BSACI guidelines for the management of allergic and non‐allergic rhinitis

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Summary

This guidance for the management of patients with allergic and non‐allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web‐based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co‐morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

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Most cited references 228

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Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

S Johnston, P Pattemore, G. Sanderson … (1995)

To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. 108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. Southampton and surrounding community. Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. Viruses were detected in 80% of reported episodes of reduced peak expiratory flow, 80% of reported episodes of wheeze, and in 85% of reported episodes of upper respiratory symptoms, cough, wheeze, and a fall in peak expiratory flow. The median duration of reported falls in peak expiratory flow was 14 days, and the median maximum fall in peak expiratory flow was 81 l/min. The most commonly identified virus type was rhinovirus. This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.

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Long-term clinical efficacy of grass-pollen immunotherapy.

S. R. Durham, S Walker, E. M. Varga … (1999)

Pollen immunotherapy is effective in selected patients with IgE-mediated seasonal allergic rhinitis, although it is questionable whether there is long-term benefit after the discontinuation of treatment. We conducted a randomized, double-blind, placebo-controlled trial of the discontinuation of immunotherapy for grass-pollen allergy in patients in whom three to four years of this treatment had previously been shown to be effective. During the three years of this trial, primary outcome measures were scores for seasonal symptoms and the use of rescue medication. Objective measures included the immediate conjunctival response and the immediate and late skin responses to allergen challenge. Cutaneous-biopsy specimens obtained 24 hours after intradermal allergen challenge were examined for T-cell infiltration and the presence of cytokine-producing T helper cells (TH2 cells) (as evidenced by the presence of interleukin-4 messenger RNA). A matched group of patients with hay fever who had not received immunotherapy was followed as a control for the natural course of the disease. Scores for seasonal symptoms and the use of rescue antiallergic medication, which included short courses of prednisolone, remained low after the discontinuation of immunotherapy, and there was no significant difference between patients who continued immunotherapy and those who discontinued it. Symptom scores in both treatment groups (median areas under the curve in 1995, 921 for continuation of immunotherapy and 504 for discontinuation of immunotherapy; P=0.60) were markedly lower than those in the group that had not received immunotherapy (median value in 1995, 2863). Although there was a tendency for immediate sensitivity to allergen to return late after discontinuation, there was a sustained reduction in the late skin response and associated CD3+ T-cell infiltration and interleukin-4 messenger RNA expression. Immunotherapy for grass-pollen allergy for three to four years induces prolonged clinical remission accompanied by a persistent alteration in immunologic reactivity.

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Rhinovirus upper respiratory infection increases airway hyperreactivity and late asthmatic reactions.

Jason Busse, R Vrtis, Luke C. Swenson … (1988)

Although viral upper respiratory infections (URIs) provoke wheezing in many asthma patients, the effect of these illnesses on the airway response to inhaled antigen is not established. The following study evaluated the effect of an experimental rhinovirus (RV) illness on airway reactivity and response to antigen in 10 adult ragweed allergic rhinitis patients. Preinfection studies included measurements of airway reactivity to histamine and ragweed antigen. Furthermore, the patients were also evaluated for late asthmatic reactions (LARs) to antigen (a 15% decrease in forced expiratory volume of the first second approximately 6 h after antigen challenge). 1 mo after baseline studies, the patients were intranasally inoculated with live RV16. All 10 patients were infected as evidenced by rhinovirus recovery in nasal washings and respiratory symptoms. Baseline FEV1 values were stable throughout the study. During the acute RV illness, there was a significant increase in airway reactivity to both histamine and ragweed antigen (P = 0.019 and 0.014, respectively). Before RV inoculation, only 1 of the 10 subjects had an LAR after antigen challenge. However, during the acute RV illness, 8 of 10 patients had an LAR (P less than 0.0085 compared with baseline); the development of LARs was independent of changes in airway reactivity and the intensity of the immediate response to antigen. Therefore, we found that not only does a RV respiratory tract illness enhance airway reactivity, but it also predisposes the allergic patient to develop LARs, which may be an important factor in virus-induced bronchial hyperresponsiveness.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Exp Allergy

Journal ID (iso-abbrev): Clin. Exp. Allergy

Journal ID (doi): 10.1111/(ISSN)1365-2222

Journal ID (publisher-id): CEA

Title: Clinical and Experimental Allergy

Publisher: Blackwell Publishing Ltd (Oxford, UK )

ISSN (Print): 0954-7894

ISSN (Electronic): 1365-2222

Publication date (Electronic): 07 December 2007

Publication date (Print): January 2008

Volume: 38

Issue: 1 ( doiID: 10.1111/cea.2008.38.issue-1 )

Pages: 19-42

Affiliations

[ ¹ ]The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK,

[ ² ]Department of Upper Respiratory Medicine, Imperial College NHLI, Guy Scadding Building, Royal Brompton Campus, London, UK,

[ ³ ]Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK,

[ ⁴ ]Department of Otorhinolaryngology‐Head & Neck Surgery, Queens Medical Centre, Nottingham, UK,

[ ⁵ ]Department of Child Health, Kings College Hospital, Denmark Hill, London, UK,

[ ⁶ ]Department of Asthma, Allergy & Respiratory Medicine, Guy's Hospital, London, UK,

[ ⁷ ]Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK,

[ ⁸ ]Education For Health, The Athenaeum, Warwick, UK,

[ ⁹ ]Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK,

[ ¹⁰ ]Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK,

[ ¹¹ ]Department of respiratory medicine, Southampton General Hospital, Southampton, UK,

[ ¹² ]Department of Occupational and Environmental Medicine, Imperial College, London, UK and

[ ¹³ ]Southampton General Hospital, Southampton UK

Author notes

[*] Correspondence:  Dr S. M. Nasser, Allergy Clinic 2a, Cambridge University NHS Foundation Trust, Cambridge CB2 0QQ, UK. E‐mail: shuaib.nasser@ 123456addenbrookes.nhs.uk

Article

Publisher ID: CEA2888 Other ID: 2888

DOI: 10.1111/j.1365-2222.2007.02888.x

PMC ID: 7162111

PubMed ID: 18081563

SO-VID: a6a6620c-5ef1-4eb0-89b7-65104cb6ff2b

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links-crossref: 207, Figures: 4, Tables: 11, Equations: 0, References: 235, Pages: 24, Words: 18581

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source-schema-version-number 2.0

cover-date January 2008

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:15.04.2020

ScienceOpen disciplines: Immunology

Keywords: allergen,allergy,antihistamine,anti‐leukotriene,aspirin,asthma,bsaci,cat allergen,child,corticosteroid,cromoglicate,decongestant,guideline,house dust mite,ige,immunotherapy,ipratropium bromide,lactation,nitric oxide,occupational,pregnancy,rhinitis,rhinosinusitis,sinusitis,skin prick test,sublingual immunotherapy,surgery

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ScienceOpen disciplines: Immunology

Keywords: allergen, allergy, antihistamine, anti‐leukotriene, aspirin, asthma, bsaci, cat allergen, child, corticosteroid, cromoglicate, decongestant, guideline, house dust mite, ige, immunotherapy, ipratropium bromide, lactation, nitric oxide, occupational, pregnancy, rhinitis, rhinosinusitis, sinusitis, skin prick test, sublingual immunotherapy, surgery

BSACI guidelines for the management of allergic and non‐allergic rhinitis

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HLA-G and immune tolerance in pregnancy

Most cited references 228

Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

Long-term clinical efficacy of grass-pollen immunotherapy.

Rhinovirus upper respiratory infection increases airway hyperreactivity and late asthmatic reactions.

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Journal

Affiliations

Author notes

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