New Guideline on Diagnosing, Treating Allergic Rhinitis

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Authors of a recently issued guideline note that allergic rhinitis (AR) is estimated to affect nearly one in every six Americans and generates $2 to $5 billion in direct health expenditures annually (Otolaryngol Head Neck Surg. 2015;152 [1 Suppl]:S1-S43). Physicians use many different diagnostic tests and treatments to manage this prevalent and costly condition, with considerable variation in results.

In an effort to optimize the care of patients with AR, the American Academy of Otolaryngology–Head and Neck Surgery organized a panel to create the guideline, “Clinical Practice Guideline: Allergic Rhinitis,” to address the most important quality improvement opportunities by evaluating the available evidence and assessing the harm-benefit balance of various diagnostic and management options. The document includes 14 recommendations that cover topics such as the value of obtaining a patient history and performing a physical examination, allergy testing and imaging, the use of environmental controls, pharmacological therapies, and alternative therapies such as acupuncture and herbal options (See “Summary of Guideline Action Statements,”).

Whit Mims, MD, associate professor of otolaryngology at Wake Forest University School of Medicine in Winston Salem, N.C., who served as a panel member for the guidelines, pointed out that, given the large number of studies related to AR, it’s not practical for one physician to sort through them individually. “We initially pulled 2,446 articles and identified 1,600 randomized controlled trials, which the committee combed through,” he said. “The guideline is a good way for practicing physicians to glean opportunities for better patient care that are supported by a large number of trials.” A variety of physicians who treat AR served on the panel, including representatives from the otolaryngology community, as well as family physicians, pediatricians, and physicians who practice complementary medicine. Consumer advocates also weighed in.

The guideline is applicable to both adult and pediatric patients with AR. However, children under age 2 years were excluded because AR may be different in this population than in older patients.

The Value of Patient History and Physical Examination

According to Sandra Lin, MD, an assistant chair of the panel, who is associate professor in the department of otolaryngology-head and neck surgery at Johns Hopkins School of Medicine in Baltimore, one key point in the guideline is that simply conducting a careful patient history and a physical examination may be all that’s needed to make an AR clinical diagnosis and prescribe treatment. “Some physicians may think that all patients need to have specific skin or blood tests to confirm AR and proceed with treatment,” she said. “But in straightforward cases, that’s not necessary. The guideline reviews what to look for as far as specific history items and physical findings that suggest AR.”