New Guidelines for Allergic Rhinitis Released

Updated clinical guidelines on allergic rhinitis (AR) were recently published in Otolaryngology–Head and Neck Surgery, recommending that clinicians treat AR with intranasal steroids when patients' symptoms impair their quality of life. The guidelines also suggest that clinicians recommend second-generation oral antihistamines, which are less likely to cause drowsiness, for patients complaining primarily of sneezing and itching.

The guideline was comprised of a multidisciplinary panel of 21 experts who created a series of actionable statements based on available evidence in the hope of reducing wide variation that now exists in care and promoting effective diagnosis for children ≥2 years of age and adults.

The panel issued a "strong" recommendation for intranasal steroids and oral antihistamines as first-line treatment. However, clinicians should not offer oral leukotriene receptor antagonists as primary therapy for patients with AR, a recommendation that clinicians generally should follow while factoring in patient preferences. Nor should they routinely perform sinonasal imaging in patients with AR symptoms, which can subject people to "unnecessary radiation exposure." Clinicians can diagnose patients with AR on the basis of their history, a physical examination, and allergy testing.

Intranasal steroids are effective, superior to other therapies, improve quality of life, and have a targeted local effect, according to the authors of the guideline.

Second-generation oral antihistamines work quickly to tamp down symptoms and, because they are available over the counter and as generics, offer potential cost savings, according to the panel.

Clinicians should offer sublingual or subcutaneous immunotherapy for patients with AR who are not responding to pharmacologic therapy.

In its review of the available evidence, the panel identified a number of gaps and suggests additional research, including randomized, controlled trials to study the effect of environmental control strategies on AR and research into the safety and efficacy of allergen-specific immunotherapy and sublingual immunotherapy.

AR is the fifth most common chronic disease in the United States, affecting 1 in 6 of all Americans, and is the most common chronic disease among children. Medical treatment in the United States costs $2 to $5 billion, with more than half of that amount devoted to prescription medications. AR also accounts for as much as $2 to $4 billion in lost productivity annually, and an estimated 800,000 to 2 million lost school days.—Kerri Fitzgerald