Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
New Guidelines on Allergic Rhinitis & Impact on Asthma
J Allergy Clin Immunol; ePub 2017 Jun 8; Brožek, et al
The 2016 Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines provide a targeted update and new recommendations about the pharmacological treatment of allergic rhinitis (AR). The guidelines were last revised in 2010. The ARIA guideline panel provides specific recommendations for the choice of treatment, the rationale for the choice, and discusses specific considerations that clinicians may want to review in order to choose the management most appropriate for an individual patient. Among the recommendations:
- For patients with seasonal AR, either a combination of an intranasal corticosteroid with an oral H1- antihistamine or an intranasal corticosteroid alone is recommended.
- In patients with perennial allergic rhinitis, an intranasal corticosteroid alone rather than a combination of an intranasal corticosteroid with an oral H1- antihistamine is recommended.
- In patients with seasonal AR or perennial AR, either a combination of an intranasal corticosteroid with an intranasal H1-antihistamine or an intranasal corticosteroid alone is recommended.
- In patients with seasonal AR, a combination of an intranasal corticosteroid with an intranasal H1-antihistamine rather than an intranasal H1-antihistamine alone is recommended.
- In seasonal AR, a leukotriene receptor antagonist or an oral H1-antihistamine is recommended; however, in perennial AR, an oral H1-antihistaimine is preferred over leukotriene receptor antagonist.
- In both seasonal AR and perennial AR, intranasal corticosteroid is recommended over intranasal H1-antihistamine.
- In both seasonal AR and perennial AR, either intranasal or oral H1-antihistamine is recommended.
Brožek JL, Bousquet J, Agache I, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines – 2016 revision. [Published online ahead of print June 8, 2017]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2017.03.050.
Allergic rhinitis is characterized by nasal itching, a dripping nose, and congestion, as well as itchy, runny eyes. It affects about 25% of the population and although it does not carry with it the morbidity that some other illnesses do, it is associated with decreased quality of life, impaired sleep, irritability, and fatigue as well as decreased school and work performance.1 In addition, uncontrolled AR can make asthma more difficult to manage.2 These evidence-based guidelines essentially recommend intranasal corticosteroids as the base of treatment due to the efficacy of intranasal steroids, with intranasal antihistamines, oral antihistamines, and leukotriene receptor antagonists recommended as alternatives or as add-on treatment for additional efficacy. —Neil Skolnik, MD