GUIDELINES

ARIA ALLERGIC RHINITIS AND
ITS IMPACT ON ASTHMA

ARIA Guidelines - 2016 Revision

In patients with seasonal allergic rhinitis, it's suggested either a combination of an intranasal corticosteroid with an oral H₁- antihistamine or an intranasal corticosteroid alone.¹

• This is a conditional recommendation; thus, different choices will be appropriate for different patients. A combination therapy may be a reasonable choice, especially in patients who are not well controlled with INCS alone, those with pronounced ocular symptoms or those commencing treatment because of likely faster onset of treatment effects.¹

^{This recommendation concerns regular use of newer, less sedative OAH and INCS in seasonal AR.¹}

^{ARIA: Allergic Rhinitis and its Impact on Asthma; OAH: oral antihistamines; INCS: intranasal corticosteroids}

^{Reference:

1- Brożek JL, Bousquet J, Agache I, et.al., Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision.

J Allergy Clin Immunol. 2017 Oct;140(4):950-958. doi: 10.1016/j.jaci.2017.03.050. Epub 2017 Jun 8. PMID: 28602936.}

EUFOREA
EUROPEAN FORUM FOR
RESEARCH AND EDUCATION
IN ALLERGY AND AIRWAY
DISEASES

EUFOREA Treatment Algorithm for Allergic Rhinitis

Oral non sedating Antihistamines are recommended for AR patients presenting with rhinorrhea/itchy nose.¹

Oral antihistamines are often used as first line therapy in patients with rhinitis symptoms. The use of these H1 receptor antagonists had long been limited due to sedating side effects; however, the newer second-generation drugs are extremely safe and efficacious with far less sedation. Oral non-sedating antihistamines are most beneficial for the suppression of nasal pruritus, sneezing, rhinorrhea, and accompanying ocular symptoms.²

^{AR: allergic rhinitis.}
^{Reference:

1. https://www.euforea.eu/news/euforea-treatment-algorithm-allergic-rhinitis

2. Sullivan, A. A., Kushnir, N. M., Scarupa, M. D., Chase, C., Kaliner, M. A., & Faaaai, M. (2020). In‐Depth Review of Allergic Rhinitis. World Allergy Organization.}

BSACI
THE BRITISH SOCIETY FOR
ALLERGY & CLINICAL
IMMUNOLOGY

BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017)

Oral antihistamines are considered the first-line therapy for mild-to-moderate intermittent and mild persistent rhinitis.
Use of first-generation antihistamines is not recommended.

First-generation antihistamines are less useful due to sedation and cognitive impairment, which can worsen driving and examination results already impaired by rhinitis.

^{BSACI: The British Society for Allergy & Clinical Immunology.}
^{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). Clin Exp Allergy. 2017;47(7):856-889. doi:10.1111/cea.12953}

AMERICAN ACADEMY OF
OTOLARYNGOLOGY-
HEAD AND NECK SURGERY

AAO-HNSF

Clinicians should recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching (Strong recommendation).
Advantages of oral antihistamines include rapid onset of action, once-daily dosing, maintenance of effectiveness with regular use, and the availability of some drugs without a prescription.

Maximum benefit is seen with continuous use but use on an as-needed basis can provide significant symptom relief and is appropriate for some patients, especially those with intermittent symptoms.

^{AAO-HNSF: American Academy of Otolaryngology Head and Neck Surgery; INS: intranasal steroid; AR: allergic rhinitis.}
^{Reference:

1. Seidman MD, Gurgel RK, Lin SY, et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery. 2015;152(1_suppl):S1-S43. doi:10.1177/0194599814561600.}

ACAAI:

American college of Allergy,
Asthma and Immunology

AAAAI/ACAAI Allergy Practice Parameters

Recommend against prescribing a first-generation antihistamine and are in favor of a second-generation antihistamine.
Strength of recommendation: strong, Certainty of evidence: High Selecting a second-generation antihistamine reduces the potential side effects including sedation, performance impairment, poor sleep quality, and anticholinergic-mediated symptoms (eg, dry eyes, dry mouth, constipation, urinary hesitancy, and retention) that have been associated with the first-generation antihistamines.

^{AAAAI: American Academy of Allergy, Asthma and Immunology; ACAAI: American College of Allergy, Asthma and Immunology; AR: allergic rhinitis.}
^{Reference:

1. Dykewicz MS, Wallace DV, et.al., Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-767. doi: 10.1016/j.jaci.2020.07.007. Epub 2020 Jul 22. PMID: 32707227.}

PUBLICATIONS

1. EAACI guidelines: Anaphylaxis (2021 update)

2. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update)

3. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis..

4. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis – A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement

5. Allergic Rhinitis in Childhood and the New EUFOREA Algorithm

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