The diagnosis and management of rhinitis: An updated practice parameter

Wallace, Dana; Dykewicz, Mark S.; Bernstein, David I.; Blessing-Moore, Joann; Cox, Linda; Khan, David A.; Lang, David M.; Nicklas, Richard A.; Oppenheimer, John; Portnoy, Jay M.; Randolph, Christopher; Schuller, Diane E.; Spector, Sheldon L.; Tilles, Stephen A.

doi:10.1016/j.jaci.2008.06.003

Cited by 932 publications

(1,022 citation statements)

References 887 publications

(1,250 reference statements)

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“…Inclusion criteria specified that children (1) were between the ages of 7 and 9 (the narrow age range allows for an indepth understanding of the larger study's hypothesized associations during the school-age years, when this age group begins to be more independent with self-management behaviors), (2) resided and went to school in one of the four targeted districts, (3) had a primary caregiver fluent in English or Spanish, (4) had a physician diagnosis of asthma according to caregiver and healthcare provider report, or (5) met criteria for persistent asthma. Specifically, participants had to have an asthma controller medication prescribed and/ or have daytime asthma symptoms greater than 2 days a week, nocturnal asthma symptoms greater than 2 times a month, short-acting beta-agonist use greater than 2 days a week, at least minor limitation in normal activity, and/or 2 or more oral steroid bursts per year.…”

Section: Patientsmentioning

confidence: 99%

“…A llergic rhinitis (AR) affects up to 40% of children in the United States, 1 with an annual economic burden estimated at $11.58 billion, of which $4.28 billion stems from indirect costs related to lost work productivity and school absenteeism. 2,3 Most patients with asthma also have rhinitis, while 10-40% of patients with rhinitis have comorbid asthma.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] AR practice guidelines highlight the need for allergy evaluation when rhinitis symptoms are persistent, moderate or severe, or impact quality of life. 1,9 Guidelines also recommend the integration of AR treatment in the management of asthma 1,4,[9][10][11] and highlight intranasal steroids as the optimal medication class for controlling AR symptoms. 1,4 Data presented here are part of a larger study, Project NAPS (Nocturnal Asthma and Performance in School), a multimethod longitudinal study of urban children with asthma investigating links between asthma, rhinitis, sleep, and school performance during one academic year in children at high risk for frequent emergency department (ED) visits and hospitalizations for asthma.…”

Section: Introductionmentioning

confidence: 99%

“…Herein we report the extent to which AR was diagnosed and treated by urban healthcare providers in this sample of urban school-aged children with persistent asthma symptoms, specifically (1) proportion of children who met criteria for AR, (2) proportion whose caregivers reported no previous diagnosis of their child's allergies, (3) This work was performed at Rhode Island Hospital, Providence, Rhode Island. Divisions of 1 Pediatric Allergy and Immunology, 2 Child and Adolescent Psychiatry, and caregivers' and healthcare providers' perceptions of child's allergic status, compared with the study assessment of allergic status, and (4) proportion of children with AR who were undertreated or lacked treatment for the condition. Finally, we compared self-report of asthma control in participants with well-controlled versus poorly controlled AR over a 4-week period following the study clinic session.…”

Section: Introductionmentioning

confidence: 99%

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Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

Esteban

Klein

Kopel

et al. 2014

Pediatric Allergy, Immunology, and Pulmonology

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Allergic rhinitis (AR) is a risk factor for the development of asthma, and if poorly controlled, it may exacerbate asthma. We sought to describe AR symptoms and treatment in a larger study about asthma, sleep, and school performance. We examined the proportion (1) who met criteria for AR in an urban sample of school children with persistent asthma symptoms, (2) whose caregivers stated that they were not told of their child's allergies, (3) who had AR but were not treated or were undertreated for the disease, as well as (4) caregivers and healthcare providers' perceptions of the child's allergy status compared with study assessment, and (5) associations between self-report of asthma and AR control over a 4-week monitoring period. One hundred sixty-six children with persistent asthma participated in a clinical evaluation of asthma and rhinitis, including allergy testing. Self-report of asthma control and rhinitis control using the Childhood Asthma Control Test (C-ACT) and Rhinitis Control Assessment Test (RCAT) were measured 1 month after the study clinic session. Persistent rhinitis symptoms were reported by 72% of participants; 54% of rhinitis symptoms were moderate in severity, though only 33% of the sample received adequate treatment. AR was newly diagnosed for 53% during the clinic evaluation. Only 15% reported using intranasal steroids. Participants with poorly controlled AR had poorer asthma control compared with those with well-controlled AR. This sample of urban school-aged children with persistent asthma had underdiagnosed and undertreated AR. Healthcare providers and caregivers in urban settings need additional education about the role of allergies in asthma, recognition of AR symptoms, and AR's essential function in the comanagement of asthma. Barriers to linkages with allergy specialists need to be identified.

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Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

Esteban

Klein

Kopel

et al. 2014

Pediatric Allergy, Immunology, and Pulmonology

View full text Add to dashboard Cite

show abstract

“…55 Guidelines provide evidence-based recommendations to inform the management of allergic rhinitis under the headings 'allergen avoidance', 'pharmacological treatment', and 'specific immunotherapy'. 55,[109][110][111] Allergen avoidance can be effective for reducing the symptoms of allergic rhinitis, [112][113][114][115] though single interventions may be insufficient to control symptoms. 116 Non pharmacological measures with some efficacy include saline douches, 55,117-120 rhinophototherapy, 121 nasal filters, 122 pollen-blocker creams, 123 or cellulose powder.…”

Section: Managementmentioning

confidence: 99%