The diagnosis and management of rhinitis: An updated practice parameter Chief Editors: Dana V. Wallace, MD, and Mark S. Dykewicz, MD Co-Editors: David I. Bernstein, MD, Joann Blessing-Moore, MD, Linda Cox, MD, David A. Khan, MD, David M. Lang, MD, Richard A. Nicklas, MD, John Oppenheimer, MD, Jay M. Portnoy, MD, Christopher C. Randolph, MD, Diane Schuller, MD, Sheldon L. Spector, MD, and Stephen A. Tilles, MD These parameters were developed by the Joint Task Force on Practice 3. Practice parameters for the diagnosis and management of Parameters, representing the American Academy of Allergy, Asthma & immunodeficiency. Ann Allergy 1996;76:282-94. Immunology; the American College of Allergy, Asthma and Immunology; 4. Practice parameters for allergen immunotherapy. J Allergy and the Joint Council of Allergy, Asthma and Immunology. Clin Immunol 1996;98:1001-11. 5. Disease management of atopic dermatitis: a practice param- The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have eter. Ann Allergy 1997;79:197-211. jointly accepted responsibility for establishing ‘‘The diagnosis and 6. The diagnosis and management of anaphylaxis. J Allergy Management of Rhinitis: An Updated Practice Parameter.’’ This is a Clin Immunol 1998;101(suppl):S465-S528. complete and comprehensive document at the current time. The medical 7. Algorithm for the diagnosis and management of asthma: a environment is a changing environment, and not all recommendations will practice parameter update. Ann Allergy 1998;81:415-20. be appropriate for all patients. Because this document incorporated the 8. Diagnosis and management of rhinitis: parameter docu- efforts of many participants, no single individual, including those who ments of the Joint Task Force on Practice Parameters in served on the Joint Task Force, is authorized to provide an official AAAAI Allergy, Asthma and Immunology. Ann Allergy 1998; or ACAAI interpretation of these practice parameters. Any request for 81(suppl):S463-S518. information about or an interpretation of these practice parameters by the 9. Parameters for the diagnosis and management of sinusitis. J AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Allergy Clin Immunol 1998;102(suppl):S107-S144. Immunology. These parameters are not designed for use by 10. Stinging insect hypersensitivity: a practice parameter. J Al- pharmaceutical companies in drug promotion. lergy Clin Immunol 1999;103:963-80. 11. Disease management of drug hypersensitivity: a practice pa- Published practice parameters of the Joint Task Force on rameter. Ann Allergy 1999;83(suppl):S665-S700. Practice Parameters for Allergy and Immunology include 12. Diagnosis and management of urticaria: a practice parame- the following: ter. Ann Allergy 2000;85(suppl):S521-S544. 1. Practice parameters for the diagnosis and treatment of 13. Allergen immunotherapy: a practice parameter. Ann Allergy asthma. J Allergy Clin Immunol 1995;96(suppl):S707-S870. 2003;90(suppl):S1-S540. 2. Practice parameters for allergy diagnostic testing. Ann Al- 14. Symptom severity assessment of allergic rhinitis, part I. Ann lergy 1995;75:543-625. Allergy 2003;91:105-14. Disclosure of potential conflict of interest: D. V. Wallace is on the speakers’ bureau for speakers’ bureau for Merck, Novartis, Genentech, Critical Therapeutics, Schering- Schering-Plough, Aventis, Pfizer, and Merck and is on the advisory board for Plough, and AstraZeneca. S. A. Tilles has consulting arrangements with GlaxoSmith- AstraZeneca. M. S. Dykewicz has consulting arrangements with AstraZeneca, Glaxo- Kline and Schering-Plough and has received research support from Meda, Alcon, and SmithKline, McNeil, Medpointe/Meda, Merck, Novartis/Genentech, Schering- Schering-Plough. F. Baroody has consulting arrangements with GlaxoSmithKline; has Plough, and Teva; has received research support from AstraZeneca, GlaxoSmithKline, received research support from GlaxoSmithKline and Alcon; and is on the speakers’ Novartis/Genentech, and Schering-Plough; and is on the speakers’ bureau for AstraZe- bureau for Merck and GlaxoSmithKline. G. Rachelefsky has consulting arrangements neca, GlaxoSmithKline, and Merck. D. I. Bernstein has research contracts with Glaxo- with AstraZeneca, Schering-Plough, Merck, and Medpoint and is on the speakers’ bu- SmithKline, AstraZeneca, Schering-Plough, Novartis, and Greer; is on the speakers’ reau for AstraZeneca, Schering-Plough, Merck, Medpoint, and Genentech. R. Setti- bureau for Sanofi and Teva; and is on the advisory panel for Schering-Plough. J. Bless- pane has consulting arrangements with GlaxoSmithKline and Alcon; has received ing-Moore has received research support from AstraZeneca and Novartis and is on the research support from Alcon, Medpoint, GlaxoSmithKline, and Schering-Plough; speakers’ bureau for Schering-Plough, Merck, AstraZeneca, Teva, Novartis-Genen- and is on the speakers’ bureau for Sanofi-Aventis, UCB, AstraZeneca, GlaxoSmith- tech, and Sepracor. L. Cox has consulting arrangements with Stallergenes, Greer, No- Kline, Alcon, and Genentech. D. Skoner has consulting arrangements with Merck; vartis/Genentech, Planet Technology, and Schering-Plough and is on the speakers’ has received research support from AstraZeneca, Sanofi-Aventis, GlaxoSmithKline, bureau for Novartis/Genentech and AstraZeneca. D. A. Khan has received research Novartis, Merck, and Greer Laboratories; and is on the speakers’ bureau for Astra- support from AstraZeneca and is on the speakers’ bureau for Merck and GlaxoSmith- Zeneca, Sanofi-Aventis, GlaxoSmithKline, Merck, Schering-Plough, and Novartis. Kline. D. M. Lang has consulting arrangements with, has received research support S. Stoloff has consulting arrangements with GlaxoSmithKline, AstraZeneca, Alcon, from, and is on the speakers’ bureau for GlaxoSmithKline, AstraZeneca, Sanofi-Aven- Schering-Plough, Novartis, Genentech, Aventis, Teva, and Dey; is on the speakers’ tis, Merck, Novartis/Genentech, Venus, Dey, and Schering-Plough. J. Oppenheimer bureau for GlaxoSmithKline and AstraZeneca; and has served as an expert witness has consulting arrangements with, has received research support from, and is on the for GlaxoSmithKline. The other authors have declared that they have no conflict of speakers’ bureau for AstraZeneca, GlaxoSmithKline, Sepracor, Apeiron, Merck, interest. and Schering-Plough. J. M. Portnoy has consulting arrangements with Glaxo- Reprint requests: Joint Council of Allergy, Asthma and Immunology, 50 N Brockway St, SmithKline, Sanofi-Aventis, and Greer; has received research support from Clorox; #3-3, Palatine, IL 60067. and is on the speakers’ bureau for Merck, Schering-Plough, Sanofi-Aventis, AstraZe- J Allergy Clin Immunol 2008;122:S1-84. neca, and GlaxoSmithKline. S. L. Spector has consulting arrangements with Merck, 0091-6749/$34.00 Novartis, Genentech, Critical Therapeutics, and AstraZeneca; has received research Ó 2008 American Academy of Allergy, Asthma & Immunology support from Merck, Genentech, Schering-Plough, and AstraZeneca; and is on the doi:10.1016/j.jaci.2008.06.003 S1 S2 Wallace et al J ALLERGY CLIN IMMUNOL AUGUST 2008 15. Disease management of atopic dermatitis: an updated prac- Stanford University Medical Center tice parameter. Ann Allergy 2004;93(suppl):S1-S21. Department of Immunology 16. Stinging insect hypersensitivity: a practice parameter up- Palo Alto, Calif date. J Allergy Clin Immunol 2004;114;4:869-86. Linda Cox, MD 17. The diagnosis and management of anaphylaxis: an updated Assistant Clinical Professor of Medicine practice parameter. J Allergy Clin Immunol 2005;115(suppl): Nova Southeastern University College of Osteopathic Medicine S483-S523. Davie, Fla 18. Practice parameter for the diagnosis and management of pri- David A. Khan, MD mary immunodeficiency. Ann Allergy 2005;94(suppl):S1-S63. Associate Professor of Internal Medicine 19. Attaining optimal asthma control: a practice parameter. J Al- University of Texas Southwestern Medical Center lergy Clin Immunol 2005;116(suppl):S3-S11. Dallas, Tex 20. The diagnosis and management of sinusitis: a practice pa- David M. Lang, MD rameter update. J Allergy Clin Immunol 2006;116(suppl): Head, Allergy/Immunology Section S13-S47. Division of Medicine 21. Food allergy: a practice parameter. Ann Allergy 2006; Director, Allergy and Immunology Fellowship Training 96(suppl):S1-S68. Program 22. Contact dermatitis: a practice parameter. Ann Allergy 2006; Cleveland Clinic Foundation 97(suppl):S1-S37. Cleveland, Ohio 23. Allergen immunotherapy: a practice parameter second up- Richard A. Nicklas, MD date. J Allergy Clin Immunol 2007;120(suppl):S25-S85. Clinical Professor of Medicine 24. Allergy diagnostic testing: an updated practice parameter. George Washington Medical Center Ann Allergy 2008;100(suppl):S1-S148. Washington, DC John Oppenheimer, MD These parameters are also available on the internet at http:// Department of Internal Medicine www.jcaai.org. New Jersey Medical School Pulmonary and Allergy Associates CONTRIBUTORS Morristown, NJ The Joint Task Force has made a concerted effort to acknowl- Jay M. Portnoy, MD edge all contributors to this parameter. If any contributors have Chief, Section of Allergy, Asthma and Immunology been excluded inadvertently, the Task Force will ensure that Children’s Mercy Hospital appropriate recognition of such contributions is made Professor of Pediatrics subsequently. University of Missouri–Kansas City School of Medicine