INTRODUCTION: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. METHODS: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. RESULTS: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. CONCLUSIONS: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.

Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

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 Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

ARIA Montpellier France

Center for Rhinology and Allergology Wiesbaden Germany

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

Chiba University Hospital and Chiba Rosai Hospital Chiba Japan

CIBER Epidemiología y Salud Pública Barcelona Spain

CICS UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal

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

Department of Allergology Medical University of Gdańsk Gdansk Poland

Department of Allergy and Immunology Hospital Quironsalud 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 Chest Medicine Centre Hospitalier Universitaire UCL Namur and Université Catholique de Louvain Yvoir Belgium

Department of Clinical Immunology Wrocław Medical University and ALL MED Medical Research Institute Wroclaw Poland

Department of Computing Science Umeå University Umeå Sweden

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

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 Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology University Hospital Duilio Casula University of Cagliari Cagliari Italy

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

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 AMC Amsterdam The Netherlands

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

Department of Otorhinolaryngology Head and Neck Surgery Dar Al Shifa Hospital Salmiya Kuwait

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 Celal Bayar University Faculty of Medicine Manisa Turkey

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

Department of Pulmonary Medicine CHU Liège and GIGA I3 research group University of Liège Liege Belgium

Department of Respiratory Medicine and Tuberculosis University Hospital Brno Czech Republic

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

ENT Department Medical Faculty Eskisehir Osmangazi University Eskisehir Turkey

Faculty of Medicine Coimbra Institute for Clinical and Biomedical Research University of Coimbra Coimbra Portugal

Faculty of Medicine Institute of Immunology University of Coimbra Coimbra Portugal

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

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

Fundaçao ProAR Federal University of Bahia and GARD WHO Planning Group Salvador Brazil

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

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

IMIM Barcelona Spain

IMSB Medical Faculty University at Cologne and ClinCompetence Cologne GmbH Cologne Germany

Imunoalergologia Centro Hospitalar Universitário de Coimbra Faculty of Medicine University of Coimbra Coimbra Portugal

Institute of Allergology Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu 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 Vilnius and 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 UK

ISGlobal Barcelona Institute for Global Health Barcelona Spain

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

KYomed INNOV Montpellier France

Laboratory of Molecular immunology National Research Center Institute of Immunology Federal Medicobiological Agency Moscow Russian Federation

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

Medical Consulting Czarlewski Levallois France

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

Pirogov Russian National Research Medical University Moscow Russian Federation

Poltava State Medical University Poltava Ukraine

Quality Use of Respiratory Medicine Group Woolcock Institute of Medical Research The University of Sydney and Sydney Local Health District Sydney New South Wales Australia

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic Clinical and Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain

RISE Health Research Network University of Porto Porto Portugal

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

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

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

Transylvania University Brasov Brasov Romania

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

Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy

Universitat Pompeu Fabra Barcelona Spain

University Clinic of Respiratory and Allergic Diseases Golnick Slovenia

University Hospital Montpellier Montpellier France

Usher Institute The University of Edinburgh Edinburgh UK

VIM Suresnes UMR 0892 Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris Saclay Suresnes France

Zobrazit více v PubMed

Bousquet J, Bedbrook A, Czarlewski W, et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma. Clin Transl Allergy. 2019;9:16.

Bousquet J, Anto JM, Bachert C, et al. From ARIA guidelines to the digital transformation of health in rhinitis and asthma multimorbidity. Eur Respir J. 2019;54(6):1901023.

Bousquet J, Bewick M, Arnavielhe S, et al. Work productivity in rhinitis using cell phones: the MASK pilot study. Allergy. 2017;72(10):1475-1484.

Sousa-Pinto B, Eklund P, Pfaar O, Klimek L. Validity, reliability and responsiveness of daily monitoring visual analogue scales in MASK-air®. Clin Transl Allergy. 2021;11(7):e12062.

Bousquet J, Devillier P, Anto JM, et al. Daily allergic multimorbidity in rhinitis using mobile technology: a novel concept of the MASK study. Allergy. 2018;73(8):1622-1631.

Bousquet J, Devillier P, Arnavielhe S, et al. Treatment of allergic rhinitis using mobile technology with real-world data: the MASK observational pilot study. Allergy. 2018;73(9):1763-1774.

Menditto E, Costa E, Midao L, et al. Adherence to treatment in allergic rhinitis using mobile technology. The MASK study. Clin Exp Allergy. 2019;49(4):442-460.

Bedard A, Basagana X, Anto JM, et al. Mobile technology offers novel insights into the control and treatment of allergic rhinitis: the MASK study. J Allergy Clin Immunol. 2019;144(1):135-143 e136.

Bedard A, Basagana X, Anto JM, et al. Treatment of allergic rhinitis during and outside the pollen season using mobile technology. A MASK study. Clin Transl Allergy. 2020;10(1):62.

Bousquet J, Schunemann HJ, Togias A, et al. Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80 e73.

Ibrahim JG, Molenberghs G. Missing data methods in longitudinal studies: a review. Test (Madr). 2009;18(1):1-43.

Dong Y, Peng CY. Principled missing data methods for researchers. Springerplus. 2013;2(1):222.

Laune D, Arnavielhe S, Viart F, et al. Adaptation of the general data protection regulation (GDPR) to a smartphone app for rhinitis and asthma (MASK-air[R]). Rev mal Respir. 2019;36(9):1019-1031.

Samreth D, Arnavielhe S, Ingenrieth F, et al. Geolocation with respect to personal privacy for the allergy diary app - a MASK study. World Allergy Organ J. 2018;11(1):15.

Bousquet J, Agache I, Aliberti MR, et al. Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - reference site twinning (EIP on AHA). Allergy. 2017;73(1):77-92.

Genolini C, Falissard B. KmL: a package to cluster longitudinal data. Comput Methods Programs Biomed. 2011;104(3):e112-e121.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. Taylor and Francis Group; 1988. doi:10.4324/9780203771587

Verboon P, Hutten E, Smeekens S, Jongen E. Trajectories of loneliness across adolescence: an empirical comparison of longitudinal clustering methods using R. J Adol. 2022;94:513-524. doi:10.1002/jad.12042

Welton N, Sutton A, Cooper N, Abrams K, Ades A. Evidence Synthesis for Decision Making in Healthcare. John Wiley & Sons, Ltd; 2012.

Sedgwick P. Bias in observational study designs: prospective cohort studies. BMJ. 2014;349:g7731.

Vieira R, Sousa-Pinto B, Anto J, et al. Usage patterns of oral H1-antihistamines in 10 European countries: a study using MASK-air® and Google trends real-world data. World Allergy Organ J. 2022;15:100660.

Hammerton G, Munafo MR. Causal inference with observational data: the need for triangulation of evidence. Psychol Med. 2021;51(4):563-578.

Bousquet J, Anto JM, Bachert C, et al. ARIA digital anamorphosis: digital transformation of health and care in airway diseases from research to practice. Allergy. 2021;76(1):168-190.

Sousa-Pinto B, Eklund P, Pfaar O, et al. Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK-air(R). Clin Transl Allergy. 2021;11(7):e12062.

Bousquet J, Anto JM, Demoly P, et al. Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper. Int Arch Allergy Immunol. 2012;158(3):216-231.

Costa C, Menesatti P, Brighetti MA, et al. Pilot study on the short-term prediction of symptoms in children with hay fever monitored with e-health technology. Eur Ann Allergy Clin Immunol. 2014;46(6):216-225.

Di Fraia M, Tripodi S, Arasi S, et al. Adherence to prescribed E-diary recording by patients with seasonal allergic rhinitis: observational study. J Med Internet Res. 2020;22(3):e16642.

Giordani P, Perna S, Bianchi A, Pizzulli A, Tripodi S, Matricardi PM. A study of longitudinal mobile health data through fuzzy clustering methods for functional data: the case of allergic rhinoconjunctivitis in childhood. PLoS ONE. 2020;15(11):e0242197.

Sousa-Pinto B, Filipe Azevedo L, Jutel M, et al. Development and validation of combined symptom-medication scores for allergic rhinitis. Allergy. 2021;77:2147-2162.