Am Fam Physician. 2015 Nov 15;92(10):942-944.
Key Points for Practice
• Intranasal steroids and second-generation antihistamines (although less effective than intranasal steroids) are strongly recommended for patients whose symptoms interfere with their quality of life.
• Immunoglobulin E–specific skin or blood testing is recommended when treatment has been ineffective, a diagnosis of allergic rhinitis is uncertain, identification of a certain allergen could affect therapy, or to aid in titration of therapy.
• Combination therapies are an option when intranasal steroids alone do not control allergic symptoms.
From the AFP Editors
Allergic rhinitis is the fifth most common chronic disease in the United States and affects about one in six Americans. The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO–HNSF) has released a clinical practice guideline for the purpose of optimizing patient care, promoting effective diagnosis and therapy, and reducing harmful or unnecessary interventions in adults and children with allergic rhinitis.
Diagnosis and Treatment Recommendations
PATIENT HISTORY AND PHYSICAL EXAMINATION
A clinical diagnosis of allergic rhinitis should be made when a patient presents with one or more of the following allergic symptoms: nasal congestion, runny nose, itchy nose, sneezing, or red and watery eyes. It is important for physicians to be able to make an initial diagnosis because therapies for allergic rhinitis may be different from those for nonallergic rhinitis.
Immunoglobulin E–specific skin or blood testing is recommended when treatment (e.g., environmental controls, allergen avoidance, medical management) has been ineffective, a diagnosis of allergic rhinitis is uncertain, identification of a certain allergen could affect therapy, or to aid in titration of therapy. Physicians who cannot perform and interpret these tests should refer patients to a physician who is able to do so.
Use of routine diagnostic imaging is not recommended for patients with allergic rhinitis because there are no specific radiologic findings for confirming the diagnosis. The cost and possible adverse effects of imaging outweigh any usefulness. Patients with suspected allergic rhinitis should be diagnosed based
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2015 by the American Academy of Family Physicians.
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