BSACI guidelines for the management of allergic and non-allergic rhinitis

January 24, 2008 9:36 am

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC.Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

Introduction

Rhinitis significantly reduces quality of life (QOL) [1], interferes with both attendance and performance at school and work [2, 3] and results in substantial NHS costs [4]. The nose is the gateway to the respiratory tract and rhinitis is associated with symptoms arising from the sinuses [5], middle ear [6], the nasopharynx and lower airways [7].

Occupational rhinitis often precedes the development of occupational asthma. Both allergic rhinitis (AR) and non-AR are risk factors for the development of asthma [7]. Rhinosinusitis can also be the presenting complaint of potentially severe systemic disorders such as Wegener’s granulomatosis, sarcoidosis and Churg–Strauss syndrome [8]. Therefore, all patients presenting with nasal symptoms require appropriate treatment based on an accurate diagnosis. Separate British Society for Allergy and Clinical Immunology (BSACI) guidelines on rhino sinusitis and nasal polyposis will also be published.

These guidelines for the management of patients with rhinitis are intended for use by physicians treating allergic conditions. Evidence for the recommendations was obtained by using electronic literature searches using the primary key words – rhinitis and non-AR. Further searches were carried out by combining these search terms with allergy, asthma, immunotherapy, sublingual immunotherapy (SLIT), corticosteroid, antihistamine, anti-leukotriene, ipratropium bromide, decongestant, cromoglicate, cat, house dust mite (HDM), anti-IgE, child, pregnancy, lactation, surgery and aspirin. Each article was reviewed for suitability for inclusion in the guideline. The recommendations were evidence graded at the time of preparation of these guidelines. The grades of recommendation and the levels of evidence are defined as in our previous guideline on urticaria [9]. During the development of these guidelines, a web-based system was used to allow consultation with all BSACI members. The draft guidelines were amended by the Standards of Care Committee (SOCC) after careful consideration of all comments and suggestions. Where evidence was lacking, a consensus was reached among the experts on the committee. Conflicts of interests were recorded by the SOCC; none jeopardized unbiased guideline development.

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