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SummaryThis guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

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CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection. (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases.Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven.Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis.The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.

The effects of rhinosinusitis treatment upon asthma are disputed.The first randomised prospective study of surgical compared with medical therapy of chronic rhinosinusitis in 90 patients with and without nasal polyps was previously reported. Asthma symptoms, control, forced expiratory volume in one second (FEV1), peak flow, exhaled nitric oxide, medication use and hospitalisation at 6 and 12 months from the start of the study were also monitored. This paper reports these results in 43 of those patients with concomitant asthma.Both medical and surgical treatment of chronic rhinosinusitis were associated with subjective and objective improvements in asthma. Overall asthma control improved significantly following both treatment modalities, but was better maintained after medical therapy, where improvement could also be demonstrated in the subgroup with nasal polyps. Medicine was superior to surgery with respect to a decrease in exhaled nitric oxide and increase in FEV1 in the polyp patients. Two patients noted worsening of asthma post-operatively.Improvement in upper airway symptoms, as assessed using a visual analogue scale, correlated with improvement in asthma symptoms and control. Treatment of chronic rhinosinusitis, medical or surgical, benefits concomitant asthma; that associated with nasal polyposis benefits more from medical therapy.KEYWORDS: Asthma, chronic rhinosinusitis, endoscopic sinus surgery, exhaled nitric oxide, forced expiratory volume in one second, nasal polyps R hinosinusitis coexisted with asthma in 34% of patients in one study [1]. Radiological studies have shown abnormal sinus radiographs in 53% [2,3] and mucosal thickening on sinus computed tomography (CT) scans in 74% [4] of patients with asthma. Recently, .84% of CT scans were found to be abnormal in severe asthma, with a correlation between the extent of CT changes, sputum eosinophilia and pulmonary function [5].A number of authors have investigated the effect of surgical treatment of rhinosinusitis upon asthma, with improvement [6-8], worsening [9, 10] and equivocal effect [11,12] being reported. Only two studies of medical chronic rhinosinusitis (CRS) treatment exist, one included four medical patients [13], whereas the other considered CRS with polyposis alone and was nonrandomised [14]. MATERIALS AND METHODSPatients were recruited over 2 yrs from the Rhinology Clinics of the Royal National Throat, Nose and Ear Hospital (London, UK). The study was approved by the Ethics Committee of the Royal Free Hospital (London, UK). After application of exclusion criteria, the study was discussed with 327 consecutive patients with a primary diagnosis of CRS. Of these, 90 patients who agreed to the process of randomisation were finally included and were randomised equally into the medical and surgical groups. The study design and flow chart showing the course of the study are presented in figures 1 and 2, respectively. Diagnosis of CRS was based on the criteria described by the Staging and Therapy Group [15]. The criteria for diagnosis of...