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Miniseminar Shares Clinical Practice Guideline on Allergic Rhinitis


Richard K. Gurgel, MD, helps present a sneak preview of a guideline on allergic rhinitis Monday morning.

A new guideline for the evaluation and treatment of allergic rhinitis was just submitted to Otolaryngology-Head and Neck Surgery last week. If accepted, it will be published in early 2015. However, Annual Meeting attendees were able to get a preview of the 14 new action statements Monday morning.

“There’s a significant cost associated with this condition,” said Seth R. Schwartz, MD, MPH, who moderated the session. “Allergic rhinitis is estimated to affect nearly one in every six Americans and generate somewhere between $2 billion and $5 billion in direct healthcare expenditures annually—and that doesn’t necessarily include the cost of over-the-counter medicines for treatment.”

Allergic rhinitis is a worldwide health problem that affects adults and children. In the United States, it is the 16th most common primary diagnosis for outpatient office visits. Large epidemiologic studies consistently show a significantly higher percentage of the population with rhinitis symptoms than those with rhinitis symptoms and positive allergy tests.

In the United States, during an eight-year time period ending in 2002, the prevalence of allergic rhinitis in 2,422 13- to 14-year-old children increased from 13 percent to 19 percent. These results illustrate that allergic rhinitis is both a common and growing global concern.

Panel members included Michael D. Seidman, MD; Sandra Y. Lin, MD; Richard K. Gurgel, MD; and James (Whit) Mims, MD. The guideline was developed using an explicit and transparent a priori protocol for creating actionable statements based on supporting evidence and the associated balance of benefit and harm.

The guideline development group included 20 panel members representing experts in otolaryngology, allergy and immunology, internal medicine, family medicine, pediatrics, sleep medicine, advanced practice nursing, complementary and alternative medicine (acupuncture and herbal therapies), and consumer advocacy.

The primary purpose of the guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with allergic rhinitis, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with allergic rhinitis. Children younger than 2 years old were excluded in this clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base.

The guideline is intended to focus on a select number of quality improvement opportunities deemed most important by the working group, and is not intended to be a comprehensive reference for diagnosing and managing allergic rhinitis. The recommendations outlined in the guideline are not intended to be an all-inclusive guide for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients.

The guideline is not intended to replace individualized patient care or clinical judgment. Its goal is to create a multidisciplinary guideline with a specific set of focused recommendations based upon an established and transparent process that considers levels of evidence, harm-benefit balance, and expert consensus to resolve gaps in evidence. These specific recommendations may then be used to develop performance measures and identify avenues for quality improvement.

“We’re not going to all agree about everything said here, but this is based upon facts and trials and that’s the important message to take home,” Dr. Seidman said.