Optimising allergic rhinitis management in primary care using the respiratory allergy optimiser: results from the AERO study

Digital tools may support healthcare professionals in providing guideline-directed management for patients with allergic rhinitis (AR). This study aimed to develop and implement the Respiratory Allergy Optimiser, a digital decision-support tool aligned with AR guideline recommendations, and evaluate its effect on symptom severity in primary care. The AERO study was an interventional study conducted in 11 general practices in the Netherlands (August-November 2025). Adult patients with a diagnosis of AR and/or allergic conjunctivitis and/or prescribed AR medication (past three years) were eligible. The Respiratory Allergy Optimiser assessed symptom severity using a visual analogue scale (VAS, 0–100 mm) and collected information on patient and disease characteristics, symptoms, medication use, adherence, and nasal spray technique. Two weeks later, patients completed a follow-up survey including the VAS. User experience data were collected. 103 patients with rhinitis were included (99 with AR; mean age 48.9 years (SD 16.6); 61% female). Mean VAS score were 35.2 (SD 26.3) at baseline and 35.2 (SD 26.1) at follow-up ( n = 91). The tool advised treatment step-up in 41% of patients, continuation in 27%, and step-down in 17%; 14 patients also received advice to consider allergy immunotherapy. Among patients with uncontrolled AR at baseline (VAS > 50 mm; n = 31), mean VAS scores decreased from 68.0 (SD 12.5)–52.7 (SD 24.9) after two weeks ( p < 0.001). In Dutch primary care, the Respiratory Allergy Optimiser frequently identified opportunities to adjust AR treatment in line with guideline recommendations. While no improvement in symptom severity was observed in the overall study population, exploratory analyses suggested symptom improvement among patients with uncontrolled symptoms. User experience was generally positive.