BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; First edition 2007)

Abstract

This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.

Does allergy explain why some children have severe asthma?

“…50 • Management of coexisting food allergy including avoidance advice, personal management plan for allergic reactions and access to self-injectable adrenaline. 50 • Management of coexisting food allergy including avoidance advice, personal management plan for allergic reactions and access to self-injectable adrenaline.…”

“…19 The recommended first-line treatment of moderate-severe persistent AR in children is intranasal corticosteroid, if necessary with oral second-generation nonsedating or intranasal antihistamines, and saline nasal washes. 33,34,49,50 Oral leukotriene receptor antagonists may be considered where symptoms persist. 33,49 Observational studies have suggested that intranasal corticosteroid use improves asthma control in children, consistent with clinical trials in adults, but no randomized controlled trials looking at the effects of treatment of AR on asthma control in children were identified.…”

Nasal cytology: a Precision Medicine tool in clinical practice

“…The diagnosis is based on typical symptoms, negative allergy assessment and of course documentation of eosinophil infiltrate >10% of total cells . As accurately pointed out by the BSACI guideline, most NARES patients may develop aspirine‐sensitive asthma and also nasal polyps . Successively, it was reported a NARES variant, characterized by the concomitant presence of eosinophil and mast cell infiltrate: the so‐called NARESMA (non‐allergic rhinitis with eosinophils and mast cells), distinguished by more severe symptoms than NARES .…”

“…1 As accurately pointed out by the BSACI guideline, most NARES patients may develop aspirine-sensitive asthma and also nasal polyps. 2,3 Successively, it was reported a NARES variant, characterized by the concomitant presence of eosinophil and mast cell infiltrate: the so-called NAR-ESMA (non-allergic rhinitis with eosinophils and mast cells), distinguished by more severe symptoms than NARES. 4 Other phenotypes of inflammatory NAR are the NARNE (with predominant neutrophilic infiltrate) type and NARMA (with predominant mast cell infiltrate) type.…”

“…2 However, the BSACI guideline states that these techniques have not been standardized, nor have the criteria for evaluating cell counts. 2 In particular, the cited reference seems to be dated and concerns AR alone. 7 So, we would remind a recent Review on this topic published in this Journal.…”