Allergic and Nonallergic Rhinitis Guideline Updates From BSACI

The British Society of Allergy and Clinical Immunology (BSACI) has updated its guidelines on allergic rhinitis (AR) and nonallergic rhinitis (NAR) for adults and children, reports Clinical & Experimental Allergy.¹

The new guidelines are the result of extensive EMBASE and MEDLINE searches from 2007 to 2014, as well as individual searches by committee members. The update includes a compendium of differential diagnoses, comorbid conditions, and algorithms for treatment, as well as a patient-friendly diagram for the proper use of nasal sprays for maximum effectiveness.

 

The guidelines emphasize the importance of diagnosing and treating AR and NAR, which affect up to 15% of children and 26% of adults in the United Kingdom, as the condition does have profound effects in terms of school and work performance.^2,3

In the decade since it last published guidelines,⁴ the BSACI has highlighted some significant changes:

Evidence for local AR, which is also referred to as entopy. This recent classification of rhinitis involves nasal production of specific IgE antibodies in patients with NAR who do not have atopy.

Combined topical antihistamines and intranasal corticosteroids are now preferred to single-agent formulations for moderate to severe AR. Combination therapy is recommended for those whose AR or NAR is not controlled with monotherapy. Newer intranasal corticosteroid formulations are safe for children and for long-term therapy.

Rhinitis control is recognized as beneficial for asthma. Both AR and NAR are considered risk factors for new-onset asthma. Rhinitis symptoms are found in up to 81% of patients with asthma.

Severe chronic upper airways disease now refers to uncontrolled AR symptoms despite guideline-recommended treatment. More than 18% of patients with AR have severe chronic upper airways disease.

More robust evidence for sublingual immunotherapy includes adult and pediatric randomized trials for AR caused by grass pollen, ragweed, and dust mites. Immunotherapy is most effective when the offending allergen is identified.

The BSACI guidelines offer timely guidance, as the American Academy of Allergy, Asthma & Immunology has not updated its rhinitis guidelines since 2008.⁵

References

1. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007) [published online July 7, 2017]. Clin Exp Allergy. doi: 10.1111/cea.12953
2. Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007;120(2):381-387. doi: 10.1016/j.jaci.2007.03.034
3. Blaiss MS. Cognitive, social, and economic costs of allergic rhinitis. Allergy Asthma Proc. 2000;21(1):7-13.
4. Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy. 2008;38(1):19-42. doi: 10.1111/j.1365-2222.2007.02888.x
5. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol. 2008;122(2 suppl):S1-84. doi: 10.1016/j.jaci.2008.06.003