta Grisle; Maria Antonieta Guzman; Rachel House Tan; Michael Hyland; Despo Ierodiakonou; Aspasia Karavelia; Paul Keith; Marta Kisiel; Tanja Soklic Kosak; Mitja Kosnik; Ilgim Vardaloglu Koyuncu; Vicky Kritikos; Justyna Litynska; Carlo Lombardi; Gilles Louis; Matteo Martini; Cem Meço; Eris Mesonjesi; Florin Mihaltan; Marcin Moniuszko; Robert N Naclerio; Kari C Nadeau; Sophia Neisinger; Markus Ollert; Michal Ordak; Giovanni Paoletti; Hae-Sim Park; Elena Parmelli; Edgar Arturo Perdomo-Flores; José Miguel Fuentes Pérez; Nhan Pham-Thi; Emmanuel Prokopakis; Inês Ribeiro-Vaz; Giovanni Rolla; Jan Romantowski; Philippe Rombaux; Philip W Rouadi; Maia Rukhadze; Dermot Ryan; Ewelina Sadowska; Daiju Sakurai; Laila Salameh; Faradiba Serpa Sarquis; Elie Serrano; Jane Da Silva; Michael Soyka; Krzysztof Specjalski; Vesna Tomic-Spiric; Katarina Stevanovic; Abirami Subramaniam; Maria Do Ceu Teixeira; Tuuli Thomander; Martina Vachova; Marianne van Hage; Pakit Vichyanond; Martin Wagenmann; Fanny Wai San Ko; Pascal Werminghaus; Paraskevi Vicky Xepapadaki; Yi-Kui Xiang; Qintai Yang; Daniela Rivero Yeverino; Jaron Zuberbier; João A Fonseca

doi:10.1111/all.70131

Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments

Bernardo Sousa-Pinto, Jean Bousquet^*, Rafael José Vieira, Holger J Schünemann, Torsten Zuberbier, Antonio Bognanni, Alkis Togias, Boleslaw Samolinski, Arunas Valiulis, Sian Williams, Anna Bedbrook, Wienczyslawa Czarlewski, Maria Jose Torres, Mohamed H Shamji, Mário Morais-Almeida, G Walter Canonica, Leticia de Las Vecillas, Mark S Dykewicz, Cristina Jacomelli, Ludger KlimekLucas Leemann, Olga Lourenço, Yuliia Palamarchuk, Nikolaos G Papadopoulos, Ana Margarida Pereira, Marine Savouré, Sanna K Toppila-Salmi, Maria Teresa Ventura, Juan José Yepes-Nuñez, Alvaro A Cruz, Giorgio Ciprandi, Bilun Gemicioglu, Mattia Giovannini, Brigita Gradauskiene, Tuomas Jartti, Miloš Jeseňák, Piotr Kuna, Violeta Kvedariene, Désirée E Larenas-Linnemann, Amir Ha Latiff, Yousser Mohammad, Ken Ohta, Padukudru A Mahesh, Isabella Pali-Schöll, Oliver Pfaar, Frederico S Regateiro, Nicolas Roche, Luís Taborda-Barata, Charlotte Suppli Ulrik, Marylin Valentin Rostan, Giovanni Viegi, Luo Zhang, Tari Haahtela, Ivan Cherrez-Ojeda, Juan Carlos Ivancevich, Nikolai Khaltaev, Arzu Yorgancioglu, Baharudin Abdullah, Mona Al-Ahmad, Maryam Ali Al-Nesf, Rita Amaral, Julijana Asllani, Karl-C Bergmann, Jonathan A Bernstein, Michael S Blaiss, Fulvio Braido, Paulo Camargos, Pedro Carreiro-Martins, Thomas Casale, Lorenzo Cecchi, Alessandro Fiocchi, Antonio F M Giuliano, George Christoff, Ieva Cirule, Jaime Correia de Sousa, Elisio M Costa, Stefano Del Giacco, Philippe Devillier, Dejan Dokic, Elham Hossny, Tomohisa Iinuma, Carla Irani, Zhanat Ispayeva, Kaja Julge, Igor Kaidashev, Kazi S Bennoor, Helga Kraxner, Inger Kull, Marek Kulus, Maciej Kupczyk, Andriy Kurchenko, Stefania La Grutta, Neven Miculinic, Lan Le Thi Tuyet, Michael Makris, Branislava Milenkovic, Sang Min Lee, Stephen Montefort, Andre Moreira, Joaquim Mullol, Rachel Nadif, Alla Nakonechna, Hugo E Neffen, Marek Niedoszytko, Dieudonné Nyembue, Robyn E O'Hehir, Ismail Ogulur, Yoshitaka Okamoto, Heidi Olze, Oscar Palomares, Petr Panzner, Vincenzo Patella, Ruby Pawankar, Constantinos Pitsios, Todor A Popov, Francesca Puggioni, Santiago Quirce, Agné Ramonaité, Marysia Recto, Maria Susana Repka-Ramirez, Graham Roberts, Karla Robles-Velasco, Menachem Rottem, Marianella Salapatas, Joaquin Sastre, Nicola Scichilone, Juan-Carlos Sisul, Dirceu Solé, Manuel E Soto-Martinez, Milan Sova, Pongsakorn Tantilipikorn, Ana Todo-Bom, Vladyslav Tsaryk, Ioanna Tsiligianni, Marilyn Urrutia-Pereira, Erkka Valovirta, Tuula Vasankari, Dana Wallace, De Yun Wang, Margitta Worm, Osman M Yusuf, Mihaela Zidarn, Sara Gil-Mata, Manuel Marques-Cruz, Bassam Mahboub, Ignacio J Ansotegui, Antonino Romano, Werner Aberer, Maria Cristina Artesani, Elena Azzolini, Bruno Barreto, Joan Bartra, Sven Becker, Bianca Beghe, Attilio Boner, Ewa Borowiack, Jacques Bouchard, Melisande Bourgoin-Heck, Luisa Brussino, Roland Buhl, José Antonio Castillo-Vizuete, Denis Charpin, Niels H Chavannes, Marta Chełmińska, Lei Cheng, Ekaterine Chkhartishvili, Seong H Cho, Herberto Jose Chong-Neto, Deepa Choudhury, Derek K Chu, Cemal Cingi, Enrico Compalati, Raquel Albuquerque Costa, Olga Mariana Cunha, Biljana Cvetkovski, Victoria Cardona-Dahl, Gennaro D'Amato, Janet Davies, Danilo Di Bona, Sandra N Gonzalez Diaz, Maria V Dimou, Maria Doulaptsi, Renato Ferreira-da-Silva, Radoslaw Gawlik, Mario Calvo-Gil, Ozlem Goksel, Maximiliano R Gómez, Maia Gotua, Christos Grigoreas, Ineta Grisle, Maria Antonieta Guzman, Rachel House Tan, Michael Hyland, Despo Ierodiakonou, Aspasia Karavelia, Paul Keith, Marta Kisiel, Tanja Soklic Kosak, Mitja Kosnik, Ilgim Vardaloglu Koyuncu, Vicky Kritikos, Justyna Litynska, Carlo Lombardi, Gilles Louis, Matteo Martini, Cem Meço, Eris Mesonjesi, Florin Mihaltan, Marcin Moniuszko, Robert N Naclerio, Kari C Nadeau, Sophia Neisinger, Markus Ollert, Michal Ordak, Giovanni Paoletti, Hae-Sim Park, Elena Parmelli, Edgar Arturo Perdomo-Flores, José Miguel Fuentes Pérez, Nhan Pham-Thi, Emmanuel Prokopakis, Inês Ribeiro-Vaz, Giovanni Rolla, Jan Romantowski, Philippe Rombaux, Philip W Rouadi, Maia Rukhadze, Dermot Ryan, Ewelina Sadowska, Daiju Sakurai, Laila Salameh, Faradiba Serpa Sarquis, Elie Serrano, Jane Da Silva, Michael Soyka, Krzysztof Specjalski, Vesna Tomic-Spiric, Katarina Stevanovic, Abirami Subramaniam, Maria Do Ceu Teixeira, Tuuli Thomander, Martina Vachova, Marianne van Hage, Pakit Vichyanond, Martin Wagenmann, Fanny Wai San Ko, Pascal Werminghaus, Paraskevi Vicky Xepapadaki, Yi-Kui Xiang, Qintai Yang, Daniela Rivero Yeverino, Jaron Zuberbier, João A Fonseca

^*Corresponding author af dette arbejde

Lungemedicinsk Forskningsenhed AHH

Abstract

BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management.

METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs.

RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH.

CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.

Originalsprog	Engelsk
Tidsskrift	Allergy
Vol/bind	81
Udgave nummer	4
Sider (fra-til)	954-976
Antal sider	23
ISSN	0105-4538
DOI	https://doi.org/10.1111/all.70131
Status	Udgivet - apr. 2026

Adgang til dokumentet

10.1111/all.70131Licens: CC BY

Citationsformater

Sousa-Pinto, B., Bousquet, J., Vieira, R. J., Schünemann, H. J., Zuberbier, T., Bognanni, A., Togias, A., Samolinski, B., Valiulis, A., Williams, S., Bedbrook, A., Czarlewski, W., Torres, M. J., Shamji, M. H., Morais-Almeida, M., Canonica, G. W., Vecillas, L. D. L., Dykewicz, M. S., Jacomelli, C., ... Fonseca, J. A. (2026). Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments. Allergy, 81(4), 954-976. https://doi.org/10.1111/all.70131

Sousa-Pinto, B, Bousquet, J, Vieira, RJ, Schünemann, HJ, Zuberbier, T, Bognanni, A, Togias, A, Samolinski, B, Valiulis, A, Williams, S, Bedbrook, A, Czarlewski, W, Torres, MJ, Shamji, MH, Morais-Almeida, M, Canonica, GW, Vecillas, LDL, Dykewicz, MS, Jacomelli, C, Klimek, L, Leemann, L, Lourenço, O, Palamarchuk, Y, Papadopoulos, NG, Pereira, AM, Savouré, M, Toppila-Salmi, SK, Ventura, MT, Yepes-Nuñez, JJ, Cruz, AA, Ciprandi, G, Gemicioglu, B, Giovannini, M, Gradauskiene, B, Jartti, T, Jeseňák, M, Kuna, P, Kvedariene, V, Larenas-Linnemann, DE, Latiff, AH, Mohammad, Y, Ohta, K, Mahesh, PA, Pali-Schöll, I, Pfaar, O, Regateiro, FS, Roche, N, Taborda-Barata, L, Ulrik, CS, Rostan, MV, Viegi, G, Zhang, L, Haahtela, T, Cherrez-Ojeda, I, Carlos Ivancevich, J, Khaltaev, N, Yorgancioglu, A, Abdullah, B, Al-Ahmad, M, Al-Nesf, MA, Amaral, R, Asllani, J, Bergmann, K-C, Bernstein, JA, Blaiss, MS, Braido, F, Camargos, P, Carreiro-Martins, P, Casale, T, Cecchi, L, Fiocchi, A, Giuliano, AFM, Christoff, G, Cirule, I, de Sousa, JC, Costa, EM, Del Giacco, S, Devillier, P, Dokic, D, Hossny, E, Iinuma, T, Irani, C, Ispayeva, Z, Julge, K, Kaidashev, I, Bennoor, KS, Kraxner, H, Kull, I, Kulus, M, Kupczyk, M, Kurchenko, A, La Grutta, S, Miculinic, N, Tuyet, LLT, Makris, M, Milenkovic, B, Lee, SM, Montefort, S, Moreira, A, Mullol, J, Nadif, R, Nakonechna, A, Neffen, HE, Niedoszytko, M, Nyembue, D, O'Hehir, RE, Ogulur, I, Okamoto, Y, Olze, H, Palomares, O, Panzner, P, Patella, V, Pawankar, R, Pitsios, C, Popov, TA, Puggioni, F, Quirce, S, Ramonaité, A, Recto, M, Repka-Ramirez, MS, Roberts, G, Robles-Velasco, K, Rottem, M, Salapatas, M, Sastre, J, Scichilone, N, Sisul, J-C, Solé, D, Soto-Martinez, ME, Sova, M, Tantilipikorn, P, Todo-Bom, A, Tsaryk, V, Tsiligianni, I, Urrutia-Pereira, M, Valovirta, E, Vasankari, T, Wallace, D, Wang, DY, Worm, M, Yusuf, OM, Zidarn, M, Gil-Mata, S, Marques-Cruz, M, Mahboub, B, Ansotegui, IJ, Romano, A, Aberer, W, Artesani, MC, Azzolini, E, Barreto, B, Bartra, J, Becker, S, Beghe, B, Boner, A, Borowiack, E, Bouchard, J, Bourgoin-Heck, M, Brussino, L, Buhl, R, Castillo-Vizuete, JA, Charpin, D, Chavannes, NH, Chełmińska, M, Cheng, L, Chkhartishvili, E, Cho, SH, Chong-Neto, HJ, Choudhury, D, Chu, DK, Cingi, C, Compalati, E, Costa, RA, Cunha, OM, Cvetkovski, B, Cardona-Dahl, V, D'Amato, G, Davies, J, Di Bona, D, Gonzalez Diaz, SN, Dimou, MV, Doulaptsi, M, Ferreira-da-Silva, R, Gawlik, R, Calvo-Gil, M, Goksel, O, Gómez, MR, Gotua, M, Grigoreas, C, Grisle, I, Guzman, MA, Tan, RH, Hyland, M, Ierodiakonou, D, Karavelia, A, Keith, P, Kisiel, M, Kosak, TS, Kosnik, M, Koyuncu, IV, Kritikos, V, Litynska, J, Lombardi, C, Louis, G, Martini, M, Meço, C, Mesonjesi, E, Mihaltan, F, Moniuszko, M, Naclerio, RN, Nadeau, KC, Neisinger, S, Ollert, M, Ordak, M, Paoletti, G, Park, H-S, Parmelli, E, Perdomo-Flores, EA, Pérez, JMF, Pham-Thi, N, Prokopakis, E, Ribeiro-Vaz, I, Rolla, G, Romantowski, J, Rombaux, P, Rouadi, PW, Rukhadze, M, Ryan, D, Sadowska, E, Sakurai, D, Salameh, L, Sarquis, FS, Serrano, E, Da Silva, J, Soyka, M, Specjalski, K, Tomic-Spiric, V, Stevanovic, K, Subramaniam, A, Teixeira, MDC, Thomander, T, Vachova, M, van Hage, M, Vichyanond, P, Wagenmann, M, Ko, FWS, Werminghaus, P, Xepapadaki, PV, Xiang, Y-K, Yang, Q, Yeverino, DR, Zuberbier, J & Fonseca, JA 2026, 'Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments', Allergy, bind 81, nr. 4, s. 954-976. https://doi.org/10.1111/all.70131

@article{a83d2f5dc29c4fb888a66ad68d8891f6,

title = "Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments",

abstract = "BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management.METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs.RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH.CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.",

keywords = "allergic rhinitis, guidelines, intranasal antihistamines, intranasal corticosteroids",

author = "Bernardo Sousa-Pinto and Jean Bousquet and Vieira, \{Rafael Jos{\'e}\} and Sch{\"u}nemann, \{Holger J\} and Torsten Zuberbier and Antonio Bognanni and Alkis Togias and Boleslaw Samolinski and Arunas Valiulis and Sian Williams and Anna Bedbrook and Wienczyslawa Czarlewski and Torres, \{Maria Jose\} and Shamji, \{Mohamed H\} and M{\'a}rio Morais-Almeida and Canonica, \{G Walter\} and Vecillas, \{Leticia de Las\} and Dykewicz, \{Mark S\} and Cristina Jacomelli and Ludger Klimek and Lucas Leemann and Olga Louren{\c c}o and Yuliia Palamarchuk and Papadopoulos, \{Nikolaos G\} and Pereira, \{Ana Margarida\} and Marine Savour{\'e} and Toppila-Salmi, \{Sanna K\} and Ventura, \{Maria Teresa\} and Yepes-Nu{\~n}ez, \{Juan Jos{\'e}\} and Cruz, \{Alvaro A\} and Giorgio Ciprandi and Bilun Gemicioglu and Mattia Giovannini and Brigita Gradauskiene and Tuomas Jartti and Milo{\v s} Jese{\v n}{\'a}k and Piotr Kuna and Violeta Kvedariene and Larenas-Linnemann, \{D{\'e}sir{\'e}e E\} and Latiff, \{Amir Ha\} and Yousser Mohammad and Ken Ohta and Mahesh, \{Padukudru A\} and Isabella Pali-Sch{\"o}ll and Oliver Pfaar and Regateiro, \{Frederico S\} and Nicolas Roche and Lu{\'i}s Taborda-Barata and Ulrik, \{Charlotte Suppli\} and Rostan, \{Marylin Valentin\} and Giovanni Viegi and Luo Zhang and Tari Haahtela and Ivan Cherrez-Ojeda and \{Carlos Ivancevich\}, Juan and Nikolai Khaltaev and Arzu Yorgancioglu and Baharudin Abdullah and Mona Al-Ahmad and Al-Nesf, \{Maryam Ali\} and Rita Amaral and Julijana Asllani and Karl-C Bergmann and Bernstein, \{Jonathan A\} and Blaiss, \{Michael S\} and Fulvio Braido and Paulo Camargos and Pedro Carreiro-Martins and Thomas Casale and Lorenzo Cecchi and Alessandro Fiocchi and Giuliano, \{Antonio F M\} and George Christoff and Ieva Cirule and \{de Sousa\}, \{Jaime Correia\} and Costa, \{Elisio M\} and \{Del Giacco\}, Stefano and Philippe Devillier and Dejan Dokic and Elham Hossny and Tomohisa Iinuma and Carla Irani and Zhanat Ispayeva and Kaja Julge and Igor Kaidashev and Bennoor, \{Kazi S\} and Helga Kraxner and Inger Kull and Marek Kulus and Maciej Kupczyk and Andriy Kurchenko and \{La Grutta\}, Stefania and Neven Miculinic and Tuyet, \{Lan Le Thi\} and Michael Makris and Branislava Milenkovic and Lee, \{Sang Min\} and Stephen Montefort and Andre Moreira and Joaquim Mullol and Rachel Nadif and Alla Nakonechna and Neffen, \{Hugo E\} and Marek Niedoszytko and Dieudonn{\'e} Nyembue and O'Hehir, \{Robyn E\} and Ismail Ogulur and Yoshitaka Okamoto and Heidi Olze and Oscar Palomares and Petr Panzner and Vincenzo Patella and Ruby Pawankar and Constantinos Pitsios and Popov, \{Todor A\} and Francesca Puggioni and Santiago Quirce and Agn{\'e} Ramonait{\'e} and Marysia Recto and Repka-Ramirez, \{Maria Susana\} and Graham Roberts and Karla Robles-Velasco and Menachem Rottem and Marianella Salapatas and Joaquin Sastre and Nicola Scichilone and Juan-Carlos Sisul and Dirceu Sol{\'e} and Soto-Martinez, \{Manuel E\} and Milan Sova and Pongsakorn Tantilipikorn and Ana Todo-Bom and Vladyslav Tsaryk and Ioanna Tsiligianni and Marilyn Urrutia-Pereira and Erkka Valovirta and Tuula Vasankari and Dana Wallace and Wang, \{De Yun\} and Margitta Worm and Yusuf, \{Osman M\} and Mihaela Zidarn and Sara Gil-Mata and Manuel Marques-Cruz and Bassam Mahboub and Ansotegui, \{Ignacio J\} and Antonino Romano and Werner Aberer and Artesani, \{Maria Cristina\} and Elena Azzolini and Bruno Barreto and Joan Bartra and Sven Becker and Bianca Beghe and Attilio Boner and Ewa Borowiack and Jacques Bouchard and Melisande Bourgoin-Heck and Luisa Brussino and Roland Buhl and Castillo-Vizuete, \{Jos{\'e} Antonio\} and Denis Charpin and Chavannes, \{Niels H\} and Marta Che{\l}mi{\'n}ska and Lei Cheng and Ekaterine Chkhartishvili and Cho, \{Seong H\} and Chong-Neto, \{Herberto Jose\} and Deepa Choudhury and Chu, \{Derek K\} and Cemal Cingi and Enrico Compalati and Costa, \{Raquel Albuquerque\} and Cunha, \{Olga Mariana\} and Biljana Cvetkovski and Victoria Cardona-Dahl and Gennaro D'Amato and Janet Davies and \{Di Bona\}, Danilo and \{Gonzalez Diaz\}, \{Sandra N\} and Dimou, \{Maria V\} and Maria Doulaptsi and Renato Ferreira-da-Silva and Radoslaw Gawlik and Mario Calvo-Gil and Ozlem Goksel and G{\'o}mez, \{Maximiliano R\} and Maia Gotua and Christos Grigoreas and Ineta Grisle and Guzman, \{Maria Antonieta\} and Tan, \{Rachel House\} and Michael Hyland and Despo Ierodiakonou and Aspasia Karavelia and Paul Keith and Marta Kisiel and Kosak, \{Tanja Soklic\} and Mitja Kosnik and Koyuncu, \{Ilgim Vardaloglu\} and Vicky Kritikos and Justyna Litynska and Carlo Lombardi and Gilles Louis and Matteo Martini and Cem Me{\c c}o and Eris Mesonjesi and Florin Mihaltan and Marcin Moniuszko and Naclerio, \{Robert N\} and Nadeau, \{Kari C\} and Sophia Neisinger and Markus Ollert and Michal Ordak and Giovanni Paoletti and Hae-Sim Park and Elena Parmelli and Perdomo-Flores, \{Edgar Arturo\} and P{\'e}rez, \{Jos{\'e} Miguel Fuentes\} and Nhan Pham-Thi and Emmanuel Prokopakis and In{\^e}s Ribeiro-Vaz and Giovanni Rolla and Jan Romantowski and Philippe Rombaux and Rouadi, \{Philip W\} and Maia Rukhadze and Dermot Ryan and Ewelina Sadowska and Daiju Sakurai and Laila Salameh and Sarquis, \{Faradiba Serpa\} and Elie Serrano and \{Da Silva\}, Jane and Michael Soyka and Krzysztof Specjalski and Vesna Tomic-Spiric and Katarina Stevanovic and Abirami Subramaniam and Teixeira, \{Maria Do Ceu\} and Tuuli Thomander and Martina Vachova and \{van Hage\}, Marianne and Pakit Vichyanond and Martin Wagenmann and Ko, \{Fanny Wai San\} and Pascal Werminghaus and Xepapadaki, \{Paraskevi Vicky\} and Yi-Kui Xiang and Qintai Yang and Yeverino, \{Daniela Rivero\} and Jaron Zuberbier and Fonseca, \{Jo{\~a}o A\}",

note = "{\textcopyright} 2025 The Author(s). Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley \& Sons Ltd.",

year = "2026",

month = apr,

doi = "10.1111/all.70131",

language = "English",

volume = "81",

pages = "954--976",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "4",

}

TY - JOUR

T1 - Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision

T2 - Part I-Guidelines on Intranasal Treatments

AU - Sousa-Pinto, Bernardo

AU - Bousquet, Jean

AU - Vieira, Rafael José

AU - Schünemann, Holger J

AU - Zuberbier, Torsten

AU - Bognanni, Antonio

AU - Togias, Alkis

AU - Samolinski, Boleslaw

AU - Valiulis, Arunas

AU - Williams, Sian

AU - Bedbrook, Anna

AU - Czarlewski, Wienczyslawa

AU - Torres, Maria Jose

AU - Shamji, Mohamed H

AU - Morais-Almeida, Mário

AU - Canonica, G Walter

AU - Vecillas, Leticia de Las

AU - Dykewicz, Mark S

AU - Jacomelli, Cristina

AU - Klimek, Ludger

AU - Leemann, Lucas

AU - Lourenço, Olga

AU - Palamarchuk, Yuliia

AU - Papadopoulos, Nikolaos G

AU - Pereira, Ana Margarida

AU - Savouré, Marine

AU - Toppila-Salmi, Sanna K

AU - Ventura, Maria Teresa

AU - Yepes-Nuñez, Juan José

AU - Cruz, Alvaro A

AU - Ciprandi, Giorgio

AU - Gemicioglu, Bilun

AU - Giovannini, Mattia

AU - Gradauskiene, Brigita

AU - Jartti, Tuomas

AU - Jeseňák, Miloš

AU - Kuna, Piotr

AU - Kvedariene, Violeta

AU - Larenas-Linnemann, Désirée E

AU - Latiff, Amir Ha

AU - Mohammad, Yousser

AU - Ohta, Ken

AU - Mahesh, Padukudru A

AU - Pali-Schöll, Isabella

AU - Pfaar, Oliver

AU - Regateiro, Frederico S

AU - Roche, Nicolas

AU - Taborda-Barata, Luís

AU - Ulrik, Charlotte Suppli

AU - Rostan, Marylin Valentin

AU - Viegi, Giovanni

AU - Zhang, Luo

AU - Haahtela, Tari

AU - Cherrez-Ojeda, Ivan

AU - Carlos Ivancevich, Juan

AU - Khaltaev, Nikolai

AU - Yorgancioglu, Arzu

AU - Abdullah, Baharudin

AU - Al-Ahmad, Mona

AU - Al-Nesf, Maryam Ali

AU - Amaral, Rita

AU - Asllani, Julijana

AU - Bergmann, Karl-C

AU - Bernstein, Jonathan A

AU - Blaiss, Michael S

AU - Braido, Fulvio

AU - Camargos, Paulo

AU - Carreiro-Martins, Pedro

AU - Casale, Thomas

AU - Cecchi, Lorenzo

AU - Fiocchi, Alessandro

AU - Giuliano, Antonio F M

AU - Christoff, George

AU - Cirule, Ieva

AU - de Sousa, Jaime Correia

AU - Costa, Elisio M

AU - Del Giacco, Stefano

AU - Devillier, Philippe

AU - Dokic, Dejan

AU - Hossny, Elham

AU - Iinuma, Tomohisa

AU - Irani, Carla

AU - Ispayeva, Zhanat

AU - Julge, Kaja

AU - Kaidashev, Igor

AU - Bennoor, Kazi S

AU - Kraxner, Helga

AU - Kull, Inger

AU - Kulus, Marek

AU - Kupczyk, Maciej

AU - Kurchenko, Andriy

AU - La Grutta, Stefania

AU - Miculinic, Neven

AU - Tuyet, Lan Le Thi

AU - Makris, Michael

AU - Milenkovic, Branislava

AU - Lee, Sang Min

AU - Montefort, Stephen

AU - Moreira, Andre

AU - Mullol, Joaquim

AU - Nadif, Rachel

AU - Nakonechna, Alla

AU - Neffen, Hugo E

AU - Niedoszytko, Marek

AU - Nyembue, Dieudonné

AU - O'Hehir, Robyn E

AU - Ogulur, Ismail

AU - Okamoto, Yoshitaka

AU - Olze, Heidi

AU - Palomares, Oscar

AU - Panzner, Petr

AU - Patella, Vincenzo

AU - Pawankar, Ruby

AU - Pitsios, Constantinos

AU - Popov, Todor A

AU - Puggioni, Francesca

AU - Quirce, Santiago

AU - Ramonaité, Agné

AU - Recto, Marysia

AU - Repka-Ramirez, Maria Susana

AU - Roberts, Graham

AU - Robles-Velasco, Karla

AU - Rottem, Menachem

AU - Salapatas, Marianella

AU - Sastre, Joaquin

AU - Scichilone, Nicola

AU - Sisul, Juan-Carlos

AU - Solé, Dirceu

AU - Soto-Martinez, Manuel E

AU - Sova, Milan

AU - Tantilipikorn, Pongsakorn

AU - Todo-Bom, Ana

AU - Tsaryk, Vladyslav

AU - Tsiligianni, Ioanna

AU - Urrutia-Pereira, Marilyn

AU - Valovirta, Erkka

AU - Vasankari, Tuula

AU - Wallace, Dana

AU - Wang, De Yun

AU - Worm, Margitta

AU - Yusuf, Osman M

AU - Zidarn, Mihaela

AU - Gil-Mata, Sara

AU - Marques-Cruz, Manuel

AU - Mahboub, Bassam

AU - Ansotegui, Ignacio J

AU - Romano, Antonino

AU - Aberer, Werner

AU - Artesani, Maria Cristina

AU - Azzolini, Elena

AU - Barreto, Bruno

AU - Bartra, Joan

AU - Becker, Sven

AU - Beghe, Bianca

AU - Boner, Attilio

AU - Borowiack, Ewa

AU - Bouchard, Jacques

AU - Bourgoin-Heck, Melisande

AU - Brussino, Luisa

AU - Buhl, Roland

AU - Castillo-Vizuete, José Antonio

AU - Charpin, Denis

AU - Chavannes, Niels H

AU - Chełmińska, Marta

AU - Cheng, Lei

AU - Chkhartishvili, Ekaterine

AU - Cho, Seong H

AU - Chong-Neto, Herberto Jose

AU - Choudhury, Deepa

AU - Chu, Derek K

AU - Cingi, Cemal

AU - Compalati, Enrico

AU - Costa, Raquel Albuquerque

AU - Cunha, Olga Mariana

AU - Cvetkovski, Biljana

AU - Cardona-Dahl, Victoria

AU - D'Amato, Gennaro

AU - Davies, Janet

AU - Di Bona, Danilo

AU - Gonzalez Diaz, Sandra N

AU - Dimou, Maria V

AU - Doulaptsi, Maria

AU - Ferreira-da-Silva, Renato

AU - Gawlik, Radoslaw

AU - Calvo-Gil, Mario

AU - Goksel, Ozlem

AU - Gómez, Maximiliano R

AU - Gotua, Maia

AU - Grigoreas, Christos

AU - Grisle, Ineta

AU - Guzman, Maria Antonieta

AU - Tan, Rachel House

AU - Hyland, Michael

AU - Ierodiakonou, Despo

AU - Karavelia, Aspasia

AU - Keith, Paul

AU - Kisiel, Marta

AU - Kosak, Tanja Soklic

AU - Kosnik, Mitja

AU - Koyuncu, Ilgim Vardaloglu

AU - Kritikos, Vicky

AU - Litynska, Justyna

AU - Lombardi, Carlo

AU - Louis, Gilles

AU - Martini, Matteo

AU - Meço, Cem

AU - Mesonjesi, Eris

AU - Mihaltan, Florin

AU - Moniuszko, Marcin

AU - Naclerio, Robert N

AU - Nadeau, Kari C

AU - Neisinger, Sophia

AU - Ollert, Markus

AU - Ordak, Michal

AU - Paoletti, Giovanni

AU - Park, Hae-Sim

AU - Parmelli, Elena

AU - Perdomo-Flores, Edgar Arturo

AU - Pérez, José Miguel Fuentes

AU - Pham-Thi, Nhan

AU - Prokopakis, Emmanuel

AU - Ribeiro-Vaz, Inês

AU - Rolla, Giovanni

AU - Romantowski, Jan

AU - Rombaux, Philippe

AU - Rouadi, Philip W

AU - Rukhadze, Maia

AU - Ryan, Dermot

AU - Sadowska, Ewelina

AU - Sakurai, Daiju

AU - Salameh, Laila

AU - Sarquis, Faradiba Serpa

AU - Serrano, Elie

AU - Da Silva, Jane

AU - Soyka, Michael

AU - Specjalski, Krzysztof

AU - Tomic-Spiric, Vesna

AU - Stevanovic, Katarina

AU - Subramaniam, Abirami

AU - Teixeira, Maria Do Ceu

AU - Thomander, Tuuli

AU - Vachova, Martina

AU - van Hage, Marianne

AU - Vichyanond, Pakit

AU - Wagenmann, Martin

AU - Ko, Fanny Wai San

AU - Werminghaus, Pascal

AU - Xepapadaki, Paraskevi Vicky

AU - Xiang, Yi-Kui

AU - Yang, Qintai

AU - Yeverino, Daniela Rivero

AU - Zuberbier, Jaron

AU - Fonseca, João A

PY - 2026/4

Y1 - 2026/4

N2 - BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management.METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs.RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH.CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.

AB - BACKGROUND: Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management.METHODS: The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs.RESULTS: Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH.CONCLUSION: This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.

KW - allergic rhinitis

KW - guidelines

KW - intranasal antihistamines

KW - intranasal corticosteroids

U2 - 10.1111/all.70131

DO - 10.1111/all.70131

M3 - Journal article

C2 - 41324154

SN - 0105-4538

VL - 81

SP - 954

EP - 976

JO - Allergy

JF - Allergy

IS - 4

ER -

Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments

Abstract

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