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Wise et al.

Page 165

• Further study of the role of single intradermal testing after a negative prick test. • Development of standardized testing and interpretation of testing for LAR, as well as further defining the clinical utility of testing. • Further elucidation of clinical uses for CRD in patient management. • Need for international consensus on allergen units in antigen standardization. There are several options for management of the AR patient. Allergen avoidance and EC strategies are often discussed, yet high-level evidence is frequently lacking, especially as it relates to AR symptom control. Many pharmacotherapy options have very high LOEs, which is helpful as we strive to choose the best drug options to control patient symptoms. SCIT and SLIT also have very high LOEs in general, yet specific issues related to AIT management could be bolstered with additional evidence. Research opportunities include: • Improved understanding of the impact of EC strategies on AR symptom control and rescue medication use, especially for cockroach, pet, and pollen allergens. • Improved understanding of the polyallergic AR patient and appropriate AIT regimens in this population. • Improved understanding and characterization of ILIT for possible routine clinical application. • Further study of comparative efficacy/effectiveness of SLIT vs SCIT. • Further study of AIT with multiple allergens. • Improved understanding of cost effective management for optimal AR control and the use of multimodality therapy, including combinations of pharmacotherapy and AIT. • Further study of the comparative effectiveness of various AR treatments. The evidence supporting an association between AR and numerous other conditions is weak or conflicting. There is clearly a need to better define the relationship between AR and several of the comorbidities identified in this document (especially rhinosinusitis, otitis media with effusion, cough, laryngeal disease, and eosinophilic esophagitis), and to further delineate the role that AR treatment has for potential improvement of associated conditions.

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XI.C. Management

XI.D. Associated conditions

XII. Conclusion

In summary, the authors of ICAR:AR have worked to collate the best external evidence for various aspects of AR, providing evidence grades and recommendations where appropriate. From this evidence, knowledge gaps and research opportunities have been identified. It is our sincere hope that the ICAR:AR document will be a reference for understanding the current AR evidence and a springboard for future investigation.

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

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