Allergic Rhinitis: Clinical Practice Guideline

Abstract

This guideline was compiled by members of a standing committee of the American Academy of Otolaryngic Allergy. The intent of this guideline is to provide practitioners, referring physicians, patients, third-party payers, and cognizant government authorities with the fundamental principles involved in the diagnosis and treatment of the patient with allergic rhinitis. Although developed solely through the American Academy of Otolaryngic Allergy, the statements and recommendations are drawn from the entire spectrum of English-speaking literature from the United States and Europe. Articles were independently reviewed by members of the Committee, many of whom sit on editorial review boards for major professional publications. A grading system was used to categorize individual articles to demonstrate the format used to arrive at conclusions. The grade is recorded at the end of each article reference. The grading scale follows: Grade A: A study involving prospective or well-selected retrospective patient populations. The conclusions drawn are well supported by the scientific work. Little controversy relating to these conclusions would be expected. Grade B: A scientific study executed without major flaws. Limitations may exist such that the conclusions drawn remain subject to controversy. Grade C: An anecdotal or case report study.

Inadequate Health Insurance Coverage: A Major Factor in Premature Discontinuation of Subcutaneous Immunotherapy for Allergic Rhinitis

“…Aft er meeting appropriate criteria, the patients with allergic rhinitis had been started on a specifi c subcutaneous immunotherapy program per published guidelines. [1][2][3] Th is program consisted of a maintenance vial and four 10-fold dilution vials for the initial buildup or escalation phase. Commonly, patients received two allergen injections, each containing a mixture of antigens.…”

“…Patients were required to stay in the offi ce for 25 to 30 minutes aft er receiving each injection. 1…”

The Importance of Glycerin‐Containing Negative Control Tests in Allergy Research Studies that Use Intradermal Skin Tests

“…The AAOA guidelines for IDT skin testing 8 specify the use of a positive histamine control, a negative control of phenol-saline, and negative dilution controls of glycerin at the same concentrations as each of the antigen-containing dilutions 9 . The guidelines also specify 10 that each IDT be made so as to create a 4-mm wheal that spreads to about 5 mm at 10 minutes.…”

Sublingual Immunotherapy: A Novel, Albeit Not so New, Immunotherapy Treatment Modality

“…They require both special considerations and careful informed consent before treatment is started. 56 The actual risk produced by ␤-blockade is unknown but may be of the same magnitude as the risk posed by asthma. 57 These patients could potentially be successfully treated with SLIT.…”