. 2018 Feb;8(2):108-352.

doi: 10.1002/alr.22073.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Sarah K Wise¹, Sandra Y Lin², Elina Toskala³, Richard R Orlandi⁴, Cezmi A Akdis⁵, Jeremiah A Alt⁴, Antoine Azar⁶, Fuad M Baroody⁷, Claus Bachert⁸, G Walter Canonica⁹, Thomas Chacko¹⁰, Cemal Cingi¹¹, Giorgio Ciprandi¹², Jacquelynne Corey⁷, Linda S Cox¹⁰, Peter Socrates Creticos⁶, Adnan Custovic¹³, Cecelia Damask¹⁴, Adam DeConde¹⁵, John M DelGaudio¹, Charles S Ebert¹⁶, Jean Anderson Eloy¹⁷, Carrie E Flanagan¹, Wytske J Fokkens¹⁸, Christine Franzese¹⁹, Jan Gosepath²⁰, Ashleigh Halderman²¹, Robert G Hamilton⁶, Hans Jürgen Hoffman²², Jens M Hohlfeld²³, Steven M Houser²⁴, Peter H Hwang²⁵, Cristoforo Incorvaia²⁶, Deborah Jarvis²⁷, Ayesha N Khalid²⁸, Maritta Kilpeläinen²⁹, Todd T Kingdom³⁰, Helene Krouse³¹, Desiree Larenas-Linnemann³², Adrienne M Laury³³, Stella E Lee³⁴, Joshua M Levy¹, Amber U Luong³⁵, Bradley F Marple²¹, Edward D McCoul³⁶, K Christopher McMains³⁷, Erik Melén³⁸, James W Mims³⁹, Gianna Moscato⁴⁰, Joaquim Mullol⁴¹, Harold S Nelson⁴², Monica Patadia⁴³, Ruby Pawankar⁴⁴, Oliver Pfaar⁴⁵, Michael P Platt⁴⁶, William Reisacher⁴⁷, Carmen Rondón⁴⁸, Luke Rudmik⁴⁹, Matthew Ryan²¹, Joaquin Sastre⁵⁰, Rodney J Schlosser⁵¹, Russell A Settipane⁵², Hemant P Sharma⁵³, Aziz Sheikh⁵⁴, Timothy L Smith⁵⁵, Pongsakorn Tantilipikorn⁵⁶, Jody R Tversky⁶, Maria C Veling²¹, De Yun Wang⁵⁷, Marit Westman⁵⁸, Magnus Wickman⁵⁹, Mark Zacharek⁶⁰

Affiliations

¹ Otolaryngology, Emory University, USA.
² Otolaryngology, Johns Hopkins University, USA.
³ Otolaryngology, Temple University, USA.
⁴ Otolaryngology, University of Utah, USA.
⁵ Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland.
⁶ Allergy/Immunology, Johns Hopkins University, USA.
⁷ Otolaryngology, University of Chicago, USA.
⁸ Otolaryngology, University of Ghent, Belgium.
⁹ Respiratory Diseases, Humanitas University, Italy.
¹⁰ Allergy/Immunology, Private Practice, USA.
¹¹ Otolaryngology, Eskisehir Osmangazi University, Turkey.
¹² Allergy/Immunology, Ospedale Policlinico San Martino, Italy.
¹³ Pediatric Allergy, Imperial College London, UK.
¹⁴ Otolaryngology, Private Practice, USA.
¹⁵ Otolaryngology, University of California San Diego, USA.
¹⁶ Otolaryngology, University of North Carolina, USA.
¹⁷ Otolaryngology, Rutgers New Jersey Medical School, USA.
¹⁸ Otolaryngology, University of Amsterdam, Netherlands.
¹⁹ Otolaryngology, University of Missouri, USA.
²⁰ Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany.
²¹ Otolaryngology, University of Texas Southwestern, USA.
²² Respiratory Diseases, University of Aarhus, Denmark.
²³ Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany.
²⁴ Otolaryngology, Case Western Reserve University, USA.
²⁵ Otolaryngology, Stanford University, USA.
²⁶ Allergy/Immunology, ASST Pini/CTO Milan, Italy.
²⁷ Public Health, Imperial College London, UK.
²⁸ Otolaryngology, Harvard Medical School, USA.
²⁹ Pulmonary/Allergy, Turku University Hospital, Finland.
³⁰ Otolaryngology, University of Colorado, USA.
³¹ Nursing, University of Texas Rio Grande Valley, USA.
³² Pediatric Allergy, Hospital Medica Sur, Mexico.
³³ Otolaryngology, San Antonio Military Medical Center, USA.
³⁴ Otolaryngology, University of Pittsburgh, USA.
³⁵ Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA.
³⁶ Otolaryngology, Ochsner Clinic Foundation, USA.
³⁷ Otolaryngology, Uniformed Services University of Health Sciences, USA.
³⁸ Pediatric Allergy, Karolinska Institutet, Sweden.
³⁹ Otolaryngology, Wake Forest University, USA.
⁴⁰ Allergy/Immunology, University of Pavia, Italy.
⁴¹ Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain.
⁴² Allergy/Immunology, National Jewish Health, USA.
⁴³ Otolaryngology, Loyola University, USA.
⁴⁴ Pediatrics, Nippon Medical School, Japan.
⁴⁵ Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany.
⁴⁶ Otolaryngology, Boston University, USA.
⁴⁷ Otolaryngology, Weill Cornell Medical College, USA.
⁴⁸ Allergy, Regional University Hospital of Málaga, Spain.
⁴⁹ Otolaryngology, University of Calgary, Canada.
⁵⁰ Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain.
⁵¹ Otolaryngology, Medical University of South Carolina, USA.
⁵² Allergy/Immunology, Alpert Medical School of Brown University, USA.
⁵³ Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA.
⁵⁴ Allergy/Asthma, University of Edinburgh, UK.
⁵⁵ Otolaryngology, Oregon Health and Science University, USA.
⁵⁶ Rhinology/Allergy, Mahidol University, Thailand.
⁵⁷ Otolaryngology, National University of Singapore, Singapore.
⁵⁸ Otolaryngology, Karolinska Institutet, Sweden.
⁵⁹ Environmental Medicine, Karolinska Institutet, Sweden.
⁶⁰ Otolaryngology, University of Michigan, USA.

PMID: 29438602
PMCID: PMC7286723
DOI: 10.1002/alr.22073

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Sarah K Wise et al. Int Forum Allergy Rhinol. 2018 Feb.

. 2018 Feb;8(2):108-352.

doi: 10.1002/alr.22073.

Authors

Affiliations

¹ Otolaryngology, Emory University, USA.
² Otolaryngology, Johns Hopkins University, USA.
³ Otolaryngology, Temple University, USA.
⁴ Otolaryngology, University of Utah, USA.
⁵ Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland.
⁶ Allergy/Immunology, Johns Hopkins University, USA.
⁷ Otolaryngology, University of Chicago, USA.
⁸ Otolaryngology, University of Ghent, Belgium.
⁹ Respiratory Diseases, Humanitas University, Italy.
¹⁰ Allergy/Immunology, Private Practice, USA.
¹¹ Otolaryngology, Eskisehir Osmangazi University, Turkey.
¹² Allergy/Immunology, Ospedale Policlinico San Martino, Italy.
¹³ Pediatric Allergy, Imperial College London, UK.
¹⁴ Otolaryngology, Private Practice, USA.
¹⁵ Otolaryngology, University of California San Diego, USA.
¹⁶ Otolaryngology, University of North Carolina, USA.
¹⁷ Otolaryngology, Rutgers New Jersey Medical School, USA.
¹⁸ Otolaryngology, University of Amsterdam, Netherlands.
¹⁹ Otolaryngology, University of Missouri, USA.
²⁰ Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany.
²¹ Otolaryngology, University of Texas Southwestern, USA.
²² Respiratory Diseases, University of Aarhus, Denmark.
²³ Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany.
²⁴ Otolaryngology, Case Western Reserve University, USA.
²⁵ Otolaryngology, Stanford University, USA.
²⁶ Allergy/Immunology, ASST Pini/CTO Milan, Italy.
²⁷ Public Health, Imperial College London, UK.
²⁸ Otolaryngology, Harvard Medical School, USA.
²⁹ Pulmonary/Allergy, Turku University Hospital, Finland.
³⁰ Otolaryngology, University of Colorado, USA.
³¹ Nursing, University of Texas Rio Grande Valley, USA.
³² Pediatric Allergy, Hospital Medica Sur, Mexico.
³³ Otolaryngology, San Antonio Military Medical Center, USA.
³⁴ Otolaryngology, University of Pittsburgh, USA.
³⁵ Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA.
³⁶ Otolaryngology, Ochsner Clinic Foundation, USA.
³⁷ Otolaryngology, Uniformed Services University of Health Sciences, USA.
³⁸ Pediatric Allergy, Karolinska Institutet, Sweden.
³⁹ Otolaryngology, Wake Forest University, USA.
⁴⁰ Allergy/Immunology, University of Pavia, Italy.
⁴¹ Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain.
⁴² Allergy/Immunology, National Jewish Health, USA.
⁴³ Otolaryngology, Loyola University, USA.
⁴⁴ Pediatrics, Nippon Medical School, Japan.
⁴⁵ Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany.
⁴⁶ Otolaryngology, Boston University, USA.
⁴⁷ Otolaryngology, Weill Cornell Medical College, USA.
⁴⁸ Allergy, Regional University Hospital of Málaga, Spain.
⁴⁹ Otolaryngology, University of Calgary, Canada.
⁵⁰ Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain.
⁵¹ Otolaryngology, Medical University of South Carolina, USA.
⁵² Allergy/Immunology, Alpert Medical School of Brown University, USA.
⁵³ Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA.
⁵⁴ Allergy/Asthma, University of Edinburgh, UK.
⁵⁵ Otolaryngology, Oregon Health and Science University, USA.
⁵⁶ Rhinology/Allergy, Mahidol University, Thailand.
⁵⁷ Otolaryngology, National University of Singapore, Singapore.
⁵⁸ Otolaryngology, Karolinska Institutet, Sweden.
⁵⁹ Environmental Medicine, Karolinska Institutet, Sweden.
⁶⁰ Otolaryngology, University of Michigan, USA.

PMID: 29438602
PMCID: PMC7286723
DOI: 10.1002/alr.22073

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: IgE; allergen extract; allergen immunotherapy; allergic rhinitis; allergy; antihistamine; asthma; atopic dermatitis; avoidance; biologic; cockroach; conjunctivitis; consensus; corticosteroid; cough; cromolyn; decongestant; environment; eosinophilic esophagitis; epicutaneous immunotherapy; epidemiology; evidence-based medicine; food allergy; genetics; house dust mite; immunoglobulin E; immunotherapy; inhalant allergy; leukotriene; microbiome; occupational rhinitis; omalizumab; pathophysiology; perennial; pet dander; pollen; probiotic; quality of life; rhinitis; rhinosinusitis; risk factor; saline; seasonal; sensitization; sinusitis; sleep; socioeconomic; specific IgE; subcutaneous immunotherapy; sublingual immunotherapy; systematic review; total IgE; transcutaneous immunotherapy; validated survey.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest: See the Appendix at the end of this article.

Figures

**FIGURE II.A-1.**
Topic development. AAP = American Academy of Pediatrics; EBRR = evidence-based review with recommendation; PE = principal editor; 1⁰ = primary; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

**FIGURE II.A-2.**
Topic EBRR iterative review. 1⁰ = primary; 2⁰ = secondary; 3⁰ = tertiary; EBRR = evidence-based review with recommendation; PE = principal editor.

**FIGURE II.A-3.**
ICAR: Allergic Rhinitis statement iterative review. ICAR:AR = International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis; PE = principal editor.

**FIGURE III.C.3.**
Classification of work-related rhinitis. Adapted from Moscato et al. *Allergy*. 2008;63:969-980.

See this image and copyright information in PMC

References

1. Orlandi RR, Kingdom TT, Hwang PH, et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(Suppl)1:S22–S209. - PubMed
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–72. - PMC - PubMed
1. Rudmik L, Smith TL. Development of an evidence-based review with recommendations using an online iterative process. Int Forum Allergy Rhinol. 2011;1:431–437. - PubMed
1. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100. - PMC - PubMed
1. Oxford Centre for Evidence-based Medicine (CEBM). Levels of Evidence. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidenc... Accessed December 19, 2017.

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International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Affiliations

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials