Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today?

Abstract

State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment. This group with so-called severe chronic upper airway disease (SCUAD) represents a therapeutic challenge. The concept of control of disease has only recently been introduced in the field of AR and CRS. In case of poor control of symptoms despite guideline-directed pharmacotherapy, one needs to consider the presence of SCUAD but also treatment-related, diagnosis-related and/or patient-related factors. Treatment-related issues of uncontrolled upper airway disease are linked with the correct choice of treatment and route of administration, symptom-oriented treatment and the evaluation of the need for immunotherapy in allergic patients. The diagnosis of AR and CRS should be reconsidered in case of uncontrolled disease, excluding concomitant anatomic nasal deformities, global airway dysfunction and systemic diseases. Patient-related issues responsible for the lack of control in chronic upper airway inflammation are often but not always linked with adherence to the prescribed medication and education. This review is an initiative taken by the ENT section of the EAACI in conjunction with ARIA and EPOS experts who felt the need to provide a comprehensive overview of the current state of the art of control in upper airway inflammation and stressing the unmet needs in this domain.

A Clinicopathological Study of Allergic Rhinitis

“…This is consistent with studies of Sheldon [3] where 21% of allergic children are found to have OME. The association between AR, recurrent otitis media, and OME is consistent with a unified airway model in atopic patients [10].…”

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

“…Although the majority of patients present with controlled symptoms during pharmacologic treatment, 10-20% are still uncontrolled and should be characterized as suffering from severe chronic upper airway disease (SCUAD) (15). Patients with SCUAD have impaired quality of life, sleep, school and/or work performance (16,17).…”

Expression of cysteinyl leukotriene receptor GPR17 in eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyps

“…15,16 Nevertheless, even with corticosteroid therapy and surgical intervention, more than 10% of severe CRSwNP patients show corticosteroid resistance. 17 There has been much research into the immunologic basis of CRSwNP with the aim of identifying more targeted pharmacologic therapies. Recent studies have shown increased levels of cysLTs and their receptors localized to nasal polyps.…”