A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023.

Sarah K Wise, Cecelia Damask, Matthew Greenhawt, John Oppenheimer, Lauren T Roland, Marcus S Shaker, Dana V Wallace, David M Lang

Journal: The journal of allergy and clinical immunology. In practice 2023;11(3):773-796

PMID: 36894277

Full Text on Elsevier Science View on PubMed

Abstract

An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.

Address: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Ga.; Department of Otolaryngology, University of Central Florida, Orlando, Fla.; Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.; Department of Internal Medicine, Pulmonary and Allergy, University of Medicine and Dentistry of New Jersey, Pulmonary and Allergy Associates, Morristown, NJ.; Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Washington University in St Louis School of Medicine, St Louis, Mo.; Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.; Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla.; Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio. Electronic address: [email protected].

DOI: 10.1016/j.jaip.2023.01.007

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MeSH Terms: Humans, Child, Iron-Dextran Complex, Rhinitis, Allergic, Histamine Antagonists, Allergens, Adrenal Cortex Hormones