The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. Clinical decision support systems (CDSSs) might be beneficial for the assessment of disease control. CDSSs should be based on the best evidence and algorithms to aid patients and health care professionals to jointly determine treatment and its step-up or step-down strategy depending on AR control. Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR [fighting chronic diseases for active and healthy ageing]), one of the reference sites of the European Innovation Partnership on Active and Healthy Ageing, has initiated an allergy sentinel network (the MACVIA-ARIA Sentinel Network). A CDSS is currently being developed to optimize AR control. An algorithm developed by consensus is presented in this article. This algorithm should be confirmed by appropriate trials.

MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis / Bousquet, Jean; Schünemann, Holger J.; Hellings, Peter W.; Arnavielhe, Sylvie; Bachert, Claus; Bedbrook, Anna; Bergmann, Karl Christian; Bosnic Anticevich, Sinthia; Brozek, Jan; Calderon, Moises; Canonica, G. Walter; Casale, Thomas B.; Chavannes, Niels H.; Cox, Linda; Chrystyn, Henry; Cruz, Alvaro A.; Dahl, Ronald; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Phillipe; Dray, Gérard; Fletcher, Monica; Fokkens, Wytske J.; Fonseca, Joao; Gonzalez Diaz, Sandra N.; Grouse, Lawrence; Keil, Thomas; Kuna, Piotr; Larenas Linnemann, Désirée; Lodrup Carlsen, Karin C.; Meltzer, Eli O.; Mullol, Jaoquim; Muraro, Antonella; Naclerio, Robert N.; Palkonen, Susanna; Papadopoulos, Nikolaos G.; Passalacqua, Giovanni; Price, David; Ryan, Dermot; Samolinski, Boleslaw; Scadding, Glenis K.; Sheikh, Aziz; Spertini, François; Valiulis, Arunas; Valovirta, Erkka; Walker, Samantha; Wickman, Magnus; Yorgancioglu, Arzu; Haahtela, Tari; Zuberbier, Torsten; Aberer, Werner; Adachi, Mitsuru; Agache, Ioana; Akdis, Cezmi; Akdis, Mubeccel; Annesi Maesano, Isabella; Ansotegui, Ignacio J.; Anto, Josep M.; Arshad, S. Hasan; Baiardini, Ilaria; Baigenzhin, Abay K.; Barbara, Cristina; Bateman, Eric D.; Beghe', Bianca; Bel, Elisabeth H.; Ben Kheder, Ali; Bennoor, Kazi S.; Benson, Michael; Bernstein, David; Michael, Bewick; Thomas, Bieber; Bindslev Jensen, Carsten; Bjermer, Leif; Blain, Hubert; Boner, Attilio; Bonini, Matteo; Bonini, Sergio; Bosse, Isabelle; Bouchard, Jacques; Boulet, Louis Philippe; Bourret, Rodolphe A.; Bousquet, Philippe J.; Braido, Fulvio; Briggs, Andrew H.; Brightling, Christopher E.; Buhl, Roland; Burney, Peter; Bush, Andrew; Caballero Fonseca, Fernando; Caimmi, Davide P.; Camargos, Paulo; Camuzat, Thierry; Carlsen, Kai Hakon; Carr, Warner; Casale, Thomas B.; Sarabia, Alfonso Cepeda; Chatzi, Leda; Chen, Yuzhi; Chiron, Raphaël; Chkhartishvili, Ekaterine; Chuchalin, Alexander; Ciprandi, Georgio; Cirule, Ieva; Correia de Sousa, Jaime; Costa, David; Crooks, George; Custovic, Adnan; Dahlen, Sven Erik; Darsow, Ulf; De Blay, Frédéric; De Manuel Keenoy, Esteban; Dedeu, Tony; Deleanu, Diana; Denburg, Judah; Didier, Alain; Dinh Xuan, Anh Tuan; Dokic, Dejan; Douagui, Habib B.; Dubakiene, Ruta; Durham, Stephen; Dykewicz, Mark; El Gamal, Yehia; Emuzyte, Regina; Fink Wagner, Antje; Fiocchi, Alessandro; Forastiere, Francesco; Gamkrelidze, Amiran; Gemicioğlu, Bilun; Gereda, Jose E.; Gerth van Wijk, Roy; Gotua, Maia; Grisle, Ineta; Guzmán, M. Antonieta; Haahtela, Tari; Heinrich, Joachim; Hellquist Dahl, Birthe; Horak, Friedrich; Howarth, Peter H.; Humbert, Marc; Hyland, Michael; Ivancevich, Juan Carlos; Jares, Edgardo J.; Johnston, Sebastian L.; Jonquet, Olivier; Joos, Guy; Jung, Ki Suck; Just, Jocelyne; Jutel, Marek; Kaidashev, Igor P.; Khaitov, Musa; Kalayci, Omer; Kalyoncu, Fuat; Keith, Paul; Khaltaev, Nikolai; Kleine Tebbe, Jorg; Klimek, Ludger; N'Goran, Bernard Koffi; Kolek, Vitezlav; Koppelman, Gerard H.; Kowalski, Marek; Kull, Inger; Kvedariene, Violeta; Lambrecht, Bart; Lau, Susanne; Laune, Daniel; Le Thi Tuyet, Lan; Li, Jing; Lieberman, Phillipe; Lipworth, Brian J.; Renaud, Louis; Magard, Yves; Magnan, Antoine; Mahboub, Bassam; Majer, Ivan; Makela, Mika; Manning, Peter J.; Masjedi, Mohamad R.; Maurer, Marcus; Mavale Manuel, Sandra; Melén, Erik; Melo Gomes, Elisabete; Mercier, Jacques; Merk, Hans; Miculinic, Neven; Mihaltan, Florin; Milenkovic, Branislava; Mohammad, Yousser; Molimard, Mathieu; Momas, Isabelle; Montilla Santana, Anna; Morais Almeida, Mario; Mösges, Ralph; Nadif, Rachel; Namazova Baranova, Leyla; Neffen, Hugo; Nekam, Kristof; Neou, Angelos; Niggemann, Bodo; Nyembue, Dieudonné; O'Hehir, Robyn; Ohta, Ken; Okamoto, Yoshitaka; Okubo, Kim; Ouedraogo, Solange; Paggiaro, Pier Luigi; Pali Schöll, Isabella; Palmer, Stephen; Panzner, Petr; Papi, Alberto; Park, Hae Sim; Pavord, Ian; Pawankar, Ruby; Pfaar, Oliver; Picard, Robert; Pigearias, Bernard; Pin, Isabelle; Plavec, Davor; Pohl, Wolfgang; Popov, Todor; Postma, Dirkje S.; Potter, Paul; Poulsen, Lars K.; Rabe, Klaus F.; Raciborski, Filip; Pontal, Françoise Radier; Reitamo, Sakari; Repka Ramirez, Maria Susana; Robalo Cordeiro, Carlos; Roberts, Graham; Rodenas, Francisco; Rolland, Christine; Rodriguez, Miguel Roman; Romano, Antonino; Rosado Pinto, José; Rosario, Nelson A.; Rosenwasser, Larry; Rottem, Menachem; Sanchez Borges, Mario; Sastre Dominguez, Joaquim; Schmid Grendelmeier, Peter; Serrano, Eli; Simons, F. Estelle R.; Sisul, Juan Carlos; Skrindo, Ingebjorg; Smit, Henriette A.; Solé, Dirceu; Sooronbaev, Talant; Spranger, Otto; Stelmach, Rafael; Strandberg, Timo; Sunyer, Jordi; Thijs, Carel; Todo Bom, Ana Maria; Triggiani, Massimo; Valenta, Rudolf; Valero, Antonio L.; van Hage, Marianne; Vandenplas, Olivier; Vezzani, Giorgio; Vichyanond, Pakit; Viegi, Giovanni; Wagenmann, Martin; Wahn, Ulrich; De Yun, Wang; Williams, Denis; Wright, John; Yawn, Barbara P.; Yiallouros, Panayiotis; Yusuf, Osman M.; Zar, Heather J.; Zernotti, Mario; Zhang, Luo; Zhong, Nanshan; Zidarn, Mihaela. - In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. - ISSN 0091-6749. - 138:2(2016), pp. 367-374.e2. [10.1016/j.jaci.2016.03.025]

MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis

BEGHE', Bianca;
2016-01-01

Abstract

The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. Clinical decision support systems (CDSSs) might be beneficial for the assessment of disease control. CDSSs should be based on the best evidence and algorithms to aid patients and health care professionals to jointly determine treatment and its step-up or step-down strategy depending on AR control. Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR [fighting chronic diseases for active and healthy ageing]), one of the reference sites of the European Innovation Partnership on Active and Healthy Ageing, has initiated an allergy sentinel network (the MACVIA-ARIA Sentinel Network). A CDSS is currently being developed to optimize AR control. An algorithm developed by consensus is presented in this article. This algorithm should be confirmed by appropriate trials.
23-apr-2016
138
2
367
374.e2
MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis / Bousquet, Jean; Schünemann, Holger J.; Hellings, Peter W.; Arnavielhe, Sylvie; Bachert, Claus; Bedbrook, Anna; Bergmann, Karl Christian; Bosnic Anticevich, Sinthia; Brozek, Jan; Calderon, Moises; Canonica, G. Walter; Casale, Thomas B.; Chavannes, Niels H.; Cox, Linda; Chrystyn, Henry; Cruz, Alvaro A.; Dahl, Ronald; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Phillipe; Dray, Gérard; Fletcher, Monica; Fokkens, Wytske J.; Fonseca, Joao; Gonzalez Diaz, Sandra N.; Grouse, Lawrence; Keil, Thomas; Kuna, Piotr; Larenas Linnemann, Désirée; Lodrup Carlsen, Karin C.; Meltzer, Eli O.; Mullol, Jaoquim; Muraro, Antonella; Naclerio, Robert N.; Palkonen, Susanna; Papadopoulos, Nikolaos G.; Passalacqua, Giovanni; Price, David; Ryan, Dermot; Samolinski, Boleslaw; Scadding, Glenis K.; Sheikh, Aziz; Spertini, François; Valiulis, Arunas; Valovirta, Erkka; Walker, Samantha; Wickman, Magnus; Yorgancioglu, Arzu; Haahtela, Tari; Zuberbier, Torsten; Aberer, Werner; Adachi, Mitsuru; Agache, Ioana; Akdis, Cezmi; Akdis, Mubeccel; Annesi Maesano, Isabella; Ansotegui, Ignacio J.; Anto, Josep M.; Arshad, S. Hasan; Baiardini, Ilaria; Baigenzhin, Abay K.; Barbara, Cristina; Bateman, Eric D.; Beghe', Bianca; Bel, Elisabeth H.; Ben Kheder, Ali; Bennoor, Kazi S.; Benson, Michael; Bernstein, David; Michael, Bewick; Thomas, Bieber; Bindslev Jensen, Carsten; Bjermer, Leif; Blain, Hubert; Boner, Attilio; Bonini, Matteo; Bonini, Sergio; Bosse, Isabelle; Bouchard, Jacques; Boulet, Louis Philippe; Bourret, Rodolphe A.; Bousquet, Philippe J.; Braido, Fulvio; Briggs, Andrew H.; Brightling, Christopher E.; Buhl, Roland; Burney, Peter; Bush, Andrew; Caballero Fonseca, Fernando; Caimmi, Davide P.; Camargos, Paulo; Camuzat, Thierry; Carlsen, Kai Hakon; Carr, Warner; Casale, Thomas B.; Sarabia, Alfonso Cepeda; Chatzi, Leda; Chen, Yuzhi; Chiron, Raphaël; Chkhartishvili, Ekaterine; Chuchalin, Alexander; Ciprandi, Georgio; Cirule, Ieva; Correia de Sousa, Jaime; Costa, David; Crooks, George; Custovic, Adnan; Dahlen, Sven Erik; Darsow, Ulf; De Blay, Frédéric; De Manuel Keenoy, Esteban; Dedeu, Tony; Deleanu, Diana; Denburg, Judah; Didier, Alain; Dinh Xuan, Anh Tuan; Dokic, Dejan; Douagui, Habib B.; Dubakiene, Ruta; Durham, Stephen; Dykewicz, Mark; El Gamal, Yehia; Emuzyte, Regina; Fink Wagner, Antje; Fiocchi, Alessandro; Forastiere, Francesco; Gamkrelidze, Amiran; Gemicioğlu, Bilun; Gereda, Jose E.; Gerth van Wijk, Roy; Gotua, Maia; Grisle, Ineta; Guzmán, M. Antonieta; Haahtela, Tari; Heinrich, Joachim; Hellquist Dahl, Birthe; Horak, Friedrich; Howarth, Peter H.; Humbert, Marc; Hyland, Michael; Ivancevich, Juan Carlos; Jares, Edgardo J.; Johnston, Sebastian L.; Jonquet, Olivier; Joos, Guy; Jung, Ki Suck; Just, Jocelyne; Jutel, Marek; Kaidashev, Igor P.; Khaitov, Musa; Kalayci, Omer; Kalyoncu, Fuat; Keith, Paul; Khaltaev, Nikolai; Kleine Tebbe, Jorg; Klimek, Ludger; N'Goran, Bernard Koffi; Kolek, Vitezlav; Koppelman, Gerard H.; Kowalski, Marek; Kull, Inger; Kvedariene, Violeta; Lambrecht, Bart; Lau, Susanne; Laune, Daniel; Le Thi Tuyet, Lan; Li, Jing; Lieberman, Phillipe; Lipworth, Brian J.; Renaud, Louis; Magard, Yves; Magnan, Antoine; Mahboub, Bassam; Majer, Ivan; Makela, Mika; Manning, Peter J.; Masjedi, Mohamad R.; Maurer, Marcus; Mavale Manuel, Sandra; Melén, Erik; Melo Gomes, Elisabete; Mercier, Jacques; Merk, Hans; Miculinic, Neven; Mihaltan, Florin; Milenkovic, Branislava; Mohammad, Yousser; Molimard, Mathieu; Momas, Isabelle; Montilla Santana, Anna; Morais Almeida, Mario; Mösges, Ralph; Nadif, Rachel; Namazova Baranova, Leyla; Neffen, Hugo; Nekam, Kristof; Neou, Angelos; Niggemann, Bodo; Nyembue, Dieudonné; O'Hehir, Robyn; Ohta, Ken; Okamoto, Yoshitaka; Okubo, Kim; Ouedraogo, Solange; Paggiaro, Pier Luigi; Pali Schöll, Isabella; Palmer, Stephen; Panzner, Petr; Papi, Alberto; Park, Hae Sim; Pavord, Ian; Pawankar, Ruby; Pfaar, Oliver; Picard, Robert; Pigearias, Bernard; Pin, Isabelle; Plavec, Davor; Pohl, Wolfgang; Popov, Todor; Postma, Dirkje S.; Potter, Paul; Poulsen, Lars K.; Rabe, Klaus F.; Raciborski, Filip; Pontal, Françoise Radier; Reitamo, Sakari; Repka Ramirez, Maria Susana; Robalo Cordeiro, Carlos; Roberts, Graham; Rodenas, Francisco; Rolland, Christine; Rodriguez, Miguel Roman; Romano, Antonino; Rosado Pinto, José; Rosario, Nelson A.; Rosenwasser, Larry; Rottem, Menachem; Sanchez Borges, Mario; Sastre Dominguez, Joaquim; Schmid Grendelmeier, Peter; Serrano, Eli; Simons, F. Estelle R.; Sisul, Juan Carlos; Skrindo, Ingebjorg; Smit, Henriette A.; Solé, Dirceu; Sooronbaev, Talant; Spranger, Otto; Stelmach, Rafael; Strandberg, Timo; Sunyer, Jordi; Thijs, Carel; Todo Bom, Ana Maria; Triggiani, Massimo; Valenta, Rudolf; Valero, Antonio L.; van Hage, Marianne; Vandenplas, Olivier; Vezzani, Giorgio; Vichyanond, Pakit; Viegi, Giovanni; Wagenmann, Martin; Wahn, Ulrich; De Yun, Wang; Williams, Denis; Wright, John; Yawn, Barbara P.; Yiallouros, Panayiotis; Yusuf, Osman M.; Zar, Heather J.; Zernotti, Mario; Zhang, Luo; Zhong, Nanshan; Zidarn, Mihaela. - In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. - ISSN 0091-6749. - 138:2(2016), pp. 367-374.e2. [10.1016/j.jaci.2016.03.025]
Bousquet, Jean; Schünemann, Holger J.; Hellings, Peter W.; Arnavielhe, Sylvie; Bachert, Claus; Bedbrook, Anna; Bergmann, Karl Christian; Bosnic Anticevich, Sinthia; Brozek, Jan; Calderon, Moises; Canonica, G. Walter; Casale, Thomas B.; Chavannes, Niels H.; Cox, Linda; Chrystyn, Henry; Cruz, Alvaro A.; Dahl, Ronald; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Phillipe; Dray, Gérard; Fletcher, Monica; Fokkens, Wytske J.; Fonseca, Joao; Gonzalez Diaz, Sandra N.; Grouse, Lawrence; Keil, Thomas; Kuna, Piotr; Larenas Linnemann, Désirée; Lodrup Carlsen, Karin C.; Meltzer, Eli O.; Mullol, Jaoquim; Muraro, Antonella; Naclerio, Robert N.; Palkonen, Susanna; Papadopoulos, Nikolaos G.; Passalacqua, Giovanni; Price, David; Ryan, Dermot; Samolinski, Boleslaw; Scadding, Glenis K.; Sheikh, Aziz; Spertini, François; Valiulis, Arunas; Valovirta, Erkka; Walker, Samantha; Wickman, Magnus; Yorgancioglu, Arzu; Haahtela, Tari; Zuberbier, Torsten; Aberer, Werner; Adachi, Mitsuru; Agache, Ioana; Akdis, Cezmi; Akdis, Mubeccel; Annesi Maesano, Isabella; Ansotegui, Ignacio J.; Anto, Josep M.; Arshad, S. Hasan; Baiardini, Ilaria; Baigenzhin, Abay K.; Barbara, Cristina; Bateman, Eric D.; Beghe', Bianca; Bel, Elisabeth H.; Ben Kheder, Ali; Bennoor, Kazi S.; Benson, Michael; Bernstein, David; Michael, Bewick; Thomas, Bieber; Bindslev Jensen, Carsten; Bjermer, Leif; Blain, Hubert; Boner, Attilio; Bonini, Matteo; Bonini, Sergio; Bosse, Isabelle; Bouchard, Jacques; Boulet, Louis Philippe; Bourret, Rodolphe A.; Bousquet, Philippe J.; Braido, Fulvio; Briggs, Andrew H.; Brightling, Christopher E.; Buhl, Roland; Burney, Peter; Bush, Andrew; Caballero Fonseca, Fernando; Caimmi, Davide P.; Camargos, Paulo; Camuzat, Thierry; Carlsen, Kai Hakon; Carr, Warner; Casale, Thomas B.; Sarabia, Alfonso Cepeda; Chatzi, Leda; Chen, Yuzhi; Chiron, Raphaël; Chkhartishvili, Ekaterine; Chuchalin, Alexander; Ciprandi, Georgio; Cirule, Ieva; Correia de Sousa, Jaime; Costa, David; Crooks, George; Custovic, Adnan; Dahlen, Sven Erik; Darsow, Ulf; De Blay, Frédéric; De Manuel Keenoy, Esteban; Dedeu, Tony; Deleanu, Diana; Denburg, Judah; Didier, Alain; Dinh Xuan, Anh Tuan; Dokic, Dejan; Douagui, Habib B.; Dubakiene, Ruta; Durham, Stephen; Dykewicz, Mark; El Gamal, Yehia; Emuzyte, Regina; Fink Wagner, Antje; Fiocchi, Alessandro; Forastiere, Francesco; Gamkrelidze, Amiran; Gemicioğlu, Bilun; Gereda, Jose E.; Gerth van Wijk, Roy; Gotua, Maia; Grisle, Ineta; Guzmán, M. Antonieta; Haahtela, Tari; Heinrich, Joachim; Hellquist Dahl, Birthe; Horak, Friedrich; Howarth, Peter H.; Humbert, Marc; Hyland, Michael; Ivancevich, Juan Carlos; Jares, Edgardo J.; Johnston, Sebastian L.; Jonquet, Olivier; Joos, Guy; Jung, Ki Suck; Just, Jocelyne; Jutel, Marek; Kaidashev, Igor P.; Khaitov, Musa; Kalayci, Omer; Kalyoncu, Fuat; Keith, Paul; Khaltaev, Nikolai; Kleine Tebbe, Jorg; Klimek, Ludger; N'Goran, Bernard Koffi; Kolek, Vitezlav; Koppelman, Gerard H.; Kowalski, Marek; Kull, Inger; Kvedariene, Violeta; Lambrecht, Bart; Lau, Susanne; Laune, Daniel; Le Thi Tuyet, Lan; Li, Jing; Lieberman, Phillipe; Lipworth, Brian J.; Renaud, Louis; Magard, Yves; Magnan, Antoine; Mahboub, Bassam; Majer, Ivan; Makela, Mika; Manning, Peter J.; Masjedi, Mohamad R.; Maurer, Marcus; Mavale Manuel, Sandra; Melén, Erik; Melo Gomes, Elisabete; Mercier, Jacques; Merk, Hans; Miculinic, Neven; Mihaltan, Florin; Milenkovic, Branislava; Mohammad, Yousser; Molimard, Mathieu; Momas, Isabelle; Montilla Santana, Anna; Morais Almeida, Mario; Mösges, Ralph; Nadif, Rachel; Namazova Baranova, Leyla; Neffen, Hugo; Nekam, Kristof; Neou, Angelos; Niggemann, Bodo; Nyembue, Dieudonné; O'Hehir, Robyn; Ohta, Ken; Okamoto, Yoshitaka; Okubo, Kim; Ouedraogo, Solange; Paggiaro, Pier Luigi; Pali Schöll, Isabella; Palmer, Stephen; Panzner, Petr; Papi, Alberto; Park, Hae Sim; Pavord, Ian; Pawankar, Ruby; Pfaar, Oliver; Picard, Robert; Pigearias, Bernard; Pin, Isabelle; Plavec, Davor; Pohl, Wolfgang; Popov, Todor; Postma, Dirkje S.; Potter, Paul; Poulsen, Lars K.; Rabe, Klaus F.; Raciborski, Filip; Pontal, Françoise Radier; Reitamo, Sakari; Repka Ramirez, Maria Susana; Robalo Cordeiro, Carlos; Roberts, Graham; Rodenas, Francisco; Rolland, Christine; Rodriguez, Miguel Roman; Romano, Antonino; Rosado Pinto, José; Rosario, Nelson A.; Rosenwasser, Larry; Rottem, Menachem; Sanchez Borges, Mario; Sastre Dominguez, Joaquim; Schmid Grendelmeier, Peter; Serrano, Eli; Simons, F. Estelle R.; Sisul, Juan Carlos; Skrindo, Ingebjorg; Smit, Henriette A.; Solé, Dirceu; Sooronbaev, Talant; Spranger, Otto; Stelmach, Rafael; Strandberg, Timo; Sunyer, Jordi; Thijs, Carel; Todo Bom, Ana Maria; Triggiani, Massimo; Valenta, Rudolf; Valero, Antonio L.; van Hage, Marianne; Vandenplas, Olivier; Vezzani, Giorgio; Vichyanond, Pakit; Viegi, Giovanni; Wagenmann, Martin; Wahn, Ulrich; De Yun, Wang; Williams, Denis; Wright, John; Yawn, Barbara P.; Yiallouros, Panayiotis; Yusuf, Osman M.; Zar, Heather J.; Zernotti, Mario; Zhang, Luo; Zhong, Nanshan; Zidarn, Mihaela
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