Review

. 2022 Apr;12(4):327-680.

doi: 10.1002/alr.22929.

International consensus statement on allergy and rhinology: Olfaction

Zara M Patel¹, Eric H Holbrook², Justin H Turner³, Nithin D Adappa⁴, Mark W Albers⁵, Aytug Altundag⁶, Simone Appenzeller⁷, Richard M Costanzo⁸, Ilona Croy⁹, Greg E Davis¹⁰, Puya Dehgani-Mobaraki¹¹, Richard L Doty¹², Valerie B Duffy¹³, Bradley J Goldstein¹⁴, David A Gudis¹⁵, Antje Haehner¹⁶, Thomas S Higgins¹⁷, Claire Hopkins¹⁸, Caroline Huart¹⁹, Thomas Hummel¹⁶, Kawinyarat Jitaroon²⁰, Robert C Kern²¹, Ashoke R Khanwalkar¹, Masayoshi Kobayashi²², Kenji Kondo²³, Andrew P Lane²⁴, Matt Lechner²⁵, Donald A Leopold²⁶, Joshua M Levy²⁷, Michael J Marmura²⁸, Lisha Mclelland²⁹, Takaki Miwa³⁰, Paul J Moberg³¹, Christian A Mueller³², Sagar U Nigwekar³³, Erin K O'Brien³⁴, Teodor G Paunescu³³, Robert Pellegrino³⁵, Carl Philpott³⁶, Jayant M Pinto³⁷, Evan R Reiter³⁸, David R Roalf³¹, Nicholas R Rowan²⁴, Rodney J Schlosser³⁹, James Schwob⁴⁰, Allen M Seiden⁴¹, Timothy L Smith⁴², Zachary M Soler³⁹, Leigh Sowerby⁴³, Bruce K Tan²¹, Andrew Thamboo⁴⁴, Bozena Wrobel⁴⁵, Carol H Yan⁴⁶

Affiliations

¹ Otolaryngology, Stanford University School of Medicine, Stanford, California, USA.
² Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
³ Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
⁴ Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Neurology, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey.
⁷ Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
⁸ Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
⁹ Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany.
¹⁰ Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA.
¹¹ Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy.
¹² Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹³ Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
¹⁴ Otolaryngology, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Otolaryngology, Columbia University Irving Medical Center, New York, USA.
¹⁶ Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany.
¹⁷ Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
¹⁸ Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK.
¹⁹ Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium.
²⁰ Otolaryngology, Navamindradhiraj University, Bangkok, Thailand.
²¹ Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²² Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan.
²³ Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
²⁴ Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁵ Otolaryngology, Barts Health and University College London, London, UK.
²⁶ Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA.
²⁷ Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.
²⁸ Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA.
²⁹ Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³⁰ Otolaryngology, Kanazawa Medical University, Ishikawa, Japan.
³¹ Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
³² Otolaryngology, Medical University of Vienna, Vienna, Austria.
³³ Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
³⁴ Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
³⁵ Monell Smell Center, Philadelphia, Pennsylvania, USA.
³⁶ Otolaryngology, University of East Anglia, Norwich, UK.
³⁷ Otolaryngology, University of Chicago, Chicago, Illinois, USA.
³⁸ Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
³⁹ Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA.
⁴⁰ Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁴¹ Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
⁴² Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA.
⁴³ Otolaryngology, University of Western Ontario, London, Ontario, Canada.
⁴⁴ Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁵ Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA.
⁴⁶ Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA.

PMID: 35373533
PMCID: PMC12261282
DOI: 10.1002/alr.22929

Review

International consensus statement on allergy and rhinology: Olfaction

Zara M Patel et al. Int Forum Allergy Rhinol. 2022 Apr.

. 2022 Apr;12(4):327-680.

doi: 10.1002/alr.22929.

Authors

Affiliations

¹ Otolaryngology, Stanford University School of Medicine, Stanford, California, USA.
² Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
³ Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
⁴ Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Neurology, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey.
⁷ Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
⁸ Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
⁹ Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany.
¹⁰ Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA.
¹¹ Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy.
¹² Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹³ Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
¹⁴ Otolaryngology, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ Otolaryngology, Columbia University Irving Medical Center, New York, USA.
¹⁶ Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany.
¹⁷ Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
¹⁸ Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK.
¹⁹ Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium.
²⁰ Otolaryngology, Navamindradhiraj University, Bangkok, Thailand.
²¹ Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²² Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan.
²³ Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
²⁴ Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁵ Otolaryngology, Barts Health and University College London, London, UK.
²⁶ Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA.
²⁷ Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA.
²⁸ Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA.
²⁹ Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
³⁰ Otolaryngology, Kanazawa Medical University, Ishikawa, Japan.
³¹ Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
³² Otolaryngology, Medical University of Vienna, Vienna, Austria.
³³ Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.
³⁴ Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
³⁵ Monell Smell Center, Philadelphia, Pennsylvania, USA.
³⁶ Otolaryngology, University of East Anglia, Norwich, UK.
³⁷ Otolaryngology, University of Chicago, Chicago, Illinois, USA.
³⁸ Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
³⁹ Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA.
⁴⁰ Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁴¹ Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
⁴² Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA.
⁴³ Otolaryngology, University of Western Ontario, London, Ontario, Canada.
⁴⁴ Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁵ Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA.
⁴⁶ Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA.

PMID: 35373533
PMCID: PMC12261282
DOI: 10.1002/alr.22929

Erratum in

Correction to International consensus statement on allergy and rhinology: Olfaction.
[No authors listed] [No authors listed] Int Forum Allergy Rhinol. 2023 Sep;13(9):1844. doi: 10.1002/alr.23163. Epub 2023 Apr 24. Int Forum Allergy Rhinol. 2023. PMID: 37095644 No abstract available.

Abstract

Background: The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O).

Methods: Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus.

Results: The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies.

Conclusion: This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.

Keywords: anosmia; evidence-based medicine; hyposmia; loss of smell; olfaction; olfactory dysfunction; olfactory loss; parosmia; phantosmia; systematic review.

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Figures

**FIGURE II.A-1**
Stage I of Iterative Review Process

**FIGURE II.A-2**
Stage II of Iterative Review Process

**FIGURE XI**
Algorithm for diagnosis and management of the patient with OD

See this image and copyright information in PMC

References

1. Buck L, Axel R. A novel multigene family may encode odorant receptors: a molecular basis for odor recognition. Cell. 1991;65:175–187. - PubMed
1. Patel ZM, Fernandez-Miranda J, Hwang PH, et al. Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87:E66–E67. - PMC - PubMed
1. Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol. 2020;10:806–813. - PMC - PubMed
1. Orlandi RR, Kingdom TT, Hwang PH, et al. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol. 2016;6(1):S22–S209. - PubMed
1. Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11:213–739. - PubMed

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International consensus statement on allergy and rhinology: Olfaction

Affiliations

International consensus statement on allergy and rhinology: Olfaction

Authors

Affiliations

Erratum in

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