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

G K Scadding, S R Durham, R Mirakian, N S Jones, S C Leech, S Farooque, D Ryan, S M Walker, A T Clark, T A Dixon, S R A Jolles, N Siddique, P Cullinan, P H Howarth, S M Nasser, British Society for Allergy and Clinical Immunology, G K Scadding, S R Durham, R Mirakian, N S Jones, S C Leech, S Farooque, D Ryan, S M Walker, A T Clark, T A Dixon, S R A Jolles, N Siddique, P Cullinan, P H Howarth, S M Nasser, British Society for Allergy and Clinical Immunology

Abstract

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.

Figures

Figure 1
Figure 1
Mechanism of allergic rhinitis. Sensitized patients with allergic rhinitis have IgE antibodies for specific allergen(s) bound to receptors on the surface of mast cells. On re‐exposure to the specific allergen(s), cross‐linking of adjacent IgE molecules occurs, and mast cell degranulation (rupture) takes place, releasing a variety of chemical mediators that may be preformed (e.g. histamine) or newly synthesized (e.g. leukotrienes, prostaglandins). These chemicals give rise to the typical immediate symptoms experienced by the patient. In many patients, there is also a late‐phase reaction in which T helper type 2 cytokines induce an eosinophilic inflammatory infiltrate, similar to that seen in asthma. This results in chronic, less obvious symptoms. GM, granulocyte macrophage; CSF, cerebrospinal fluid; PAF, platelet‐activating factor.
Figure 2
Figure 2
Classification of allergic rhinitis. Each box may be further sub‐classified into seasonal or perennial.
Figure 3
Figure 3
Algorithm for the treatment of rhinitis. *Spray or drops. OC, oral corticosteroids; α‐H1, antihistamines; LTRA, leukotriene receptor antagonist; Sx, symptoms; Rx, treatment; SPT, skin prick test.
Figure 4
Figure 4
(a) Correct procedure for the application of nasal sprays. (b) Correct procedure for the installation of nasal drops.

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