New Nasal Allergy Guidelines
New guidelines from ear, nose and throat doctors – the American Academy of Otolaryngology, Head and Neck Surgery – offer help to healthcare professionals who treat the 50 million people in the United States with allergies, as well as recommendations for patients.
The guidelines encourage patients to consult their physician for an accurate diagnosis and not tolerate burdensome symptoms. “What you think is allergies may be something else,” according to the guidelines. No sense toughing out symptoms or using the wrong kind of medicine for the wrong illness.
Control your symptoms and reduce medication by avoiding things you are allergic to and use allergy control products. When prevention is not enough, consult a board-certified allergist and discuss immunotherapy – either allergy shots or under-the-tongue allergy tablets. Or, consult a surgeon who can treat nasal airway blockage.
For healthcare providers:
Once the patient/physician connection is established, the otolaryngologists’ guidelines provide a clear roadmap for diagnosing, preventing and treating nasal allergies, with the following 12 recommendations:
• Patient History and Physical Examination: Clinicians should make a clinical diagnosis of allergic rhinitis when a patient’s medical history and physical exam are consistent with allergy and when symptoms include one or more of the following: nasal congestion, runny nose, itchy nose, or sneezing.
• Allergy Testing: Clinicians should perform and interpret (or refer to a clinician who can perform and interpret) specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy.
• Imaging: Clinicians should not routinely perform perform sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of allergic rhinitis.
• Environmental Factors: Clinicians may advise patients to avoid exposure to known allergens or use environmental controls to reduce exposure, when identified allergens correlate with clinical symptoms.
• Chronic Conditions: Clinicians should assess patients for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
• Topical Steroids: Clinicians should recommend corticosteroid nasal sprays for allergic rhinitis patients whose symptoms affect their quality of life.
• Oral Antihistamines: Clinicians should recommend oral second-generation/less sedating antihistamines for patients with primary complaints of sneezing and itching
• Intranasal Antihistamines: Clinicians may offer antihistamine nasal sprays for patients with seasonal, perennial, or episodic allergic rhinitis.
• Oral Leukotriene Receptor Antagonists (LTRAs): Clinicians should not offer LTRAs as primary therapy for patients with allergic rhinitis.
• Combination Therapy: Clinicians may offer a combination of medications for patients who have inadequate response to one medication alone.
• Immunotherapy: Clinicians should offer (or refer to a clinician who can offer) immunotherapy (sublingual tablets or subcutaneous shots) for patients who have inadequate response to symptoms with medication with or without environmental controls.
• Inferior Turbinate Reduction: Clinicians may offer (or refer to a surgeon who can offer) inferior turbinate reduction in patients with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.
• Acupuncture: Clinicians may offer (or refer to a clinician who can offer) acupuncture, for patients interested in nonpharmacologic therapy.
• Herbal Therapy: No recommendation regarding the use of herbal therapy for patients with allergic rhinitis.
“Clinical Practice Guideline: Allergic Rhinitis,” published in Otolaryngology – Head and Neck Surgery 2015, Volume 152, is available online for all to read: the full text and diagnostic tables for healthcare professionals and summarized information for patients.