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Rhinitis 2020: a Practice Parameter Update

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Rhinitis 2020: a Practice Parameter Update 1 1 Rhinitis 2020: A Practice Parameter Update 2 3 Authors: Dykewicz MS, Wallace DV, Amrol D, Baroody F, Bernstein J, Craig T, Dinakar C, Ellis A, Finegold I, Golden 4 DBK, Greenhawt M, Hagan J, Horner C, Khan DA, Lang D, Larenas-Linnemann D, Lieberman J, Meltzer E, 5 Oppenheimer J, Rank M, Shaker M, Shaw J, Steven G, Stukus D, Wang J 6 7 Chief Editor(s): Dykewicz MS and Wallace DV 8 Workgroup Contributors: Dykewicz MS, Wallace DV, Amrol D, Baroody F, Bernstein J, Craig T, Finegold I, Hagan J, 9 Larenas-Linnemann D, Meltzer E, Shaw J, Steven G 10 Joint Task Force on Practice Parameters Reviewers: Wallace DV, Golden DBK, Bernstein JA, Dinakar C, Ellis A, 11 Greenhawt M, Horner C, Khan DA, Lang D, Lieberman J, Oppenheimer J, Rank M, Shaker M, Stukus D, Wang J 12 13 Reprints: Joint Task Force on Practice Parameters (JTFPP) liaison: Peris Flagg (American Academy of Allergy, 14 Asthma, and Immunology, 555 E. Wells Street, Suite 1100, Milwaukee, WI 53202, [email protected]); 15 [email protected] 16 17 Previously published practice parameters and guidelines of the JTFPP are available at 18 http://www.allergyparameters.org.; http://www.AAAAI.org, and http://www.ACAAI.org. 19 20 Resolving conflict of interest: 21 The Joint Task Force on Practice Parameters (JTFPP) is committed to ensuring that all guidelines are based on the 22 best scientific evidence at the time of publication, and that such evidence is free of commercial bias to the greatest 23 extent possible. Before confirming the selection of the work group chairperson and members, the JTFPP discusses 24 and resolves all relevant potential conflicts of interest (COI) of each workgroup member. The JTFPP recognizes that 25 experts in a field are likely to have interests that could come into conflict with the development of a completely 26 unbiased and objective guideline. Therefore, a process has been developed to acknowledge potential COI when 27 making specific recommendations. To preserve the greatest transparency regarding potential COI, all members of 28 the JTFPP and workgroup complete a COI form prior to the development of each document and again prior to the 29 guideline submission for publication. 30 31 During the review process there are additional measures to avoid bias. At the workgroup level, all the 32 recommendations and discussion sections are reviewed by all workgroup members to ensure that content is 33 appropriate and without apparent bias. If any recommendation or section is deemed to have apparent bias, it is 34 appropriately revised, without the section author’s involvement, in an attempt to remove potential bias. In 35 addition, the entire document is also reviewed by the JTFPP and any apparent bias is acknowledged and removed 36 at that level. For each and every recommendation, a vote is required by the workgroup and JTFPP, and any 37 member with any perceived COI is recused from that vote (and so explained in the document). Any dissenting 38 votes that cannot be resolved are described and explained in the document. 39 40 In a final stage of review, the practice parameter is sent to invited expert reviewers for review, selected by the 41 American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and 42 Immunology (ACAAI). The document is also posted on the AAAAI and ACAAI websites for general membership and 43 the public-at-large to review and offer comment. All reviewers must provide statements of potential COI. Although 44 the JTFPP has the final responsibility for the content of the documents submitted for publication, each reviewer’s 45 comments will be discussed and reviewers will receive written responses to comments when appropriate. 46 47 The JTFPP members and work group members’ conflict of interest disclosure forms can be found at 48 www.allergyparameters.org. 49 50 Disclaimer: The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, 51 Asthma, and Immunology have jointly accepted responsibility for developing the Rhinitis 2019: A Practice 52 Parameter Update. The medical environment is rapidly changing, and not all recommendations will be appropriate 2 53 or applicable to all patients and may change over time. Because this document incorporates the efforts of many 54 participants, no single individual, including members serving on the JTFPP, is authorized to provide an official 55 AAAAI or ACAAI interpretation of this guideline. Any request for information or interpretation of this practice 56 parameter by the AAAAI or ACAAI should be directed to the executive offices of the AAAAI and the ACAAI. Practice 57 parameters and guidelines are not designed for use by the pharmaceutical industry in drug development or 58 promotion. The JTFPP understands that the cost of diagnostic tests and therapeutic interventions is an important 59 concern that may appropriately influence the evaluation and treatment selected for a given patient. The JTFPP 60 recognizes that the emphasis of our primary recommendations regarding a medication may vary, for example, 61 depending on third-party payer issues and product patent expiration dates. However, because a given test or a 62 therapeutic intervention’s cost is so widely variable, and there is a relative paucity of pharmacoeconomic data, the 63 JTFPP is not always able to consider cost when formulating recommendations. In extraordinary circumstances, 64 when the cost benefit of an intervention is prohibitive as supported by pharmacoeconomic data, commentary may 65 be provided. 66 67 Contributors: The JTFPP has made a concerted effort to acknowledge all contributors to this parameter. If any 68 contributors have been excluded inadvertently, the JTFPP will ensure that appropriate recognition is provided. 69 70 Key Words: Allergic rhinitis; Non-allergic rhinitis; Seasonal allergic rhinitis; Perennial allergic rhinitis; Vasomotor 71 rhinitis; Nasal polyps; Chronic rhinosinusitis; Local allergic rhinitis; Antihistamines; Corticosteroids; Ipratropium; 72 Antileukotriene; Allergen immunotherapy; decongestants; Chinese herbal medicine; NARES; Skin prick testing; sIgE 73 74 Abbreviations: AAAAI American Academy of Allergy, Asthma, and Immunology ACAAI American College of Allergy, Asthma, and Immunology ACE Angiotensin-converting enzyme AR Allergic rhinitis ARCT Allergic rhinitis control test AUC Area under the curve BENARS Blood eosinophilic non-allergic rhinitis CBS Consensus based statements CHM Chinese herbal medicine CNS Central nervous system CRSsNP Chronic rhinosinusitis without nasal polyps CRSwNP Chronic rhinosinusitis with nasal polyps CysLTs Cysteinyl leukotrienes DP Dermatophagoides pteronyssinus DSCG Disodium cromoglycate FDA Federal Drug Administration GINA Global Initiative for Asthma GRADE Grading of Recommendations, Assessment, Development and Evaluation HPA Hypothalamic–pituitary–adrenal ICRs Individual Case Safety Reports IgE Immunoglobulin E INAH Intranasal antihistamine INS Intranasal corticosteroids IR Irritant rhinitis JTFPP Joint Task Force on Practice Parameters kDa Kilodalton LAR Local allergic rhinitis LTRA(s) Leukotriene receptor antagonist(s) MASK Mobile Airways Sentinel network NAPT Nasal allergen provocation test 3 NAR Non-allergic rhinitis NARES Non-allergic rhinitis with eosinophilia syndrome OAS Oral allergy syndrome PA Pyrrolizidine alkaloids PAR Perennial allergic rhinitis PGA Physician’s global assessment PSE Pseudoephedrine QALY Quality-adjusted life-year QOL Quality of life RCAT Rhinitis control assessment test RCT Randomized controlled trial REM Rapid eye movement RQLQ Rhinitis Quality of Life Questionnaire RUDS Reactive upper airways dysfunction syndrome SAR Seasonal allergic rhinitis SCIT Subcutaneous allergy immunotherapy sIgE Specific IgE SLIT Sublingual immunotherapy TNSS Total nasal symptom score TRPV1 Transient receptor potential vanilloid 1 TSDDs Total standardized daily doses TVRSS Total vasomotor rhinitis symptom score VMR Vasomotor rhinitis WER Work exacerbated rhinitis 75 76 Corresponding Author: 77 Mark S. Dykewicz, MD 78 Raymond and Alberta Slavin Endowed Professor in Allergy & Immunology 79 Chief, Section of Allergy & Immunology; 80 Division of Infectious Diseases, Allergy and Immunology; Department of Internal Medicine 81 Director, Allergy & Immunology Fellowship Program 82 School of Medicine 83 1402 S. Grand Blvd, M157 84 St. Louis, MO 63104 85 Email: [email protected] 86 87 Introduction 88 The diagnosis of rhinitis is suggested by the presence of 1 or more of the following symptoms: 89 nasal congestion, rhinorrhea (anterior and posterior), sneezing, and itching. (1) Rhinitis can be 90 classified by etiology, as allergic or non-allergic and differentiated from conditions that have 91 overlapping symptoms of rhinitis. 92 93 Although the term rhinitis connotes inflammation, and allergic rhinitis (AR) and some types of 94 non-allergic rhinitis (NAR) are associated with inflammation, (e.g., non-allergic rhinitis with 95 eosinophilia syndrome (NARES), infectious rhinitis) some forms of NAR such as vasomotor 96 rhinitis or atrophic rhinitis may not be associated with inflammation of the nasal mucosa. 97 Rhinitis frequently is accompanied by symptoms involving the eyes, ears, and throat. Conditions 98 that have overlapping symptoms with rhinitis include rhinosinusitis w/wo nasal polyps, 99 cerebrospinal fluid rhinorrhea, ciliary dyskinesia syndrome, and structural/mechanical factors, 4 100 such as congenital anomalies, deviated septum and pharyngonasal reflux. Recognition of
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