Joint Practice Parameters on the Management of Allergic Rhinitis

Abstract

Introduction Allergic rhinitis is a common disease entity that may be easily misdiagnosed and mistreated. It is a global concern, affecting 10% to 25% of the population worldwide, that has to be controlled since it can be disabling affecting the quality of life of patients. The Philippine Society of OtolaryngologyHead and Neck Surgery is currently updating its 2006 guideline on Allergic Rhinitis. The Section of Rhinology, Department of Otorhinolaryngology together with the Section of Allergy and Immunology, Departments of Pediatrics and Internal Medicine, came up with practice parameters in the diagnosis and management of adult and pediatric patients suspected to have allergic rhinitis to guide clinicians in managing these patients. Locally, it is the first collaboration of otorhinolaryngologists and allergists. Scope of the Guideline This practice parameter was developed to guide general physicians, otorhinolaryngologists and allergists in the diagnosis and management of adult and pediatric patients with allergic rhinitis in an ambulatory care setting. Objectives This guideline aims to (1) assist general physicians, otorhinolaryngologists and allergists diagnose true allergic rhinitis; (2) evaluate current techniques and practices in diagnosing allergic rhinitis; and (3) describe treatment and management options for allergic rhinitis. Development process The Section of Rhinology of the Department of Otorhinolaryngology and Section of Allergy and Immunology of the Departments of Pediatrics and Internal Medicine of the UP-Philippine General Hospital convened a working group to create a consensus document to be used primarily for the Allergic Rhinitis Clinic, a joint clinic of the aforementioned sections in the Out-Patient Department of the UP-PGH, and to serve as a guide to general physicians, otorhinolaryngologists and allergists. The working group agreed to come up with an algorithm for the diagnosis and management of a patient with allergic rhinitis. Clinical questions were subsequently formulated based on the algorithm. The members then searched for relevant literature (including clinical practice guidelines, systematic reviews) in the National Library of Medicine’s PubMed database, Herdin database and unpublished local articles on allergic rhinitis. Appraisal of literature was done by an epidemiologist and evidence was presented and discussed within the working group. Applicability and availability of the diagnostic tests and therapeutic interventions were considered. All materials were assessed for relevance and further classified according to levels of evidence and grades of evidence based on guidelines. Recommendations were based on nominal approval of the working group. The document was then presented to stakeholders--consultants and residents of four clinical departments (Family Medicine, Internal Medicine, Otorhinolaryngology, Pediatrics), medical interns, medical students, nurses and patients. The opinions of the stakeholders were considered in the final draft.