Allergies: Clinical guidance and practice resources
Comprehensive resources to help diagnose and treat the allergies most often seen in family medicine
Allergic conditions are common, often chronic, and a frequent reason for visits in primary care. Family physicians play a central role in the recognition, diagnosis, and longitudinal management of allergic disease, including distinguishing allergic conditions from other causes of respiratory, dermatologic, and systemic symptoms. This hub provides evidence-based clinical guidance and patient education resources to support family physicians in managing common allergic conditions, coordinating care, and referring to allergy specialists when appropriate.
Guidelines and recommendations
Clinical practice guideline
(Endorsed 2014) (Reaffirmed, April 2020)
The guideline, Allergic Rhinitis, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and was endorsed by the American Academy of Family Physicians (AAFP).
The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose or sneezing.
Individuals with AR should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
Specific Immunoglobulin E (IgE) testing (blood or skin) should be performed for patients with a clinical diagnosis of AR who do not respond to empiric treatment, when diagnosis is uncertain, or when determination of specific target allergen is needed.
Sino nasal imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
Intranasal steroids should be prescribed for patients with AR whose symptoms affect quality of life.
Oral second-generation/less sedating antihistamines should be prescribed for patients with AR and primary complaints of sneezing and itching.
Intranasal antihistamines may be prescribed for patients with seasonal, perennial or episodic AR.
Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
Combination pharmacologic therapy may be prescribed for patients with AR who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
Immunotherapy should be prescribed for patients with AR who have inadequate response to pharmacologic therapy.
Avoidance of known allergens or environmental control may be considered in patients with AR who have identified allergens that correlate with their clinical symptoms.
Inferior turbinate reduction may be considered for patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.
See the full recommendation for more details, including a treatment flow chart and specific pharmacologic options.
Clinical preventive service recommendations
The U.S. Preventive Services Task Force (USPSTF) reviewed the evidence on the accuracy of screening in asymptomatic adults, adolescents and children; the potential benefits and harms of screening vs. not screening and targeted vs. universal screening; and the benefits and harms of treatment of screen-detected celiac disease.
The USPSTF found inadequate evidence on the accuracy of screening for celiac disease, the potential benefits and harms of screening vs. not screening or targeted vs. universal screening and the potential benefits and harms of treatment of screen-detected celiac disease.
Food allergy management
Food allergies represent a significant public health concern, affecting millions of individuals worldwide. Globally, food allergies affect approximately 220 to 250 million people, including 33 million in the United States. Certain populations, including children, people with lower household incomes and people from racial and ethnic minority groups are disproportionately impacted by food allergies.
Family physicians are often the first point of contact for patients with suspected food allergies and are integral in allergy management through early detection, education, treatment and referrals to specialists. While epinephrine and avoidance strategies remain critical, the development of new medications that prevent anaphylaxis may offer better protection and a higher quality of life for those affected. Ongoing research and increased access to treatments are essential to address the disparities in care and improve outcomes for all populations.
This section features excerpts from the "Talking to Your Patients About IgE-Mediated Food Allergy: A Conversation Guide," which includes resources that help you deliver equitable, patient-centered care for your patients with food allergies.
Read the unabridged conversation guide.
Symptoms of IgE-mediated food allergic reactions
IgE-mediated food allergic reactions are associated with a variety of symptoms that can affect the cutaneous, digestive, respiratory and cardiovascular systems and typically appear within a few minutes to two hours after a food allergen is ingested.
Management of IgE-mediated food allergy
You can empower patients by providing clear guidance on distinguishing a food allergy from a food intolerance, reading food labels, communicating effectively in restaurants and planning for emergencies. In addition, addressing your patients’ health literacy is essential to support safe, informed decision-making.
Effective food allergy management requires a comprehensive approach that includes advising patients to avoid specific foods, planning for emergencies and considering available treatment options. Living with a food allergy—or taking care of someone who has one—can be very stressful, so it is also important to address the psychological needs of patients and their caregivers.
Dietary management
- Allergen avoidance
- Consumption of safe foods
- Individualized dietary advice
Psychological support
- Coping strategies
- Cognitive behavioral therapy
Treatment plan
- Emergency medications
- Written treatment plan with emergency contacts
- Training on how to use an adrenaline auto-injector (AAI)
Immunomodulatory treatments
- Omalizumab
- Allergen-specific immunotherapy:
- Peanut: oral immunotherapy (OIT), sublingual immunotherapy (SLIT) or epicutaneous immunotherapy (EPIT)
- Egg: OIT
- Milk: OIT
Patient education
The AAFP patient education website FamilyDoctor.org provides many patient-facing resources.