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ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem

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An Erratum to this article was published on 25 March 2020

This article has been updated

Zusammenfassung

Hintergrund

Die Anzahl der von Allergien betroffenen Patienten nimmt weltweit zu. Hiermit gehen erhebliche Kosten für die Gesundheits- und Sozialsysteme durch allergische Erkrankungen einher. Integrierte Versorgungskonzepte sind erforderlich, die innerhalb der nationalen Gesundheitssysteme eine umfassende Versorgung ermöglichen. Die ARIA-Initiative entwickelt international gültige Leitlinien für allergische Atemwegserkrankungen.

Methoden

ARIA dient der verbesserten Versorgung von Patienten mit Allergien und chronischen Atemwegserkrankungen. In Zusammenarbeit mit anderen internationalen Initiativen, nationalen Fachgesellschaften und Patientenorganisationen im Bereich Allergien und Atemwegserkrankungen wurde eine realitätsnahe, integrative Versorgungsleitlinie („integrated care pathways“, ICPs) für eine digital unterstützte, integrative, individualisierte Behandlung von allergischer Rhinitis (AR) mit komorbidem Asthma entwickelt, die in der vorliegenden Arbeit auf das deutsche Gesundheitssystem übertragen wird.

Ergebnisse

Die vorliegende ICP-Versorgungsleitlinie umfasst wesentliche Bereiche der Versorgung von Patienten mit AR mit und ohne Asthma einschließlich der Sicht von Patienten und weiterer versorgungsnaher Gesundheitsdienstleister.

Diskussion

Eine umfassende ICP-Leitlinie kann die Versorgungsrealität wesentlich besser abbilden als herkömmliche Leitlinienmodelle.

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Change history

  • 25 March 2020

    Affiliation und Disclaimer von Vera Mahler wurden fehlerhaft dargestellt und werden hiermit korrigiert: Medizinische Fakultät, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Deutschland Die in diesem Review geäußerten Inhalte und Positionen geben die persönliche Expertenmeinung der Auto...

Abbreviations

AEC:

Allergen exposure chamber

AeDA:

Ärzteverband deutscher Allergologen

AIRWAYS-ICPs’:

Integrated care pathways for airway diseases

AIT:

Allergenspezifische Immuntherapie

AMG:

Arzneimittelgesetz

AMR:

Arzneimittelrichtlinie

AR:

Allergische Rhinitis

ARIA:

Allergic rhinitis and its impact on asthma

CP:

Centralized procedure

CRD:

Chronic respiratory disease

DAAB:

Deutscher Allergie- und Asthmabund

DBPCRCT:

Double-blind placebo-controlled randomized clinical trial

DCP:

Decentralized procedure

EAACI:

European Academy for Allergy and Clinical Immunology

EG:

Europäische Gemeinschaft

EIP on AHA:

European Innovation Partnership on Active and Healthy Ageing

EIT:

European Institute for Innovation and Technology

EMA:

European Medicines Agency

EU:

Europäische Union

G-BA:

Gemeinsamer Bundesausschuss

GKV:

Gesetzliche Krankenversicherung

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

ICER:

Incremental cost effectiveness ratio

ICP:

Integrated care pathway

INAH:

Intranasale Antihistaminika

INCS:

Intranasale Kortikosteroide

JA-CHRODIS:

Joint Action on chronic diseases and promoting healthy ageing across the life cycle

KV:

Krankenversicherung

LTRA:

Leukotrienrezeptor-Antagonist

MACVIA:

MAladies Chroniques pour un VIeillissement Actif (Fighting chronic diseases for active and healthy ageing)

MASK:

Mobile Airways Sentinel Network

MASK-air:

Formerly Allergy Diary

MPAzeFlu:

Nasale Fixkombination aus Azelastin und Fluticason

MRP:

Mutual recognition procedure

MS:

Mitgliedsstaaten

NICE:

National Institute for Health and Clinical Excellence (UK)

NIH:

National Institute of Health (USA)

NPP:

Named patients product

OAH:

Orale Antihistaminika

OTC:

Over the counter

PDC:

Proportion of days covered

PEI:

Paul-Ehrlich-Institut

POLLAR:

Impact of air POLLution on Asthma and Rhinitis

RCT:

Randomized controlled trials

RKI:

Robert Koch-Institut

RMS:

Reference Member State

RWE:

Real-world evidence

SCIT:

Subkutane Immuntherapie

SDM:

Shared decision making

SLIT:

Sublinguale Immuntherapie

TAV:

Therapieallergeneverordnung

UAW:

Unerwünschte Arzneimittelwirkung

VAS:

Visual analogue scale

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Zentrum für Rhinologie und Allergologie Wiesbaden, Wiesbaden, Deutschland

    Ludger Klimek, Ingrid Casper & Annette Sperl

  2. Forschungslabor für obere Atemwege und Abteilung für Hals-Nasen-Ohren-Heilkunde, Universität Gent und Universitätsklinikum Gent, Gent, Belgien

    Claus Bachert

  3. Abteilung für HNO-Erkrankungen, CLINTEC, Karolinska-Institut, Universität Stockholm, Stockholm, Schweden

    Claus Bachert

  4. Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Abteilung für Rhinologie und Allergologie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland

    Oliver Pfaar

  5. Klinik für Hals-, Nasen- und Ohrenheilkunde, Universität Tübingen, Tübingen, Deutschland

    Sven Becker

  6. Klinik für Dermatologie und Allergologie, Universität Bonn, Bonn, Deutschland

    Thomas Bieber

  7. Christine Kühne - Zentrum für Allergieforschung und -bildung (CK-CARE) Davos-Augsburg-Bonn-St. Gallen-Zürich, St. Gallen, Schweiz

    Thomas Bieber

  8. Universitätsklinikum Münster, Klinik für Allergologie, Arbeitsmedizin und Umweltmedizin, Münster, Deutschland

    Randolf Brehler

  9. Lungenabteilung, Universitätsklinikum Mainz, Deutschland

    Roland Buhl

  10. Klinik für Hals-Nasen-Ohren-Heilkunde und Zentrum für Allergie & Umwelt (ZAUM), Klinikum rechts der Isar, Technische Universität und Helmholtz-Zentrum München, München, Deutschland

    Adam Chaker

  11. Klinik für Dermatologie, Universität Freiburg, Freiburg, Deutschland

    Wolfgang Czech

  12. Klinik für Dermatologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland

    Jörg Fischer

  13. Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland

    Thomas Fuchs

  14. Abteilung für Kinderpneumologie und Allergologie, Medizinische Universität Augsburg, Augsburg, Deutschland

    Michael Gerstlauer

  15. Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Mannheim, Mannheim, Deutschland

    Karl Hörmann

  16. Klinik für Dermatologie und Allergologie, Universitätsklinikum Gießen und Marburg, Campus Gießen, Justus-Liebig-Universität, Gießen, Deutschland

    Thilo Jakob

  17. Erfurt, Deutschland

    Kirsten Jung (Gemeinschaftspraxis für Dermatologie)

  18. Klinik für Kinder- und Jugendmedizin, Universität Lübeck, Airway Research Center North (ARCN), Mitglied des Deutschen Lungenzentrums (DZL), Lübeck, Deutschland

    Matthias V. Kopp

  19. Klinik für Dermatologie, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Vera Mahler

  20. Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

    Hans Merk

  21. Asthma- und Allergiezentrum, Leverkusen, Deutschland

    Norbert Mülleneisen

  22. Klinik für Pädiatrie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland

    Katja Nemat

  23. Klinik für Allergologie, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Deutschland

    Uta Rabe

  24. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland

    Johannes Ring

  25. Christine Kühne - Zentrum für Allergieforschung und -bildung (CK-Care), Davos, Schweiz

    Johannes Ring

  26. Klinik für Dermatologie, Universitätsklinikum Mainz, Mainz, Deutschland

    Joachim Saloga & Petra Staubach

  27. Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Universität zu Lübeck, Lübeck, Deutschland

    Wolfgang Schlenter

  28. Zentrum für Allergie & Umwelt (ZAUM), Technische Universität München und Helmholtz-Zentrum München, München, Deutschland

    Carsten Schmidt-Weber

  29. Vorsitzender des Apothekenverbandes in Hessen, Hessischer Apothekerverband, Offenbach, Deutschland

    Holger Seyfarth

  30. Klinik für Pädiatrische Pneumologie und Allergologie, Lungenzentrum Süd-West, Wangen im Allgäu, Deutschland

    Thomas Spindler

  31. Universitätsklinikum Mainz, Mainz, Deutschland

    Sebastian Strieth

  32. Klinik für Dermatologie, Venerologie und Allergologie, Universität Leipzig, Leipziger interdisziplinäres Centrum für Allergologie — LICA, Leipzig, Deutschland

    Regina Treudler

  33. Klinik für Kinderpneumologie und Allergologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland

    Christian Vogelberg

  34. Bundesgeschäftsführerin des Deutschen Allergie- und Asthmabundes DAAB, Mönchengladbach, Deutschland

    Andrea Wallrafen

  35. Münster, Deutschland

    Wolfgang Wehrmann (Dermatologische Gemeinschaftspraxis)

  36. Hals-, Nasen- und Ohrenarzt, Herford, Nordrhein-Westfalen, Deutschland

    Holger Wrede

  37. Klinik für Dermatologie und Allergologie, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Deutschland

    Torsten Zuberbier

  38. MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich

    Anna Bedbrook

  39. Allergie und Atemwegserkrankungen, DIMI, Universität Genua, Genua, Italien

    Giorgio W. Canonica

  40. Klinik für Innere Medizin, Universitätsklinikum Vall d’Hebron, Barcelona, Spanien

    Victoria Cardona

  41. Abteilung für Allergie und Immunologie, University of South Florida, Tampa, Florida, USA

    Thomas B. Casale

  42. Medizinische Beratung Czarlewski, Levallois, Frankreich

    Wienczylawa Czarlewski

  43. Abteilung Otorhinolaryngologie, Akademische Medizinische Zentren, Amsterdam, Niederlande

    Wytske J. Fokkens

  44. Kinderzentrum, Evangelisches Krankenhaus Bethel, Bielefeld und Allergiezentrum, Ruhr-Universität Bochum, Bochum, Deutschland

    Eckard Hamelmann

  45. Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätskliniken Leuven, Leuven, Belgien

    Peter W. Hellings

  46. Klinik für klinische Immunologie, Medizinische Universität Wroclaw und medizinisches Forschungsinstitut „ALL-MED“, Wroclaw (Breslau), Polen

    Marek Jutel

  47. Krankenhaus Médica Sur, México City, México

    Désirée Larenas-Linnemann

  48. Unitat de Rinologia i Clínica de l'Olfacte, Servei d'ORL, Universitat de Barcelona, Klinische und experimentelle respiratorische Immunallergie, IDIBAPS, CIBERES, Barcelona, Spanien

    Joaquim Mullol

  49. Abteilung für Allergie, 2. Kinderklinik, Universität Athen, Athen, Griechenland

    Nikolaos G. Papadopoulos

  50. Haartman-Institut, Universität Helsinki, Helsinki, Finnland

    Sanna Toppila-Salmi

  51. Klinik für Immundermatologie und Allergieforschung, Klinik für Dermatologie und Allergie, Medizinische Hochschule Hannover, Hannover, Deutschland

    Thomas Werfel

  52. MACVIA-LR CHU, Montpellier, Frankreich

    Jean Bousquet

  53. Centre Hospitalier Régional Universitaire de Montpellier (CHU), 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, Frankreich

    Jean Bousquet

Authors
  1. Ludger Klimek
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  2. Claus Bachert
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  3. Oliver Pfaar
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  4. Sven Becker
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  5. Thomas Bieber
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  6. Randolf Brehler
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  7. Roland Buhl
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  8. Ingrid Casper
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  9. Adam Chaker
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  10. Wolfgang Czech
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  11. Jörg Fischer
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  12. Thomas Fuchs
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  13. Michael Gerstlauer
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  14. Karl Hörmann
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  15. Thilo Jakob
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  16. Kirsten Jung
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  17. Matthias V. Kopp
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  18. Vera Mahler
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  19. Hans Merk
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  20. Norbert Mülleneisen
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  21. Katja Nemat
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  22. Uta Rabe
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  23. Johannes Ring
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  24. Joachim Saloga
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  25. Wolfgang Schlenter
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  26. Carsten Schmidt-Weber
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  27. Holger Seyfarth
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  28. Annette Sperl
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  29. Thomas Spindler
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  30. Petra Staubach
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  31. Sebastian Strieth
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  32. Regina Treudler
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  33. Christian Vogelberg
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  34. Andrea Wallrafen
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  35. Wolfgang Wehrmann
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  36. Holger Wrede
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  37. Torsten Zuberbier
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  38. Anna Bedbrook
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  39. Giorgio W. Canonica
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  40. Victoria Cardona
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  41. Thomas B. Casale
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  42. Wienczylawa Czarlewski
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  43. Wytske J. Fokkens
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  44. Eckard Hamelmann
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  45. Peter W. Hellings
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  46. Marek Jutel
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  47. Désirée Larenas-Linnemann
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  48. Joaquim Mullol
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  49. Nikolaos G. Papadopoulos
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  50. Sanna Toppila-Salmi
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  51. Thomas Werfel
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  52. Jean Bousquet
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Corresponding author

Correspondence to Jean Bousquet.

Additional information

Interessenkonflikt

C. Bachert hat Honorare von Mylan, Stallergenes und ALK erhalten, außerhalb der vorliegenden Arbeit.

S. Becker hat Zuschüsse und/oder Honorare von ALK, Allergopharma, HAL Allergy, Bencard Allergy, Sanofi-Genzyme, Thermo Fisher Scientific, B.R.A.I.N AG und PARI GmbH erhalten, außerhalb der vorliegenden Arbeit.

T. Bieber hat Honorare von Sanofi, Novartis, AbbVIe, Galderma, Pfizer, Lilly und Kymab, außerhalb der vorliegenden Arbeit, erhalten.

J. Bousquet hat Honorare von Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi-Aventis, Takeda, Teva und Uriach erhalten, außerhalb der vorliegenden Arbeit. Außerdem war er beratend tätig für KYomed-Innov (advisory board, Vorträge).

R. Brehler hat Zuschüsse oder Honorare von Berufsgenossenschaften, Gerichten, ÄK Nordwürtemberg, ÄK Westfalen-Lippe, ALK, Allergopharma, Allmiral, Apothekerkammer, Astra Zeneca, Bencard, DPC, Gesellschaft zur Förderung der Dermatologischen Forschung und Fortbildung, GSK, HAL, HNO-Gesellschaft, Leti, Novartis, Pohl-Boskamp, Pfleger, Phadia, Update GmbH, Stallergenes, Biotechtools, Genentech, Novartis, Bencard, HAL, AstraZeneca und ALK erhalten, außerhalb der vorliegenden Arbeit.

V. Cardona hat Honorare von ALK, Allergopharma, Allergy Therapeutics, Diater, LETI, Thermofisher und Stallergenes erhalten, außerhalb der vorliegenden Arbeit.

J. Mullol hat Zuschüsse und/oder Honorare von ALK-Abelló, Sanofi-Genzyme & Regeneron, Menarini Group, MSD, Mitsubishi-Tanabe, Novartis, UCB Pharma, GENENTECH - Roche, URIACH Group und MYLAN-MEDA Pharma erhalten, außerhalb der vorliegenden Arbeit.

H. F. Merk hat Honorare von MEDA, Grünenthal und Coty erhalten, außerhalb der vorliegenden Arbeit.

T. Jakob hat Zuschüsse, Honorare oder nicht finanzielle Unterstützung von Novartis, ALK-Abelló, Bencard/Allergy Therapeutics, Allergopharma, Thermo Fisher Scientific und Celgene erhalten, außerhalb der vorliegenden Arbeit.

M. Jutel hat — während der Entstehung der Leitlinie — Honorare von ALK-Abelló, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Circassia, Leti, Biomay und HAL erhalten. Zudem hat er Honorare von Astra-Zeneka, GSK, Novartis, Teva, Vectura, UCB, Takeda, Roche, Janssen, Medimmune und Chiesi erhalten, außerhalb der vorliegenden Arbeit.

L. Klimek hat Zuschüsse und/oder Honorare von ALK-Abelló, Novartis, Allergopharma, Bionorica, GSK, Lofarma, Boehringer Ingelheim, MEDA, Biomay, HAL, LETI, Roxall und Bencard erhalten, außerhalb der vorliegenden Arbeit.

P. Hellings hat während der Entstehung der Leitlinie Zuschüsse und Honorare von Mylan, erhalten sowie Honorare von Sanofi, Allergopharma und Stallergenes, außerhalb der vorliegenden Arbeit.

J. Saloga hat Honorare von ALK-Abelló, Novartis Pharma und Thermo Fisher erhalten, außerhalb der vorliegenden Arbeit.

C. Schmidt-Weber hat — während der Entstehung der Leitlinie — Zuschüsse von DFG und DZL erhalten. Zudem hat er Zuschüsse und/oder Honorare von Bencard, Allergopharma, Leti Pharma erhalten, außerhalb der vorliegenden Arbeit. Außerdem hat er ein Patent auf AIT biomarker.

S. Strieth hat Zuschüsse und/oder Honorare von der Deutschen Forschungsgemeinschaft (DFG), Stiftung Tumorforschung Kopf-Hals, Andreas Fahl Medizintechnik-Vertrieb, Atos Medical, Tracoe Medical, Heimomed Heinze, Bromepithetik, Fresenius Kabi, Auris Medical, Merck Serono, Otonomy, Inc., Nordmark Arzneimittel, Sanofi Genzyme und ALK-Abelló sowie nicht finanzielle Unterstützung von MED-EL AG erhalten, außerhalb der vorliegenden Arbeit.

R. Treudler hat Zuschüsse oder Honorare von Sanofi-Genzyme, ALK-Abello, Takeda, Novartis und Hautnetz Leipzig, erhalten. Außerdem gab es eine wissenschaftliche Zusammenarbeit mit Fraunhofer-IZI Leipzig, außerhalb der vorliegenden Arbeit.

S. Toppila-Salmi war beratend tätig für Mylan Laboratories Ltd, ERT Ltd und Roche Products Ltd, außerhalb der vorliegenden Arbeit.

C. Vogelberg hat Zuschüsse und/oder Honorare von ALK-Abelló, Allergopharma, AstraZeneca, Boehringer Ingelheim, Bencard Allergy, DBV Technologies, Novartis Pharma und Sanofi Avensis erhalten, außerhalb der vorliegenden Arbeit.

A. Bedbrook, R. Buhl, G. W. Canonica, T. B. Casale, I. Casper, A. Chaker, W. Czarlewski, W. Czech, J. Fischer, W. Fokkens, T. Fuchs, M. Gerstlauer, E. Hamelmann, K. Hörmann, K. Jung, M. Kopp, D. Larenas-Linnemann, V. Mahler, N. Mülleneisen, K. Nemat, N. G. Papadopoulos, O. Pfaar, U. Rabe, J. Ring, W. Schlenter, H. Seyfarth, A. Sperl, T. Spindler, P. Staubach, A. Wallrafen, W. Wehrmann, T. Werfel, H. Wrede und T. Zuberbier erklären, dass keine Interessenkonflikte bestehen.

Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.

Zitierweise

Klimek L, Bachert C, Pfaar O, Becker S, Bieber T, Brehler R, Buhl R, Casper I, Chaker A, Czech W, Fischer J, Fuchs T, Gerstlauer M, Hörmann K, Jakob T, Jung K, Kopp MV, Mahler V, Merk H, Mülleneisen N, Nemat K, Rabe U, Ring J, Saloga J, Schlenter W, Schmidt-Weber C, Seyfarth H, Sperl A, Spindler T, Staubach P, Strieth S, Treudler R, Vogelberg C, Wallrafen A, Wehrmann W, Wrede H, Zuberbier T, Bedbrook A, Canonica GW, Cardona V, Casale TB, Czarlewski W, Fokkens WJ, Hamelmann E, Hellings PW, Jutel M, Larenas-Linnemann D, Mullol J, Papadopoulos NG, Toppila-Salmi S, Werfel T, Bousquet J et al. ARIA guideline 2019: treatment of allergic rhinitis in the German healthcare system. ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergo J Int 2019;28:255–76

https://doi.org/10.1007/s40629-019-00110-9

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Klimek, L., Bachert, C., Pfaar, O. et al. ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem. Allergo J 28, 20–46 (2019). https://doi.org/10.1007/s15007-019-1938-2

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  • DOI: https://doi.org/10.1007/s15007-019-1938-2

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