Classification of Allergic Rhinitis: What is Most Suitable in Korea?

© Copyright The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease http://e-aair.org Allergic rhinitis (AR) has traditionally been classified as perennial or seasonal, depending on the kind of allergen responsible for the symptoms; however, this classification is not satisfactory for many reasons. Some seasonal AR (SAR) patients present with perennial symptoms due to exposure to several pollens over several months. Conversely, perennial AR (PAR) patients can present symptoms for only a few weeks per year. Furthermore, most patients have multiple sensitizations and symptoms throughout the year. Based on these findings, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were published in 2001. This report was innovative especially in proposing a new AR classification using duration and severity of symptoms as criteria. The classifications of duration and severity were based on empirical criteria that required validation. Many validation studies of the ARIA classification have been performed in both European and international studies, and these established that “intermittent” and “persistent” are not synonymous with “seasonal” and “perennial,” respectively. The ARIA classification appears to be closer to the patient’s need than the traditional classification system. After 2001, more than 251 original articles conducted in 43 countries used the ARIA classification of intermittent and persistent AR. The ARIA 2008 update was published based on studies over 7 years, but the classification system was maintained. Currently, except for in North America, most countries use the ARIA guidelines as standard. In Korea, the ARIA guidelines have also been considered as standard. Nevertheless, a questionnaire survey to 348 ENT doctors in 2012 showed that just 60% of clinicians use the ARIA guidelines. This relatively low frequency of use might be because of doctors’ beliefs that traditional allergen-based classifications have some advantage. In Korea, tree pollens have seasonal peaks in the spring, grass pollens in the summer, and weed pollens in the fall. Thus, it is a logical deduction that seasonal allergens would produce symptoms specifically during their peak pollen season. In the present issue of Allergy, Asthma & Immunology Research, Classification of Allergic Rhinitis: What is Most Suitable in Korea?