BACKGROUND: Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. OBJECTIVE: To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. METHODS: We assessed the MASK-air® data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. RESULTS: We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). CONCLUSION: In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.

ALL MED Medical Research Institute Wroclaw Poland

Allergy Center CUF Descobertas Hospital Lisbon Portugal

Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece

Allergy Section Department of Internal Medicine Hospital Vall d'Hebron and ARADyAL Research Network Barcelona Spain

Allergy Unit 'D Kalogeromitros' 2nd Department of Dermatology and Venereology National and Kapodistrian University of Athens 'Attikon' University Hospital Chaidari Greece

Center for Rhinology and Allergology Wiesbaden Germany

Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico

CIBER Epidemiología y Salud Pública Barcelona Spain

CINTESIS Center for Health Technology and Services Research University of Porto Porto Portugal

ClinCompetence Cologne GmbH Cologne Germany

Clinical and Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain

Corporate Member of Freie Universität Berlin Berlin Germany

Department of Allergology and Clinical Immunology of the Kazakh National Medical University Almaty Kazakhstan

Department of Allergy and Immunology Hospital Quirónsalud Bizkaia Bilbao Spain

Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy

Department of Cardiovascular and Thoracic Sciences Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Department of Clinical Immunology Wrocław Medical University Wroclaw Poland

Department of General ORL H and NS Medical University of Graz ENT University Hospital Graz Graz Austria

Department of Immunoallergology Cova da Beira University Hospital Centre Covilhã Portugal

Department of Medical Sciences Allergy and Clinical Immunology Unit University of Torino and Mauriziano Hospital Torino Italy

Department of Medicine and Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada

Department of Medicine Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada

Department of Medicine Surgery and Dentistry 'Scuola Medica Salernitana' University of Salerno Salerno Italy

Department of Otolaryngology Head and Neck Surgery Eye and Ear University Hospital Beirut Lebanon

Department of Otolaryngology Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany

Department of Otorhinolaryngology Amsterdam University Medical Centres location AMC Amsterdam The Netherlands

Department of Otorhinolaryngology Chiba University Hospital Chiba Japan

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Otorhinolaryngology Head and Neck Surgery Semmelweis University Budapest Hungary

Department of Prevention of Environmental Hazards Allergology and Immunology Medical University of Warsaw Warsaw Poland

Department of Pulmonary Diseases Istanbul University Cerrahpasa Cerrahpasa Faculty of Medicine Istanbul Turkey

Department of Pulmonary Medicine and Tuberculosis University Hospital Brno Liskovec Czech Republic

Department of Pulmonary Medicine CHU Sart Tilman Liege Belgium

Department of Pulmonology Celal Bayar University Manisa Turkey

Division of Allergy and Clinical Immunology Department of Medicine Agency of Health ASL Salerno 'Santa Maria della Speranza' Hospital Salerno Italy

Division of Allergy immunology University of South Florida Tampa Florida USA

Division of Internal Medicine Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland

Ecole Polytechnique Palaiseau IRBA Bretigny France

EFA European Federation of Allergy and Airways Diseases Patients' Associations Brussels Belgium

ENT Department Dar Al Shifa Hospital Salmiya Kuwait

ERS President 2017 2018 Athens Chest Hospital 7th Respiratory Medicine Department and Asthma Center Athens Greece

Eskisehir Osmangazi University Medical Faculty ENT Department Eskisehir Turkey

Faculty of Health Sciences University of Beira Interior Covilhã Portugal

Fraunhofer Institute for Translational Medicine and Pharmacology ITMP Allergology and Immunology Berlin Germany

Fundaçao ProAR Federal University of Bahia Salvador Bahia Brazil

Fundacion Jimenez Diaz CIBERES Faculty of Medicine Autonoma University of Madrid Madrid Spain

GARD WHO Planning Group Salvador Bahia Brazil

GIGA I3 Research Group Liege Belgium

Health Planning Unit Department of Social Medicine Faculty of Medicine University of Crete Rethymno Greece

Humboldt Universität zu Berlin Berlin Germany

IMIM Barcelona Spain

IMSB Medical Faculty University of Cologne Cologne Germany

Institute of Allergology Charité Universitätsmedizin Berlin Berlin Germany

Institute of Biomedical Sciences Department of Pathology Faculty of Medicine Vilnius University Vilnius Lithuania

Institute of Clinical Medicine and Institute of Health Sciences Medical Faculty of Vilnius University Vilnius Lithuania

Institute of Clinical Medicine Clinic of Chest Diseases and Allergology Faculty of Medicine Vilnius University Vilnius Lithuania

International Primary Care Respiratory Group IPCRG Aberdeen Scotland

ISGlobal Barcelona Institute for Global Health Barcelona Spain

KYomed INNOV Montpellier France

MASK air Montpellier France

MEDCIDS Department of Community Medicine Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal

Medical Consulting Czarlewski Levallois France

Medicina EDucação 1 and D e Avaliação Lda Porto Portugal

NOVA Medical School Comprehensive Health Research Centre Lisbon Portugal

Nova Southeastern University Fort Lauderdale Florida USA

Personalized Medicine Asthma and Allergy Humanitas Clinical and Research Center IRCCS Rozzano Italy

Poltava State Medical University Poltava Ukraine

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic Barcelona Spain

School of Medicine University CEU San Pablo Madrid Spain

Scottish Centre for Respiratory Research Cardiovascular and Diabetes Medicine Medical Research Institute Ninewells Hospital University of Dundee Dundee UK

Servicio de Alergia e Immunologia Clinica Santa Isabel Buenos Aires Argentina

Serviço de Imunoalergologia Hospital de Dona Estefânia Centro Hospitalar Universitário de Lisboa Central Lisbon Portugal

Skin and Allergy Hospital Helsinki University Hospital University of Helsinki Helsinki Finland

SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy

UBIAir Clinical and Experimental Lung Centre University of Beira Interior Covilhã Portugal

UCIBIO REQUINTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto Porto Portugal

Universitat Pompeu Fabra Barcelona Spain

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

University Hospital Montpellier Montpellier France

University of Bari Medical School Unit of Geriatric Immunoallergology Bari Italy

University of Ljubljana Faculty of Medicine Ljubljana Slovenia

VIM Suresnes UMR_0892 Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris Saclay Suresnes France

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Digitally-enabled, patient-centred care in rhinitis and asthma multimorbidity: The ARIA-MASK-air® approach