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April 25, 2022
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Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air(R) real-world data

Publicated to: Allergy. 77 (9): 2699-2711 - 2022-09-01 77(9), DOI: 10.1111/all.15275

Authors:

Sousa-Pinto, Bernardo; Sa-Sousa, Ana; Vieira, Rafael Jose; Amaral, Rita; Klimek, Ludger; Czarlewski, Wienczyslawa; Anto, Josep M; Pfaar, Oliver; Bedbrook, Anna; Kvedariene, Violeta; Ventura, Maria Teresa; Ansotegui, Ignacio J; Bergmann, Karl-Christian; Brussino, Luisa; Canonica, G Walter; Cardona, Victoria; Carreiro-Martins, Pedro; Casale, Tomas; Cecchi, Lorenzo; Chivato, Tomas; Chu, Derek K; Cingi, Cemal; Costa, Elisio M; Cruz, Alvaro A; De Feo, Giulia; Devillier, Philippe; Fokkens, Wytske J; Gaga, Mina; Gemicioglu, Bilun; Haahtela, Tari; Ivancevich, Juan Carlos; Ispayeva, Zhanat; Jutel, Marek; Kuna, Piotr; Kaidashev, Igor; Kraxner, Helga; Larenas-Linnemann, Desiree E; Laune, Daniel; Lipworth, Brian; Louis, Renaud; Makris, Michael; Monti, Riccardo; Morais-Almeida, Mario; Mosges, Ralph; Mullol, Joaquim; Odemyr, Mikaela; Okamoto, Yoshitaka; Papadopoulos, Nikolaos G; Patella, Vincenzo; Pham-Thi, Nhan; Regateiro, Frederico S; Reitsma, Sietze; Rouadi, Philip W; Samolinski, Boleslaw; Sova, Milan; Todo-Bom, Ana; Taborda-Barata, Luis; Tomazic, Peter Valentin; Toppila-Salmi, Sanna; Sastre, Joaquin; Tsiligianni, Ioanna; Valiulis, Arunas; Vandenplas, Olivier; Wallace, Dana; Waserman, Susan; Yorgancioglu, Arzu; Zidarn, Mihaela; Zuberbier, Torsten; Fonseca, Joao A; Bousquet, Jean
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Affiliations

ALL MED Med Res Inst, Wroclaw, Poland - Author
Amsterdam Univ Med Ctr, Dept Otorhinolaryngol, Locat AMC, Amsterdam, Netherlands - Author
ARADyAL Res Network, Barcelona, Spain - Author
Athens Chest Hosp, Asthma Ctr, Athens, Greece - Author
Athens Chest Hosp, Resp Med Dept 7, Athens, Greece - Author
Barcelona Inst Global Hlth, ISGlobal, Barcelona, Spain - Author
Catholic Univ Louvain, Ctr Hosp Univ UCL Namur, Dept Chest Med, Yvoir, Belgium - Author
Celal Bayar Univ, Dept Pulmonol, Manisa, Turkey - Author
Charite Univ Med Berlin, Inst Allergol, Berlin, Germany - Author
Chiba Univ Hosp, Dept Otorhinolaryngol, Chiba, Japan - Author
CHU Sart Tilman, Dept Pulm Med, Liege, Belgium - Author
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain - Author
Clin Santa Isabel, Serv Alergia & Immunol, Buenos Aires, DF, Argentina - Author
ClinCompetence Cologne GmbH, Cologne, Germany - Author
Cova da Beira Univ Hosp Ctr, Dept Immunoallergol, Covilha, Portugal - Author
Ctr Hosp Univ Lisboa Cent, Hosp Dona Estefania, Serv Imunoalergol, Lisbon, Portugal - Author
Ctr Rhinol & Allergol, Wiesbaden, Germany - Author
CUF Descobertas Hosp, Allergy Ctr, Lisbon, Portugal - Author
Dar Al Shifa Hosp, ENT Dept, Salmiya, Kuwait - Author
EFA European Federat Allergy & Airways Dis Patien, Brussels, Belgium - Author
Eskisehir Osmangazi Univ, Med Fac, ENT Dept, Eskisehir, Turkey - Author
Eye & Ear Univ Hosp, Dept Otolaryngol Head & Neck Surg, Beirut, Lebanon - Author
Fraunhofer Inst Translat Med & Pharmacol ITMP, Allergol & Immunol, Berlin, Germany - Author
Free Univ Berlin, Berlin, Germany - Author
GARD WHO Planning Grp, Salvador, BA, Brazil - Author
GIGA I3 Res Grp, Liege, Belgium - Author
Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland - Author
Hosp Quironsalud Bizkaia, Dept Allergy & Immunol, Bilbao, Spain - Author
Hosp Valle De Hebron, Dept Internal Med, Allergy Sect, Barcelona, Spain - Author
Humanitas Clin & Res Ctr IRCCS, Personalized Med Asthma & Allergy, Rozzano, Italy - Author
Humanitas Univ, Dept Biomed Sci, Pieve Emanuele, Italy - Author
Humboldt Univ, Berlin, Germany - Author
IMIM Hosp del Mar Med Res Inst, Barcelona, Spain - Author
Int Primary Care Resp Grp IPCRG, Aberdeen, Scotland - Author
IRBA Inst Rech Biomed Armees, Ecole Polytech Palaiseau, Bretigny Sur Orge, France - Author
Istanbul Univ Cerrahpasa, Cerrahpasa Fac Med, Dept Pulm Dis, Istanbul, Turkey - Author
Kazakh Natl Med Univ, Dept Allergol & Clin Immunol, Alma Ata, Kazakhstan - Author
KYomed INNOV, Montpellier, France - Author
MASK Air, Montpellier, France - Author
Mauriziano Hosp, Turin, Italy - Author
McMaster Univ, Dept Med & Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada - Author
McMaster Univ, Dept Med Clin Immunol & Allergy, Hamilton, ON, Canada - Author
Med Consulting Czarlewski, Levallois Perret, France - Author
Med Sur Clin Fdn & Hosp, Ctr Excellence Asthma & Allergy, Mexico City, DF, Mexico - Author
Med Univ Graz, ENT Univ Hosp Graz, Dept Gen ORL, H&NS, Graz, Austria - Author
Med Univ Lodz, Barlicki Univ Hosp, Div Internal Med Asthma & Allergy, Lodz, Poland - Author
Med Univ Warsaw, Dept Prevent Environm Hazards Allergol & Immunol, Warsaw, Poland - Author
Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Dept Dermatol & Venereol 2, Allergy Unit D Kalogeromitros, Athens, Greece - Author
NOVA Med Sch, Comprehens Hlth Res Ctr CHRC, Lisbon, Portugal - Author
Nova Southeastern Univ, Ft Lauderdale, FL 33314 USA - Author
Philipps Univ Marburg, Univ Hosp Marburg, Dept Otorhinolaryngol Head & Neck Surg, Sect Rhinol & Allergy, Marburg, Germany - Author
Poltava State Med Univ, Poltava, Ukraine - Author
Santa Maria della Speranza Hosp, Dept Med, Div Allergy & Clin Immunol, Agcy Hlth ASL Salerno, Salerno, Italy - Author
Semmelweis Univ, Dept Otorhinolaryngol Head & Neck Surg, Budapest, Hungary - Author
Univ Athens, Allergy Dept, Pediat Clin 2, Athens, Greece - Author
Univ Autonoma Madrid, Fdn Jimenez Diaz, Fac Med, CIBERES, Madrid, Spain - Author
Univ Barcelona, CIBERES, IDIBAPS,Rhinol Unit, Clin & Expt Resp Immunoallergy,Hosp Clin,ENT Dept, Barcelona, Spain - Author
Univ Barcelona, IDIBAPS, CIBERES,ENT Dept, Clin & Expt Resp Immunoallergy,Hosp Clin,Smell Cl, Barcelona, Spain - Author
Univ Bari Med Sch, Unit Geriatr Immunoallergol, Bari, Italy - Author
Univ Beira Interior, Fac Hlth Sci, Covilha, Portugal - Author
Univ Beira Interior, UBIAir Clin & Expt Lung Ctr, Covilha, Portugal - Author
Univ CEU San Pablo, Sch Med, Madrid, Spain - Author
Univ Clin Resp & Allerg Dis, Golnick, Slovenia - Author
Univ Coimbra, Fac Med, Coimbra Inst Clin & Biomed Res iCBR, Coimbra, Portugal - Author
Univ Coimbra, Fac Med, Ctr Hosp & Univ Coimbra, Allergy & Clin Immunol Unit, Coimbra, Portugal - Author
Univ Coimbra, Fac Med, Inst Immunol, Coimbra, Portugal - Author
Univ Cologne, Med Fac, IMSB, Cologne, Germany - Author
Univ Crete, Fac Med, Dept Social Med, Hlth Planning Unit, Aberdeen, Scotland - Author
Univ Dundee, Ninewells Hosp, Scottish Ctr Resp Res Cardiovasc & Diabet Med, Med Res Inst, Dundee, Scotland - Author
Univ Fed Bahia, Fundacao ProAR, Salvador, BA, Brazil - Author
Univ Helsinki, Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland - Author
Univ Helsinki, Helsinki, Finland - Author
Univ Hosp Brno, Dept Pulm Med & TB, Brno, Czech Republic - Author
Univ Hosp Montpellier, Montpellier, France - Author
Univ Ljubljana, Fac Med, Ljubljana, Slovenia - Author
Univ Med Mainz, Dept Otolaryngol Head & Neck Surg, Mainz, Germany - Author
Univ Paris Saclay, Hop Foch, Pole Malad Voies Resp, VIM Suresnes,UMR 0892, Suresnes, France - Author
Univ Pompeu Fabra UPF, Barcelona, Spain - Author
Univ Porto Porto4Ageing, Competence Ctr Act & Hlth Ageing, Porto, Portugal - Author
Univ Porto Porto4Ageing, REQUINTE, UCIBIO, Fac Pharm, Porto, Portugal - Author
Univ Porto, CINTESIS Ctr Hlth Technol & Serv Res, Porto, Portugal - Author
Univ Porto, Fac Med, MEDCIDS Dept Community Med Informat & Hlth Decis, Porto, Portugal - Author
Univ Porto, RISE Hlth Res Network, Porto, Portugal - Author
Univ S Florida, Div Allergy Immunol, Tampa, FL USA - Author
Univ Salerno, Dept Med Surg & Dent, Scuola Med Salernitana, Salerno, Italy - Author
Univ Torino, Allergy & Clin Immunol Unit, Dept Med Sci Allergy, Turin, Italy - Author
Univ Torino, Dept Med Sci, Allergy & Clin Immunol Unit, Turin, Italy - Author
USL Toscana Ctr, SOS Allergol & Clin Immunol, Prato, Italy - Author
Vilnius Univ, Dept Pathol, Fac Med, Inst Biomed Sci, Vilnius, Lithuania - Author
Vilnius Univ, Fac Med, Clin Chest Dis & Allergol, Inst Clin Med, Vilnius, Lithuania - Author
Vilnius Univ, Inst Clin Med, Med Fac, Vilnius, Lithuania - Author
Vilnius Univ, Med Fac, Inst Hlth Sci, Vilnius, Lithuania - Author
Wroclaw Med Univ, Dept Clin Immunol, Wroclaw, Poland - Author
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Abstract

Background Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods We analysed 2015-2020 MASK-air(R) European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H-1-antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Conclusions Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.
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Keywords

allergic rhinitisco-medicationmask-airAllergic rhinitisCo-medicationMask-airVisual analogue scale

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal ALLERGY due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 2/28, thus managing to position itself as a Q1 (Primer Cuartil), in the category Allergy. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 4.18. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 3.12 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-02, the following number of citations:

  • WoS: 40
  • Scopus: 43
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 26.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 24 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 6.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 11 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; Austria; Belgium; Brazil; Canada; Czech Republic; Finland; France; Germany; Greece; Hungary; Italy; Japan; Kazakhstan; Kuwait; Lebanon; Lithuania; Mexico; Netherlands; Poland; Portugal; Slovenia; Turkey; Ukraine; United Kingdom; United States of America.

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Awards linked to the item

This study was funded by ARIA. MASK--air (R) has been supported by EU grants (EU Structural and Development grant, POLLAR: EIT Health and Structural and Development Funds) and educational grants from Mylan--Viatris, ALK, GSK, Novartis and Uriach. Open Access funding enabled and organized by Projekt DEAL.
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