Turkish Guidelines for Diagnosis and Treatment of Allergic Rhinitis (ART)

Abstract

Object: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Allergic Rhinitis and Depression: Profile and Proposal

“…Based on the baseline number of 500 million AR patients globally and the minimum incidence of depression of 20% among these patients, literally at least 100 million patients with depression secondary to AR need help. Thirdly, no guidelines on the depression in AR have been available in any country, except that montelukast may trigger depression as a very rare side effect, which was most frequently mentioned ( 17 , 18 ). Thus, we define and classify the roles of depression in AR, which may enhance the awareness of depression in AR among medical staff and promote the development of guidelines for diversified treatment protocols, thus achieving the precise treatment of depressed AR patients.…”

“…Two major factors are involved in the depression caused by AR treatment: (a) excessive concern about the side effects of the treatments; in particular, about 66% of AR patients developed depressive symptoms after long-term use of glucocorticoids ( 27 ); and (b) depression caused by the medication itself. Although the risk of depression associated with montelukast use has been mentioned in several guidelines ( 17 , 18 ), the incidence of depression in such AR patients using montelukast is roughly negligible. Nevertheless, assessment before medication and monitoring during drug administration are essential in some special and sensitive populations.…”

Allergic rhinitis in children: a comprehensive approach to treatment

“…Несмотря на то что ответ на него остается пока отрицательным, сама постановка вопроса подчеркивает высокую актуальность информации о диагностике и терапии этого заболевания для врачей самого широкого круга специальностей, не только аллергологов-иммунологов и оториноларингологов [3]. В международных и отечественных рекомендациях по АР подчеркивается необходимость вовлечения в постановку диагноза, выбор и коррекцию терапии АР в первую очередь врачей семейной медицины, участковых педиатров и терапевтов [1,4,5].…”

“…Известно, что риск поведенческих нарушений у детей прямо связан с длительностью периодов обострений АР [9,11]. Для прогноза течения заболевания в целом, а также риска осложнений имеет значение не только тяжесть, но и длительность периодов обострений, и быстрота начала экстренной терапии [1,4,5,12].…”

“…Актуальные международные и российские согласительные документы обращают внимание на то, что значительная часть исследований по АР проведена среди взрослых пациентов [9,13]. Формирование на их основе клинических рекомендаций, ориентированных на педиатрическую практику, может быть затруднено и/или недостаточно обоснованно; потребность в наблюдениях АР у детей в условиях реальной клинической практики высока [4,13]. Актуальны сравнительные характеристики триггеров обострений АР у пациентов разных возрастных групп, а также пациентов с разным спектром сенсибилизации.…”