xRead - September 2022

Wise et al.

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should leverage these capabilities to better understand the epidemiology of AR. Research opportunities include: • Improved understanding of the incidence and prevalence of AR and its phenotypes (ie, SAR, PAR, IAR, PER) worldwide. • Improved understanding of AR variation by geographic region, patient age, and sex. • Evaluation of climate change and its effect on the pattern and degree of allergen exposure. Our understanding of the risk factors for the development of AR should also be improved. While certain areas (ie, early childhood exposure to pets as a risk factor vs protective factor) have seen numerous articles published, the data is highly conflicting. In other areas, such as early exposure to pollens and mites, the data is more limited. Genetic studies provide some notable evidence for potential AR risk but functional data needs to be expanded. Research opportunities include: • Understanding the role of candidate gene alterations in the pathophysiology of AR via functional characterization. • Investigation of epigenetic mechanisms to provide a functional explanation between gene-environment interactions and AR disease development. • Improved understanding of environmental exposures as a risk/protective factor for AR disease development, especially in diverse geographic locations. • Further study of the role of pollutants and tobacco smoke in the development of AR and in the severity of allergic rhinitis symptoms. • Greater elucidation of the environmental risk factors and protective factors for AR, particularly exposure to pets, HDM, and breastfeeding. • Longitudinal study evaluating risk factor reduction and its effect on the incidence of AR. Evaluation of the patient with suspected AR classically relies on a thorough history, often reinforced by findings on physical examination. The diagnosis is further supported with skin or in vitro testing methods. These techniques have been rather dependable, provided objective testing is correlated to the patient’s clinical symptoms and not used in isolation to determine a treatment plan, as there are distinct differences between sensitization and clinical allergy. As newer testing methods gain their footing, we have the opportunity to bring them to widespread clinical practice with solid supporting evidence. Research opportunities include: • Improved characterization of newer testing techniques (ie, nasal sIgE, BAT) in larger populations to provide standardization for incorporation into mainstream clinical practice. • Need for comparative studies for IDT and single-dilution intradermal testing.

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XI.B. Evaluation and diagnosis

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.