Allergic Rhinitis and its Impact on Asthma - ARIA

ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010
<strong>Allergic</strong> rhinitis represents a global health problem affecting 10 to 20% of the population (section
5.1.–5.2. in ARIA 2008 Update (2)). This is probably an underestimate, since many patients do not
recognise rhinitis as a disease <strong>and</strong> the prevalence is increasing (8-12). Although allergic rhinitis is
not usually a severe disease, it affects patients’ social life, school performance, <strong>and</strong> work
productivity (section 5.3.–5.7. in ARIA 2008 Update (2)).
<strong>Allergic</strong> rhinitis <strong>and</strong> asthma are linked by epidemiological, pathological, <strong>and</strong> physiological
characteristics <strong>and</strong> by a common therapeutic approach (13-17). They frequently coexist –
epidemiological studies suggest that asthma is found in as many as 15% to 38% of patients with
allergic rhinitis (13, 18, 19). Some studies estimate that nasal symptoms are present in at least 75%
of patients with asthma, but these estimates vary widely from 6% to 85% depending on the study
(13, 20-23).
For specific treatment of asthma, complications of allergic rhinitis or non-allergic rhinitis(e.g.
infectious rhinitis, chronic sinusitis, otitis media, <strong>and</strong> nasal polyps)clinicians should consult clinical
practice guidelines focusing on those diseases.
Several other conditions can cause symptoms similar to allergic rhinitis: viral <strong>and</strong> bacterial
infections, hormonal imbalance, exposure to physical agents, <strong>and</strong> other causes. <strong>Rhinitis</strong> may also be
a side effect of some drugs. Therefore, a detailed <strong>and</strong> correct diagnosis should be made before
selecting optimal treatment. These guidelines do not address the issues related to diagnosis of
allergic rhinitis <strong>and</strong> it is assumed that the correct diagnosis had been established before
commencing treatment.
How to use these guidelines
The ARIA guidelines are not intended to impose a st<strong>and</strong>ard of care for individual countries. They
should, as any guideline, provide a basis for rational decisions in the management of allergic rhinitis
to clinicians <strong>and</strong> their patients. Clinicians, patients, third-party payers, institutional review
committees, other stakeholders, or the courts should never view these recommendations as dictates.
Strong recommendations based on high quality evidence will apply to most patients for whom these
recommendations are made, but they may not apply to all patients in all circumstances. No
guidelines or recommendations can take into account all of the often-compelling unique features of
individual clinical circumstances. Therefore, nobody charged with evaluating clinicians’ actions
should attempt to apply the recommendations from these guidelines as rote or in a blanket fashion.
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