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AAO-HNSF clinical practice guideline: Allergic rhinitis

The American Academy of Otolaryngology–Head and Neck Surgery Foundation addresses quality improvement opportunities in the diagnosis and management of allergic rhinitis in a new multi-disciplinary, evidence-based clinical practice guideline, published in Otolaryngology-Head and Neck Surgery.

“Allergic rhinitis occurs when you inhale something that you’re allergic to, like pet dander or pollen, and then the inside lining of your nose becomes inflamed, resulting in congestion, runny nose, sneezing or itching,” explains Sandra Y. Lin, MD, one of the guideline’s authors. “It has a major impact in the U.S., affecting about 1 in every 6 Americans and generating an estimated $2 to $5 billion in expenditures each year.”

As the fifth most common chronic disease in the U.S., there has been considerable variation in the treatments used to manage allergic rhinitis. The guideline’s strongest recommendations are for topical steroids and oral antihistamines. A recommendation is also made on allergy-specific immunotherapy, which modifies how a patient’s immune system responds to allergens, an increasingly popular option given the FDA’s recent approval of under-the-tongue immunotherapy tablets.

“Most importantly, the guideline makes clear what should be and should not be the first lines of treatment for allergic rhinitis,” said Dr. Lin.

The clinical guideline for allergic rhinitis was created by a multi-disciplinary panel of experts in otolaryngology, allergy and immunology, internal medicine, family medicine, pediatrics, sleep medicine, advanced pediatric nursing, and complementary and integrative medicine.

AAO-HNSF Clinical Practice Guideline: Allergic Rhinitis

“Allergic rhinitis occurs when you inhale something that you’re allergic to, like pet dander or pollen, and then the inside lining of your nose becomes inflamed, resulting in congestion, runny nose, sneezing or itching. It has a major impact in the U.S., affecting about 1 in every 6 Americans and generating an estimated $2 to $5 billion in expenditures each year.” — Sandra Y. Lin, MD, guideline co-author

What is allergic rhinitis?

  • Allergic rhinitis, often called “hay fever,” is inflammation of the inside lining of the nose. It occurs in response to a person inhaling something to which he or she is allergic.
  • Allergic rhinitis is characterized by nasal congestion, drainage, sneezing and/or itching.
  • It is classified by its pattern of exposure to a triggering allergen, such as seasonal (pollen), perennial (dust), or episodic (pets); and by the frequency and severity of symptoms.

Why is the allergic rhinitis guideline important?

  • Allergic rhinitis is the fifth most common chronic disease in the United States overall, and the most common among children. It is estimated to affect 1 in every 6 Americans.
  • Allergic rhinitis generates an estimated $2 to $5 billion in direct health expenditures annually, and is responsible for as much as $2 to $4 billion in lost productivity annually.
  • In children, allergic rhinitis and its associated comorbidities are responsible for 800,000 to 2 million lost school days each year.

What is the purpose of the allergic rhinitis guideline?