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

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Published in final edited form as: Int Forum Allergy Rhinol . 2018 February ; 8(2): 108–352. doi:10.1002/alr.22073.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

A full list of authors and affiliations appears at the end of the article.

Abstract Background: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). Methods: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. Results: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. Conclusion: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding. Keywords allergen extract; allergy; allergen immunotherapy; allergic rhinitis; antihistamine; asthma; atopic dermatitis; avoidance; biologic; cockroach; conjunctivitis; consensus; corticosteroid; cough; cromolyn; decongestant; eosinophilic esophagitis; environment; epicutaneous immunotherapy; epidemiology; evidence-based medicine; food allergy; genetics; house dust mite; IgE; immunoglobulin E; immunotherapy; inhalant allergy; leukotriene; microbiome; occupational rhinitis; omalizumab; pathophysiology; perennial; pet dander; pollen; probiotic; quality of life; Correspondence to: Sarah K. Wise, MD, MSCR, Emory University, Department of Otolaryngology-Head and Neck Surgery, 550 Peachtree Street, MOT 11th Floor, Atlanta, GA 30308; skmille@emory.edu. Additional Supporting Information may be found in the online version of this article. The American Academy of Otolaryngic Allergy Foundation provided funding for administrative support in preparation of this document but exercised no control over its content. Potential conflicts of interest: See the Appendix at the end of this article.