xRead - September 2022

Wise et al.

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rhinitis; rhinosinusitis; risk factor; saline; seasonal; sensitization; sinusitis; sleep; socioeconomic; specific IgE; subcutaneous immunotherapy; sublingual immunotherapy; systematic review; rhinitis; total IgE; transcutaneous immunotherapy; validated survey

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I. Introduction

The available literature on allergic rhinitis (AR) grows more quickly with each passing decade. A search of “allergic rhinitis” in the PubMed database yielded 4135 articles published between 1945 and 1979. The next 20 years (1980-2000) saw 7064 AR articles published. Each subsequent decade has surpassed this number with 8143 AR articles published between 2000 and 2010, and 8212 published from 2010 to the present day. Like many other areas of medicine, a close look at the available literature demonstrates a wide variation in the type and quality of AR publications, ranging from case reports to meta analyses, review articles to randomized controlled trials (RCTs), and large prospective studies to small retrospective case series. As a medical professional reads the literature or hears literature quoted by others, it is important that he/she understand the quality of the evidence in order to appropriately translate the findings and recommendations into daily clinical care of the AR patient. With such vast AR literature available, developing an appropriate understanding of the relevant evidence can be daunting. This International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) was developed to summarize the best external evidence relating to AR, with the goal of gathering and critically reviewing the available literature on AR epidemiology, risk factors, diagnosis, management, and associated conditions/comorbidities. More than 100 international authors from various specialties utilized a structured review process to evaluate the evidence related to AR. Initial topic development and writing by a primary author or team of authors, followed by a stepwise anonymous iterative review process for over 100 AR topics held this process to extremely high standards. The resulting document provides a strong review of the existing AR literature. The recommendations for AR diagnostic modalities and treatment contained herein rely directly on this evidence, with a clear delineation of the benefit, harm, and cost considerations that supported each recommendation level. Like the 2016 International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS) by Orlandi et al., 1 this ICAR:AR document places high value on the strength of the evidence in making recommendations. Therefore, for example, expert opinion receives lower value (Table II.A-1). There are limitations, however. Like ICAR:RS, this document is not a clinical practice guideline (CPG) or a meta-analysis. This document summarizes the findings of meta-analyses and other systematic reviews when those are identified in the literature for a specific AR topic area. However, a meta-analysis was not performed on the data included in this document. In addition, much of the available AR literature is not appropriate for meta-analysis due to its heterogeneous nature and inconsistent methodologies. ICAR:AR is also not a CPG, as the typical steps of a CPG (ie, medical specialty society and patient advocate review) were not employed here.

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