A new approach to allergic rhinitis: mobile health

A recent iPhone software update made news headlines as it left users shocked; a new screen time feature provides a breakdown of hours spent using the device. Although the length of time was surprising to some users, a US report in 2017 found consumers spent an average of 4 hours a day on their smartphone, with mobile applications (apps) taking up approximately 90% of that time (Hackernoon, 2017). However, it seems unlikely this new tool will change our habits, so how can we use this new behavioural norm to improve our day-to-day lives?  

The concept of mobile health (m-health) has become increasingly popular in recent years, with users continuously tracking their biometric data. The idea of tracking health-related data has also been shown to be beneficial for monitoring of chronic diseases and could benefit those with allergic rhinitis.

Digital communication

Patients and physicians face several challenges with allergic rhinitis, including changes in symptom patterns, reporting accurate symptom control, and monitoring adherence to treatment regimens. Several studies have turned to digital technology, such as SMS, voice calls, websites, and apps, in an effort to solve some of these challenges. A recent analysis of mobile devices in patients with asthma and/or allergic rhinitis found SMS communication to improve medication adherence across all 9 studies that included this method with some reporting improvement in symptom control, burden, and quality of life. Telephone consultations may also be a feasible option and allow pharmacists to contact patients, breaking communication barriers and improving treatment (Huang & Matricardi, 2016). However, these forms of communication are becoming outdated and less appealing to a generation born in the digital era.

The Allergy Diary app by MACVIA-ARIA

Could a more digital-friendly approach hold the answer to some of these challenges? MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK) is a group of digital tools aimed at tackling these unmet needs, including the Allergy Diary app.

The app has been designed to empower patients, encouraging patients to record four daily visual analogue scale (VAS) scores (global, nasal, ocular, and bronchial), allowing for self-management and monitoring of the condition. Trends over time can be viewed and shared with physicians in conjunction with the clinical decision support system (CDSS) to gain a better understanding of treatment effectiveness (Bousquet et al., 2015). To find out more about the benefits of the app and how to use it, you can view a video here.

The Allergy Diary app has provided insights not only in individual allergic rhinitis trends over seasons and time, but also how the condition is treated, managed, and changes at a wider population level. Recent real-world data have been published from the MASK study group, analysing data inputted by allergic rhinitis patients. Findings from the series of studies have provided insights into the impact of allergic rhinitis on productivity, quality of life, multimorbidity (figure 1), and medication behaviour (figure 2).

Real-world data collected from the MACVIA-ARIA Allergy Diary app.

Figure 1. Real-world data collected from the MACVIA-ARIA Allergy Diary app (Bousquet et al., 2018a; Bousquet et al., 2018b; Bousquet et al., 2018c)

EQ-5Q, EuroQol-5 Dimension; IQR, interquartile range; Q, question; VAS, visual analogue scale; WPAI-AS, work productivity and activity impairment allergic specific questionnaire. EQ-5Q: higher values indicate poorer quality of life, WPAI-AS scores: high values indicate increased impairment, VAS: a scale measuring how bothersome nasal, ocular, bronchial, and global symptoms are, a higher value indicates less control.

Real-world data collected from the MACVIA-ARIA Allergy Diary app.

Figure 2. Real-world data collected from the MACVIA-ARIA Allergy Diary app (Bousquet et al., 2018d)

VAS, visual analogue scale.

Precision medicine at the tap of a button

But how can these digital developments aid physicians to improve patient care? Improving early diagnosis and providing the optimum treatment are key issues MACVIA are hoping to tackle, by bringing the current treatment algorithms into the 21st Century, with the development of the Allergy Diary Companion app. The app has been designed to sit alongside the Allergy Diary app and will act as a reference, providing guideline recommendations for treatments during patient consultations. The app contains an electronic version of the CDSS which provides treatment suggestions based on an individual's VAS score and current treatments. The app is due to be launched in 2018 (Courbis et al., 2018).

The insights from diary apps also allows for the development of precision medicine. One study demonstrated the potential benefits of diagnosing seasonal allergic rhinitis with smartphone technology. The study included two patients with persistent moderate-severe allergic rhinitis, sensitised to multiple allergens with overlapping pollen seasons. The patients recorded their allergy symptoms daily using AllergyMonitor; an electronic clinical diary app, which enables a Rhinoconjunctivitis Total Symptoms Score (RTSS) to be compared to local pollen counts. As the patients were sensitised to multiple allergens it had been difficult for the physician to tailor their treatments. However, after using the app, the physician was able to see the peak of the first patient’s symptoms coincided with the peak olive pollen counts, and the second patient's peak was in line with the peak in grass pollen count (figure 3). Based on this information, immunotherapy for olive pollen was prescribed to the first patient and immunotherapy for grass pollen was prescribed to the second patient. This is the first known study to implement the novel use of smartphone apps for diagnostic purposes in allergic rhinitis (Bianchi et al., 2016).

Allergic rhinitis symptom severity measured using daily RTSS compared to local pollen counts in two patients with moderate-severe allergic rhinitis.

Figure 3. Allergic rhinitis symptom severity measured using daily RTSS compared to local pollen counts in two patients with moderate-severe allergic rhinitis (Bianchi et al., 2016).

Considering how society has evolved to a more digital approach in day to day life, the developments seen in healthcare have been welcome additions, particularly for the management of allergic rhinitis. Tools such as the Allergy Diary app appear to be well received by patients and should be considered for enhancing our understanding of the condition and aiding consultations.

References

Bianchi A, Tsilochristou O, Gabrielli F, Tripodi S, Matricardi PM. The Smartphone: A Novel Diagnostic Tool in Pollen Allergy? J Investig Allergol Clin Immunol. 2016;26:204–7.

Bousquet J, Arnavielhe S, Bedbrook A, Fonseca J, Morais Almeida M, Todo Bom A, et al. The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: The MASK study. Allergy. 2018c;73:505–10.

Bousquet J, Devillier P, Anto JM, Bewick M, Haahtela T, Arnavielhe S, et al. Daily allergic multimorbidity in rhinitis using mobile technology: A novel concept of the MASK study. Allergy. 2018a;73:1622–31.

Bousquet J, Devillier P, Arnavielhe S, Bedbrook A, Alexis-Alexandre G, van Eerd M, et al. Treatment of allergic rhinitis using mobile technology with real-world data: The MASK observational pilot study. Allergy. 2018d;73:1763–74.

Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, et al. MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy. 2015;70:1372–92.

Bousquet J, VanderPlas O, Bewick M, Arnavielhe S, Bedbrook A, Murray R, et al. The Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire Using Mobile Technology: The MASK Study. J Investig Allergol Clin Immunol. 2018b;28:42–4.

Courbis AL, Murray RB, Arnavielhe S, Caimmi D, Bedbrook A, van Eerd M, et al. Electronic Clinical Decision Support System for allergic rhinitis management: MASK e-CDSS. Clin Exp Allergy. 2018. [Epub ahead of print].

Hackernoon, 2017. Available at https://hackernoon.com/how-much-time-do-people-spend-on-their-mobile-phones-in-2017-e5f90a0b10a6 (accessed October 2018).

Huang X, Matricardia PM. Allergy and Asthma Care in the Mobile Phone Era. Clin Rev Allergy Immunol. 2016. [Epub ahead of print].

 

Publications (5)
  • EAACI 2018: Hot topics in allergic rhinitis

    The EAACI 2018 Congress focussed on innovation in allergy, with numerous advances in allergic rhinitis discussed; including the burden of AR, the benefits of the Allergic Rhinitis and its impact on Asthma guidelines, and the diagnosis of local allergic rhinitis.

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