The diagnosis and management of rhinitis: An updated practice parameter - 12/08/11

Doi : 10.1016/j.jaci.2008.06.003

Dana V. Wallace, MD : Chief Editor, Mark S. Dykewicz, MD : Chief Editor, David I. Bernstein, MD : Co-Editor, Joann Blessing-Moore, MD : Co-Editor, Linda Cox, MD : Co-Editor, David A. Khan, MD : Co-Editor, David M. Lang, MD : Co-Editor, Richard A. Nicklas, MD : Co-Editor, John Oppenheimer, MD : Co-Editor, Jay M. Portnoy, MD : Co-Editor, Christopher C. Randolph, MD : Co-Editor, Diane Schuller, MD : Co-Editor, Sheldon L. Spector, MD : Co-Editor, Stephen A. Tilles, MD : Co-Editor

Abstract

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “The diagnosis and Management of Rhinitis: An Updated Practice Parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

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Plan

Contributors

Chief editor—joint task force

Chief editor—parameter workgroup chair

Task force reviewers

Assigned reviewers

Parameter workgroup members

Preface [summary statements 8, 9, 13]

Components and organization of this parameter

Abbreviations

Collation of summary statements

Definition and classification of rhinitis

Differential diagnosis of rhinitis and associated conditions

Burden and epidemiology of rhinitis

Allergic rhinitis

Nonallergic rhinitis syndromes

Conditions that mimic rhinitis

Evaluation and diagnostic studies

Management of rhinitis

Executive summary

Definition of rhinitis [Summary Statement 1]

Classification and differential diagnosis of rhinitis and associated conditions [Summary Statements 2-7]

Conditions that mimic rhinitis

Evaluation and diagnostic studies in patients with rhinitis

Management of rhinitis

Annotations

Box 1: Patient presents with symptoms of rhinitis ()

Box 2: Is history and examination suggestive of allergic rhinitis?

Box 3: Therapeutic trial for allergic rhinitis symptoms

Box 4: Therapeutic trial for nonallergic rhinitis symptoms

Box 5: Does the patient respond?

Box 6: Further follow-up, meets consultation criteria?

Box 7: Consultation with an allergist/immunologist

Box 8: Does patient have an allergic basis for rhinitis?

Box 9: Management of allergic rhinitis

Box 10: Management of nonallergic rhinitis

Box 11: Cooperative follow-up

Disclosure of potential conflict of interest: D. V. Wallace is on the speakers’ bureau for Schering-Plough, Aventis, Pfizer, and Merck and is on the advisory board for AstraZeneca. M. S. Dykewicz has consulting arrangements with AstraZeneca, GlaxoSmithKline, McNeil, Medpointe/Meda, Merck, Novartis/Genentech, Schering-Plough, and Teva; has received research support from AstraZeneca, GlaxoSmithKline, Novartis/Genentech, and Schering-Plough; and is on the speakers’ bureau for AstraZeneca, GlaxoSmithKline, and Merck. D. I. Bernstein has research contracts with GlaxoSmithKline, AstraZeneca, Schering-Plough, Novartis, and Greer; is on the speakers’ bureau for Sanofi and Teva; and is on the advisory panel for Schering-Plough. J. Blessing-Moore has received research support from AstraZeneca and Novartis and is on the speakers’ bureau for Schering-Plough, Merck, AstraZeneca, Teva, Novartis-Genentech, and Sepracor. L. Cox has consulting arrangements with Stallergenes, Greer, Novartis/Genentech, Planet Technology, and Schering-Plough and is on the speakers’ bureau for Novartis/Genentech and AstraZeneca. D. A. Khan has received research support from AstraZeneca and is on the speakers’ bureau for Merck and GlaxoSmithKline. D. M. Lang has consulting arrangements with, has received research support from, and is on the speakers’ bureau for GlaxoSmithKline, AstraZeneca, Sanofi-Aventis, Merck, Novartis/Genentech, Venus, Dey, and Schering-Plough. J. Oppenheimer has consulting arrangements with, has received research support from, and is on the speakers’ bureau for AstraZeneca, GlaxoSmithKline, Sepracor, Apeiron, Merck, and Schering-Plough. J. M. Portnoy has consulting arrangements with GlaxoSmithKline, Sanofi-Aventis, and Greer; has received research support from Clorox; and is on the speakers’ bureau for Merck, Schering-Plough, Sanofi-Aventis, AstraZeneca, and GlaxoSmithKline. S. L. Spector has consulting arrangements with Merck, Novartis, Genentech, Critical Therapeutics, and AstraZeneca; has received research support from Merck, Genentech, Schering-Plough, and AstraZeneca; and is on the speakers’ bureau for Merck, Novartis, Genentech, Critical Therapeutics, Schering-Plough, and AstraZeneca. S. A. Tilles has consulting arrangements with GlaxoSmith-Kline and Schering-Plough and has received research support from Meda, Alcon, and Schering-Plough. F. Baroody has consulting arrangements with GlaxoSmithKline; has received research support from GlaxoSmithKline and Alcon; and is on the speakers’ bureau for Merck and GlaxoSmithKline. G. Rachelefsky has consulting arrangements with AstraZeneca, Schering-Plough, Merck, and Medpoint and is on the speakers’ bureau for AstraZeneca, Schering-Plough, Merck, Medpoint, and Genentech. R. Settipane has consulting arrangements with GlaxoSmithKline and Alcon; has received research support from Alcon, Medpoint, GlaxoSmithKline, and Schering-Plough; and is on the speakers’ bureau for Sanofi-Aventis, UCB, AstraZeneca, GlaxoSmithKline, Alcon, and Genentech. D. Skoner has consulting arrangements with Merck; has received research support from AstraZeneca, Sanofi-Aventis, GlaxoSmithKline, Novartis, Merck, and Greer Laboratories; and is on the speakers’ bureau for AstraZeneca, Sanofi-Aventis, GlaxoSmithKline, Merck, Schering-Plough, and Novartis. S. Stoloff has consulting arrangements with GlaxoSmithKline, AstraZeneca, Alcon, Schering-Plough, Novartis, Genentech, Aventis, Teva, and Dey; is on the speakers’ bureau for GlaxoSmithKline and AstraZeneca; and has served as an expert witness for GlaxoSmithKline. The other authors have declared that they have no conflict of interest.

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