International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31563934 Joint action with European CRSwNP Patients for better outcomes 321 321 EN P.W. Hellings Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium 2052 10.4193/Rhin19.405

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31152646 Effect of gender on odor identification at different life stages: a meta-analysis 322 330 EN X. Wang School of Kinesiology, Shanghai University of Sport, 399 Chang Hai Road, Shanghai, 200438, P.R. China C. Zhang School of Kinesiology, Shanghai University of Sport, 399 Chang Hai Road, Shanghai, 200438, P.R. China X. Xia School of Kinesiology, Shanghai University of Sport, 399 Chang Hai Road, Shanghai, 200438, P.R. China Y. Yang School of Kinesiology, Shanghai University of Sport, 399 Chang Hai Road, Shanghai, 200438, P.R. China C. Zhou School of Kinesiology, Shanghai University of Sport, 399 Chang Hai Road, Shanghai, 200438, P.R. China 1898 10.4193/Rhin19.005 BACKGROUND: Although conflicting findings abound, gender-related differences in olfactory identification have received continuous attention. To our best knowledge, no systematic and quantitative research has examined gender differences in olfaction identification at various stages of life. The present study aimed to find out if there is gender difference in human olfaction identification in different life stages. METHODOLOGY: Studies cited in the PubMed database were searched from its inception to August 2017 using the terms "olfact" or "smell" and "gender" or "sex&quot". The effect size of each comparison was calculated. 24 studies were included in this meta-analysis. RESULTS: In this meta-analysis, we used Cohen's d to determine the effects sizes for the comparisons between women versus men among different groups. Its value was 0.18 (95% CI: -0.13 to 0.49) in Group A (age less than 18 years), 0.62 (95% CI: 0.43 to 0.81) in Group B (age 18-50 years), and 0.33 (95% CI: -0.01 to 0.66) in Group C. The effect was considered relatively small in Group A (age less than 18 years) and Group C (age more than 50 years), and a medium effect in Group B (age 18-50 years). Moreover, a significant difference was only present in Group B (age 18-50 years). Summarizing, the gender effect was only present in the group aged 18-50 years, in which women outperformed men significantly in odor identification. CONCLUSIONS: This meta-analytic review indicated that the gender differences only exist in young adults (age 18-50 years), while absent in juveniles (age less than 18 years) or an aged cohort (age more than 50 years). Females outperformed males in the young adults.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 30963145 Patient Advisory Board for Chronic Rhinosinusitis â€" A EUFOREA initiative 331 335 EN B. Pugin European Forum for Research and Education in Allergy and Airway diseases (EUFOREA), Brussels, Belgium; Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium L. Deneyer European Forum for Research and Education in Allergy and Airway diseases (EUFOREA), Brussels, Belgium C. Bachert The Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, Clintec, Karolinska Institute, Stockholm, Sweden I. Alobid IDIBAPS, Hospital ClÃ要ic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain J. Bousquet Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France G. De Carlo The European Federation of Allergy and Airways Diseases patients associations (EFA), Brussels, Belgium W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands S. Gane Department of Otolaryngology, Royal National Throat Nose and Ear Hospital, London, UK C. Hopkins ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK C. Holzmeister Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria C. Langdon IDIBAPS, Hospital ClÃ要ic, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain E.S. Lourijsen Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands V.J. Lund Department of Otolaryngology, Royal National Throat Nose and Ear Hospital, London, UK G. Marien European Forum for Research and Education in Allergy and Airway diseases (EUFOREA), Brussels, Belgium M. Mavris European Medicines Agency (EMA), London, UK J. Mullol IDIBAPS, Hospital ClÃ要ic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain C. Pereira-Perez IDIBAPS, Hospital ClÃ要ic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria O. Vanderveken ENT Department, University Hospital of Antwerp, Wilrijk, Belgium P.W. Hellings Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands; Clinical Department of Otorhin S.F. Seys European Forum for Research and Education in Allergy and Airway diseases (EUFOREA), Brussels, Belgium; Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium 1887 10.4193/Rhin19.012 Despite the high prevalence of chronic rhinosinusitis (CRS) and its impact on patients’ quality of life, no European patient organization that advocates for patients with CRS currently exists. To fill this gap and give a voice to CRS patients, EUFOREA has created a patient advisory board, whose goal is to better understand the real-life needs of patients, to raise awareness at political level and to involve patients in the development of novel integrated solutions to accelerate access to accurate diagnosis and treatments. This report summarizes the key discussion points from the kick-off meeting of the board on the 8th June 2018 and provides an outline of the key objectives for the future.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31317972 Immunological profiling of key inflammatory drivers of nasal polyp formation and growth in chronic rhinosinusitis 336 342 EN T.C. Biggs Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; University Ho S.M. Hayes Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; University Ho P.G. Harries University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom R.N. Allan NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust; Department of Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom A.F. Walls Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom S.L.F. Pender Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom R.J. Salib Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton; Southampton NIHR Respiratory Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; University Ho 1924 10.4193/Rhin19.167 BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic inflammatory condition of the upper airways, often associated with the formation of nasal polyps (CRSwNP). It is well established that macroscopically normal (non-polypoidal) sinonasal mucosa in CRSwNP patients can undergo polypoidal change over time, turning into frank polyps. However, little is known about what drives this process. This study aimed to investigate potential drivers of nasal polyp formation or growth through comparison of the immunological profiles of nasal polyps with contiguous non-polypoidal sinonasal mucosa, from the same patients. METHODS: The immune profiles of three types of tissue were compared; nasal polyps and adjacent non-polypoidal sinonasal mucosa from 10 CRSwNP patients, and sinonasal mucosa from 10 control patients undergoing trans-sphenoidal pituitary surgery. Nasal polyp and control samples were also stimulated with Staphylococcus aureus enterotoxin B (SEB) using a nasal explant model, prior to cytokine analysis. Real time quantitative polymerase chain reaction (IL-5, T-bet, IL-17A, FoxP3, TLR-4, IL-8, IL-1beta and IL-6) and Luminex (IFNgamma, IL-5 and IL-17A) were used to quantify pro-inflammatory responses. RESULTS: Nasal polyps and contiguous non-polypoidal sinonasal mucosa from CRSwNP patients displayed a very similar pro-inflammatory profile. When stimulated with SEB, nasal polyps displayed a Th2/Th17 mediated response when compared to controls. CONCLUSIONS: In CRSwNP, nasal polyps and non-polypoidal sinonasal mucosa from the same patient displayed a similar pro-inflammatory profile skewed towards the Th2/Th17 pathway in nasal polyps following SEB stimulation, with evidence of disordered bacterial clearance. These factors may contribute to enhanced survival of bacteria and development of a chronic inflammatory milieu, potentially driving new polyp formation and recurrence following surgical removal.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31318362 The GALEN rhinosinusitis cohort: chronic rhinosinusitis with nasal polyps affects health-related quality of life 343 351 EN A. Khan Sanofi, Chilly Mazarin, France; Ghent University Hospital, Ghent, Belgium T.M.T. Huynh Sanofi, Chilly Mazarin, France G. Vandeplas Ghent University Hospital, Ghent, Belgium V.N. Joish Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA L.P. Mannent Sanofi, Chilly Mazarin, France P. Tomassen Ghent University Hospital, Ghent, Belgium T. van Zele Ghent University Hospital, Ghent, Belgium L.-O. Cardell CLINTEC, Karolinska Institutet, Stockholm, Sweden J. Arebro CLINTEC, Karolinska Institutet, Stockholm, Sweden H. Olze Charite-Universitatsmedizin Berlin, Berlin, Germany U. Forster-Ruhrmann Charite-Universitatsmedizin Berlin, Berlin, Germany M.L. Kowalski Medical University of Lodz, Lodz, Poland A. Olszewska-Ziaber Medical University of Lodz, Lodz, Poland W. Fokkens Academic Medical Center, Amsterdam, the Netherlands C. van Drunen Academic Medical Center, Amsterdam, the Netherlands J. Mullol Hospital ClÃ要ic â€" IDIBAPS, CIBERES, Barcelona, Spain I. Alobid Hospital ClÃ要ic â€" IDIBAPS, CIBERES, Barcelona, Spain P.W. Hellings University Hospitals Leuven, Leuven, Belgium V. Hox University Hospitals Leuven, Leuven, Belgium E. Toskala Temple University School of Medicine, Philadelphia, PA, USA G. Scadding Royal National Throat, Nose and Ear Hospital, London, UK V. Lund Royal National Throat, Nose and Ear Hospital, London, UK C. Bachert Ghent University Hospital, Ghent, Belgium; CLINTEC, Karolinska Institutet, Stockholm, Sweden 1925 10.4193/Rhin19.158 BACKGROUND: Chronic rhinosinusitis (CRS) significantly affects health-related quality of life (HRQoL). Few multinational observational studies have evaluated the impact of CRS with nasal polyps (CRSwNP) on patients’ HRQoL. This study aimed to assess HRQoL outcomes (including analyses by disease severity and impact of comorbidities and refractory disease) in CRSwNP patients from a large European database. METHODOLOGY: Data were analysed from the Global Allergy and Asthma European Network (GALEN) Rhinosinusitis Cohort, including sociodemographic data, patient-reported disease severity (visual analogue scale), and scores on the 36-Item ShortForm Health Survey (SF-36) questionnaire. Differences in mean SF-36 scores were evaluated between patients with CRSwNP and population norms and between subgroups of interest (disease severity, comorbidity, and refractory disease, defined by a history of sinonasal surgery). RESULTS: Patients with CRSwNP (N = 445) had significantly lower mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores vs population norms, demonstrating that CRSwNP negatively affects HRQoL. The presence of comorbidities affected HRQoL, as shown by significant differences in PCS scores in patients with asthma or non-steroidal antiinflammatory drug-exacerbated respiratory disease, compared with patients without asthma. Patients with moderate-to-severe disease had significantly lower PCS scores than patients with mild disease. Severe disease had a significant impact on MCS score. History of surgery had a clinically meaningful negative effect on HRQoL compared with no history of surgery. CONCLUSIONS: CRSwNP patients have significantly lower HRQoL compared with population norms. The impact is greater in patients with greater disease severity, comorbidities, or refractory disease.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31162492 Value of turbinoplasty in rhinosurgery - a controlled randomized study 352 357 EN F. Sommer Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany M.O. Scheithauer Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany T.K. Hoffmann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany A.-S. Grossi Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany K. Hauck Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany J. Lindemann Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075 Ulm, Germany 1899 10.4193/Rhin19.084 BACKGROUND: Turbinoplasty is a common procedure in patients with nasal obstruction and hypertrophy of the nasal turbinates. A general recommendation regarding the necessity of turbinoplasty in functional rhinosurgery is still missing. For the first time, the value of turbinoplasty in septo- and septorhinoplasty regarding patient satisfaction as well as objective data in rhinomanometry and acoustic rhinometry was analyzed in a prospective randomized controlled trial. METHODOLOGY: 73 patients with nasal obstruction due to septal deviation and / or a deviated nose were included in the study. After randomization, anterior turbinoplasty was or was not performed during septo- or septorhinoplasty. Pre- and postoperative rhinomanometry and acoustic rhinometry were accomplished. NOSE© and SNOT 20 questionnaires were completed by the patients before and 9 months after surgery. Additionally, the patients were asked about their subjective satisfaction. RESULTS: 81% of the patients were subjectively satisfied with the postoperative improvement of nasal breathing. There was a significant improvement in the values of NOSE© and SNOT 20 questionnaires with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry showed values in MCA1 and 2, Vol 1 and Vol 2 as well as higher nasal flows with no statistically significant difference between the two study groups. CONCLUSIONS: Patient satisfaction after functional septo- and septorhinoplasty is high and does not seem to be affected by turbinate surgery. There was no statistically significant difference in the postoperative results regarding objective rhinological measurements with or without turbinoplasty. As extensive resections of the turbinates can have a negative impact on nasal physiology, the indication for turbinoplasty must be considered carefully.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31403137 Optimising trial outcomes and patient retention for the MACRO trial for chronic rhinosinusitis 358 366 EN N.H. Ta Norwich Medical School, University of East Anglia, Norwich, UK C. Hopkins ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK J. Vennik University of Southampton, Southampton, UK C. Philpott Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK 1936 10.4193/Rhin19.142 BACKGROUND: This study aimed to evaluate current subjective and objective outcome assessments for the MACRO (defining best Management for Adults with Chronic RhinOsinusitis) Trial which compares antibiotics, placebo and sinus surgery. This was to identify any redundant assessments and to include patient perspectives to determine acceptability for confirmation in the trial. METHODS : Adults CRS patients meeting the provisional eligibility criteria for the MACRO trial were recruited to this mixed-method study at 2 sites. Correlations between the objective outcome measures and SNOT-22 scores were evaluated. Selected participants took part in a semi-structured telephone interview to explore their experiences and views of undergoing outcome measures. RESULTS: Seventy patients (37% male) were recruited, 36 had CRS without nasal polyps, 34 had CRS with nasal polyps. There was a weak inverse correlation between the SNOT-22 �Blockage� ratings and Peak Nasal Inspiratory Flow readings, a moderate inverse correlation between the SNOT-22 �Smell� ratings and Sniffin’ Sticks scores, but no significant correlation between the SNOT-22 and Saccharin test results. The participants’ experience of the trial visit was positive with an acceptable duration of trial visit. Most proposed outcome measures were valued by participants with the exception of the Saccharin test. DISCUSSION: The Sniffin’ Sticks test and PNIF correlate with their respective component SNOT-22 scores but are considered important by patients; PNIF is simple, cheap test to perform. The Saccharin test will be removed as participants did not value it and was not highly rated in parallel work on a core outcome set for CRS.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31210177 Tavipec in acute rhinosinusitis: a multi-centre, doubleblind, randomized, placebo-controlled, clinical trial 367 374 EN D. Dejaco Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria J. Bocian-Sobkowska BONUS Centre, Skorzewo, Poznanska, Poland W. Szymanski VITA MED Centre Witold Szymanski, Regnow, Poland G. Zacke Department of Clinical Research, Pharmazeutische Fabrik Montavit Ges.m.b.H., Absam, Austria V. Hockner Department of Clinical Research, Pharmazeutische Fabrik Montavit Ges.m.b.H., Absam, Austria H. Riechelmann Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria 1900 10.4193/Rhin19.089 BACKGROUND: This randomized clinical trial was designed to evaluate the efficacy and safety of Tavipec® (Spicae aetheroleum), a phytomedicine obtained by steam distillation of the flowering tops of Lavandula latifolia, as compared to placebo in adult patients suffering from acute viral rhinosinusitis. METHODOLOGY: Patients with acute viral rhinosinusitis were randomly assigned to treatment with 2 capsules Tavipec® 150 mg or placebo thrice daily over a period of 7 days in a double-blind, parallel-group design. No additional treatment was admitted. The efficacy endpoints comprised the improvement of the main rhinosinusitis symptoms as per Major Symptom Score (MSS) and Sino-Nasal Outcome Test (SNOT-22) as well as of quality of life (QoL) by global assessment scale, evaluated at baseline, day 5 and day 8, respectively. RESULTS: 288 patients were enrolled and randomized to treatment. At day 8 the patients in the Tavipec® group had a significantly lower MSS compared to placebo and the impact of rhinosinusitis symptoms on QoL was significantly reduced. A significantly higher proportion of Tavipec® treated patients experienced a change in SNOT-22 score greater than or equal to 10 points at day 5 or day 8. No new safety signals were identified. CONCLUSIONS: The treatment with Tavipec® effectively reduced the symptoms of acute rhinosinusitis in adult patients.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 Development of a new psychophysical method to assess intranasal trigeminal chemosensory function 375 384 EN C. Huart Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Universite catholique de Louvain, Brussels, Belgium T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany C. Kaehling Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany I. Konstantinidis Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece V. Hox Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium A. Mouraux Institute of Neuroscience, Universite catholique de Louvain, Brussels, Belgium P. Rombaux Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Universite catholique de Louvain, Brussels, Belgium 1904 10.4193/Rhin19.024 BACKGROUND: The aim of this study was to develop a new psychophysical test to assess intranasal trigeminal chemosensory function. METHODOLOGY: The test is similar to the Sniffin’ Sticks test, but using pens impregnated with substances preferentially activating trigeminal afferents. Our test comprises detection threshold, discrimination, identification and lateralization tasks. In a first study, we evaluated healthy controls. In a second study, we evaluated the potential usefulness of this test in patients with rhinological conditions. RESULTS: Study 1: 86 controls were included. Threshold, identification and lateralization performance decreased with age. Test-retest reliability was similar to that of olfactory tests. Study 2: results of the controls group were compared to those of 59 patients (14 allergic rhinitis, 11 chronic rhinosinusitis with nasal polyps (CRSwNP), 9 without nasal polyps (CRSsNP), and 25 with an olfactory disorder (OD)). Controls had 1) lower detection thresholds compared to CRSwNP, CRSsNP and OD, 2) better discrimination and identification scores compared to OD, and 3) better lateralization scores compared to CRSwNP and CRSsNP. CONCLUSIONS: Our test allows to identify age-related changes in trigeminal chemosensory function. Trigeminal function seems to be differently affected in different pathologies. Further studies are necessary to validate our results and evaluate the impact of olfactory co-activation on the observed results.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31062767 Testing gustatory function using either a forced-choice or a non-forced-choice paradigm - Does it make a difference? 385 391 EN G. Besser Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria A. Prassl Department of Anaesthesiology, Medical University of Vienna, Austria C.A. Mueller Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Austria B. Renner Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nurnberg, Erlangen, Germany 1890 10.4193/Rhin19.021 BACKGROUND: Recently more interest is evolving for research on gustatory function, also due to findings of �extraoral� taste receptors with postulated participation in a pathogen detection network. Also, bitter taste function seems to be reduced in patients with chronic rhinosinusitis. For testing gustatory function �taste strips� (TS) have been validated in a forced-choice (fc) and a non-forced-choice (nfc) paradigm and used in several studies. Purpose of the investigation was to evaluate possible differences of named modalities. METHODOLOGY: Healthy subjects (n=102) with subjective normal gustatory function and patients (n=30) with potential taste dysfunction were included. All participants were tested twice (using TS in four concentrations of sweet, sour, salty, and bitter taste), either starting with a fc or a nfc paradigm. RESULTS: In tested patients there was a difference between fc and nfc procedure with higher results for bitter in the fc testing procedure, while other qualities did not differ. This effect was also visible in the overall participants with higher scores in the fc procedure for bitter taste. CONCLUSION: TS are valid to be used in a forced and a non-forced choice paradigm, with bitter taste showing slightly higher scores in forced-choice testing. Future investigators with focus on bitter taste perception should be particularly cautious when comparing results in regard to testing procedure.

International Rhinologic Society Rhinology 0300-0729 57 5 2019 10 1 31322142 ARIA masterclass 2018: From guidelines to real-life implementation 392 399 EN P.W. Hellings Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium S.F. Seys European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium and Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium G. Marien European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium and Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium I. Agache Department of Allergy and Clinical Immunology, University of Transylvania, Brasov, Romania W. Canonica Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS - Rozzano (MI), Italy P. Gevaert Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, University of Ghent, Belgium T. Haahtela Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland L. Klimek Center for Rhinology and Allergology, Wiesbaden, Germany J. Mullol Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain O. Pfaar Department of Otorhinolaryngolgy, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universitat Marburg, Germany G. Scadding Department of Allergy and Rhinology, Royal National Throat, Nose and Ear Hospital, University College London School of Medicine, London, UK G. Scadding Royal Brompton and Harefield NHS Trust, London, UK A. Valiulis Professor of Clinic of Children's Diseases of Institute of Clinical Medicine of Vilnius University Faculty of Medicine, Vilnius, Lithuania ARIA masterclass discussants (ARIA) Listed in Acknowledgements J. Bousquet University Hospital, Montpellier, MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France B. Pugin European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium and Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium 1916 10.4193/Rhin19.011 Over the past 20 years, ARIA (Allergic Rhinitis and its Impact on Asthma) has developed various guidelines for the treatment of allergic rhinitis (AR) and asthma multimorbidity. Over time, the ARIA initiative has evolved to ensure the highest level of bestpractices adoption in real life settings. It has evolved towards Integrated Care Pathways (ICPs) using mobile technology, and has now entered a new phase in which change management is key to provide an active and healthy life to all AR patients. With that in mind, the first ARIA masterclass was held on 12th September 2018 in Brussels, Belgium. The masterclass aimed at informing clinicians about the principles of change management, providing unbiased education on diagnosis and treatments, sharing the most recent research data on AR and multimorbidities, and creating a snowball effect to increase the adoption of best practices around the globe. This report provides an overview of the ARIA masterclass concept, summarizes the key lectures and discussions, and gives an outline of the future key development.