BACKGROUND: Adherence to rhinitis treatment has been insufficiently assessed. We aimed to use data from the MASK-air mHealth app to assess adherence to oral antihistamines (OAH), intra-nasal corticosteroids (INCS) or azelastine-fluticasone in patients with allergic rhinitis. METHODS: We included regular European MASK-air users with self-reported allergic rhinitis and reporting at least 1 day of OAH, INCS or azelastine-fluticasone. We assessed weeks during which patients answered the MASK-air questionnaire on all days. We restricted our analyses to data provided between January and June, to encompass the pollen seasons across the different assessed countries. We analysed symptoms using visual analogue scales (VASs) and the combined symptom-medication score (CSMS), performing stratified analyses by weekly adherence levels. Medication adherence was computed as the proportion of days in which patients reported rhinitis medication use. Sensitivity analyses were performed considering all weeks with at most 1 day of missing data and all months with at most 4 days of missing data. RESULTS: We assessed 8212 complete weeks (1361 users). Adherence (use of medication > 80% days) to specific drug classes ranged from 31.7% weeks for azelastine-fluticasone to 38.5% weeks for OAH. Similar adherence to rhinitis medication was found in users with or without self-reported asthma, except for INCS (better adherence in asthma patients). VAS and CSMS levels increased from no adherence to full adherence, except for INCS. A higher proportion of days with uncontrolled symptoms was observed in weeks with higher adherence. In full adherence weeks, 41.2% days reported rhinitis co-medication. The sensitivity analyses displayed similar results. CONCLUSIONS: A high adherence was found in patients reporting regular use of MASK-air. Different adherence patterns were found for INCS compared to OAH or azelastine-fluticasone that are likely to impact guidelines.

Agency of Health ASL Salerno Italy

Allergy and Clinical Immunology Department Hospitais da Universidade de Coimbra Unidade Local de Saúde de Coimbra Coimbra Portugal

Allergy and Clinical Immunology Unit Mauriziano Hospital Torino Italy

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 Barcelona Spain

Allergy Service Fundacion Jimenez Diaz Universidad Autonoma de Madrid CIBERES ISCIII Madrid Spain

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

ARADyAL Research Network Barcelona Spain

ARIA Montpellier France

Asthma and Allergy Unit IRCCS Humanitas Research Hospital Rozzano Milan Italy

Biochemistry Lab Faculty of Pharmacy and Competence Center on Active and Healthy Ageing University of Porto Porto Portugal

Center for Innovative Biomedicine and Biotechnology Faculty of Medicine University of Coimbra Coimbra Portugal

Center for Rhinology and Allergology Wiesbaden Germany

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

ClinCompetence Cologne GmbH Cologne Germany

Clinic of Asthma Allergy and Chronic Lung Diseases Vilnius Lithuania

Clinic of Children's Diseases Institute of Clinical Medicine and Institute of Health Sciences Medical Faculty of Vilnius University Vilnius Lithuania

Department of Allergology Medical University of Gdańsk Gdansk Poland

Department of Allergy and Immunology Hospital Quironsalud Bizkaia Bilbao Spain

Department of Allergy Skin and Allergy Hospital Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy

Department of Cardiovascular and Respiratory Sciences Porto Health School Polytechnic Institute of Porto Porto Portugal

Department of Immunoallergology Cova da Beira University Hospital Centre Covilhã Portugal

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 Medical Sciences University of Torino Torino 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 AMC Amsterdam the Netherlands

Department of Otorhinolaryngology Chiba University Hospital Chiba Japan

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 Otorhinolaryngology University of Eastern Finland and the North Savo Wellbeing Services County Kuopio Finland

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 Istanbul University Cerrahpaşa Cerrahpaşa Faculty of Medicine Istanbul Turkey

Department of Pulmonary Medicine CHU Liège Liège Belgium

Department of Respiratory Medicine and Tuberculosis University Hospital Brno Czech Republic

Department of Women's and Children's Health Paediatric Research Uppsala University Uppsala Sweden

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

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

Ecole Polytechnique de Palaiseau Palaiseau France

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

for Health Technology and Services Research Health Research Network Faculty of Medicine University of Porto Porto Portugal

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

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

GIGA I3 Research Group University of Liège Liège Belgium

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

Institute of Immunology Faculty of Medicine University of Coimbra Coimbra Portugal

Institute of Medical Statistics and Computational Biology University of Cologne Cologne Germany

Institute of Pulmonology and Tuberculosis Istanbul University Cerrahpaşa Istanbul Turkey

Institute of Sciences of Food Production National Research Council Bari Italy

Interdisciplinary Research Group of Human Ecology Institute of Clinical Medicine and Institute of Health Sciences Medical Faculty of Vilnius University Vilnius Lithuania

IRBA Bretigny sur Orge France

KYomed INNOV Montpellier France

MASK Air SAS 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

Medical Faculty ENT Department Eskisehir Osmangazi University Eskisehir Turkey

PaCeIT Patient Centered Innovation and Technologies Center for Health Technology and Services Research Faculty of Medicine University of Porto Porto Portugal

Postgraduate Program in Allergy and Clinical Immunology University of Naples Federico 2 Naples Italy

Respiralab Research Group Guayaquil Guayas Ecuador

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

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

SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy

UBIAir Clinical and Experimental Lung Centre and CICS UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal

Universidad Espíritu Santo Samborondón Ecuador

Université Paris Cité Paris France

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

University of Bari Medical School Bari Italy

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

Erratum In

Clin Exp Allergy. 2025 Mar 24. doi: 10.1111/cea.70041. PubMed

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