Review

. 2023 Apr;13(4):293-859.

doi: 10.1002/alr.23090. Epub 2023 Mar 6.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

Sarah K Wise¹, Cecelia Damask², Lauren T Roland³, Charles Ebert⁴, Joshua M Levy¹, Sandra Lin⁵, Amber Luong⁶, Kenneth Rodriguez⁷, Ahmad R Sedaghat⁸, Elina Toskala⁹, Jennifer Villwock¹⁰, Baharudin Abdullah¹¹, Cezmi Akdis¹², Jeremiah A Alt¹³, Ignacio J Ansotegui¹⁴, Antoine Azar¹⁵, Fuad Baroody¹⁶, Michael S Benninger¹⁷, Jonathan Bernstein¹⁸, Christopher Brook¹⁹, Raewyn Campbell²⁰, Thomas Casale²¹, Mohamad R Chaaban²², Fook Tim Chew²³, Jeffrey Chambliss²⁴, Antonella Cianferoni²⁵, Adnan Custovic²⁶, Elizabeth Mahoney Davis²⁷, John M DelGaudio¹, Anne K Ellis²⁸, Carrie Flanagan¹, Wytske J Fokkens²⁹, Christine Franzese³⁰, Matthew Greenhawt³¹, Amarbir Gill³², Ashleigh Halderman³³, Jens M Hohlfeld³⁴, Cristoforo Incorvaia³⁵, Stephanie A Joe³⁶, Shyam Joshi³⁷, Merin Elizabeth Kuruvilla³⁸, Jean Kim³⁹, Adam M Klein¹, Helene J Krouse⁴⁰, Edward C Kuan⁴¹, David Lang⁴², Desiree Larenas-Linnemann⁴³, Adrienne M Laury⁴⁴, Matt Lechner⁴⁵, Stella E Lee⁴⁶, Victoria S Lee³⁶, Patricia Loftus⁴⁷, Sonya Marcus⁴⁸, Haidy Marzouk⁴⁹, Jose Mattos⁵⁰, Edward McCoul⁵¹, Erik Melen⁵², James W Mims⁵³, Joaquim Mullol⁵⁴, Jayakar V Nayak⁵⁵, John Oppenheimer⁵⁶, Richard R Orlandi¹³, Katie Phillips⁸, Michael Platt²⁷, Murugappan Ramanathan Jr³⁹, Mallory Raymond⁵⁷, Chae-Seo Rhee⁵⁸, Sietze Reitsma⁵⁹, Matthew Ryan³³, Joaquin Sastre⁶⁰, Rodney J Schlosser⁶¹, Theodore A Schuman⁶², Marcus S Shaker⁶³, Aziz Sheikh⁶⁴, Kristine A Smith¹³, Michael B Soyka⁶⁵, Masayoshi Takashima⁶⁶, Monica Tang⁶⁷, Pongsakorn Tantilipikorn⁶⁸, Malcolm B Taw⁶⁹, Jody Tversky¹⁵, Matthew A Tyler⁷⁰, Maria C Veling³³, Dana Wallace⁷¹, De Yun Wang⁷², Andrew White⁷³, Luo Zhang⁷⁴

Affiliations

¹ Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA.
² Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA.
³ Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA.
⁴ Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA.
⁶ Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA.
⁷ Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁸ Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA.
⁹ Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁰ Otolaryngology-HNS, University of Kansas, Kansas City, Kansas, USA.
¹¹ Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia.
¹² Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland.
¹³ Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA.
¹⁴ Allergy/Immunology, Hospital Quironsalud Bizkala, Bilbao, Spain.
¹⁵ Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁶ Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA.
¹⁷ Otolaryngology-HNS, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁸ Allergy/Immunology, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁹ Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
²⁰ Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia.
²¹ Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA.
²² Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA.
²³ Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore.
²⁴ Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA.
²⁵ Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²⁶ Pediatric allergy, Imperial College London, London, UK.
²⁷ Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA.
²⁸ Allergy/Immunology, Queens University, Kingston, ON, Canada.
²⁹ Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands.
³⁰ Otolaryngology-HNS, University of Missouri, Columbia, Missouri, USA.
³¹ Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA.
³² Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA.
³³ Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA.
³⁴ Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany.
³⁵ Allergy, Private Practice, Milan, Italy.
³⁶ Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA.
³⁷ Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA.
³⁸ Allergy/Immunology, Emory University, Atlanta, Georgia, USA.
³⁹ Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA.
⁴⁰ Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA.
⁴¹ Otolaryngology-HNS, University of California Irvine, Orange, California, USA.
⁴² Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA.
⁴³ Allergy/Immunology, Pediatric, Medica Sur Clinical Foundation and Hospital, Mexico City, Mexico.
⁴⁴ Otolaryngology-HNS, Bellevue ENT, Bellevue, Washington, USA.
⁴⁵ Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK.
⁴⁶ Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴⁷ Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA.
⁴⁸ Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA.
⁴⁹ Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA.
⁵⁰ Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA.
⁵¹ Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA.
⁵² Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden.
⁵³ Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA.
⁵⁴ Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain.
⁵⁵ Otolaryngology-HNS, Stanford University, Palo Alto, California, USA.
⁵⁶ Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA.
⁵⁷ Otolaryngology-HNS, Mayo Clinic, Jacksonville, Florida, USA.
⁵⁸ Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea.
⁵⁹ Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands.
⁶⁰ Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain.
⁶¹ Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA.
⁶² Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA.
⁶³ Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA.
⁶⁴ Primary Care, University of Edinburgh, Edinburgh, Scotland.
⁶⁵ Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
⁶⁶ Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA.
⁶⁷ Allergy/Immunology, University of California San Francisco, San Francisco, California, USA.
⁶⁸ Rhinology/Allergy, Mahidol University, Siriraj Hospital, Bangkok, Thailand.
⁶⁹ Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA.
⁷⁰ Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA.
⁷¹ Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA.
⁷² Otolaryngology-HNS, National University of Singapore, Singapore, Singapore.
⁷³ Allergy/Immunology, Scripps Clinic, San Diego, California, USA.
⁷⁴ Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China.

PMID: 36878860
DOI: 10.1002/alr.23090

Free article

Review

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

Sarah K Wise et al. Int Forum Allergy Rhinol. 2023 Apr.

Free article

. 2023 Apr;13(4):293-859.

doi: 10.1002/alr.23090. Epub 2023 Mar 6.

Authors

Affiliations

¹ Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA.
² Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA.
³ Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA.
⁴ Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA.
⁶ Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA.
⁷ Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
⁸ Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA.
⁹ Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁰ Otolaryngology-HNS, University of Kansas, Kansas City, Kansas, USA.
¹¹ Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia.
¹² Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland.
¹³ Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA.
¹⁴ Allergy/Immunology, Hospital Quironsalud Bizkala, Bilbao, Spain.
¹⁵ Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁶ Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA.
¹⁷ Otolaryngology-HNS, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁸ Allergy/Immunology, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁹ Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
²⁰ Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia.
²¹ Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA.
²² Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA.
²³ Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore.
²⁴ Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA.
²⁵ Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²⁶ Pediatric allergy, Imperial College London, London, UK.
²⁷ Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA.
²⁸ Allergy/Immunology, Queens University, Kingston, ON, Canada.
²⁹ Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands.
³⁰ Otolaryngology-HNS, University of Missouri, Columbia, Missouri, USA.
³¹ Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA.
³² Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA.
³³ Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA.
³⁴ Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany.
³⁵ Allergy, Private Practice, Milan, Italy.
³⁶ Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA.
³⁷ Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA.
³⁸ Allergy/Immunology, Emory University, Atlanta, Georgia, USA.
³⁹ Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA.
⁴⁰ Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA.
⁴¹ Otolaryngology-HNS, University of California Irvine, Orange, California, USA.
⁴² Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA.
⁴³ Allergy/Immunology, Pediatric, Medica Sur Clinical Foundation and Hospital, Mexico City, Mexico.
⁴⁴ Otolaryngology-HNS, Bellevue ENT, Bellevue, Washington, USA.
⁴⁵ Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK.
⁴⁶ Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴⁷ Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA.
⁴⁸ Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA.
⁴⁹ Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA.
⁵⁰ Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA.
⁵¹ Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA.
⁵² Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden.
⁵³ Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA.
⁵⁴ Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain.
⁵⁵ Otolaryngology-HNS, Stanford University, Palo Alto, California, USA.
⁵⁶ Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA.
⁵⁷ Otolaryngology-HNS, Mayo Clinic, Jacksonville, Florida, USA.
⁵⁸ Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea.
⁵⁹ Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands.
⁶⁰ Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain.
⁶¹ Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA.
⁶² Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA.
⁶³ Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA.
⁶⁴ Primary Care, University of Edinburgh, Edinburgh, Scotland.
⁶⁵ Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
⁶⁶ Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA.
⁶⁷ Allergy/Immunology, University of California San Francisco, San Francisco, California, USA.
⁶⁸ Rhinology/Allergy, Mahidol University, Siriraj Hospital, Bangkok, Thailand.
⁶⁹ Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA.
⁷⁰ Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA.
⁷¹ Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA.
⁷² Otolaryngology-HNS, National University of Singapore, Singapore, Singapore.
⁷³ Allergy/Immunology, Scripps Clinic, San Diego, California, USA.
⁷⁴ Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China.

PMID: 36878860
DOI: 10.1002/alr.23090

Abstract

Background: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

Methods: ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

Results: ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

Conclusion: The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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; epidemiology; evidence-based medicine; food allergy; house dust mite; immunoglobulin E; immunotherapy; inhalant allergy; leukotriene; microbiome; occupational rhinitis; omalizumab; pediatric; perennial; pet dander; pollen; probiotic; rhinitis; rhinosinusitis; saline; seasonal; sensitization; sinusitis; socioeconomic; specific IgE; subcutaneous immunotherapy; sublingual immunotherapy; systematic review; total IgE; transcutaneous immunotherapy; validated survey.

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Comment in

Intramuscular corticosteroid injections should be an option under the policy level recommendation in the International Consensus Statement on Allergic Rhinitis.
Wise SK, Baroody F. Wise SK, et al. Int Forum Allergy Rhinol. 2023 Sep;13(9):1838-1840. doi: 10.1002/alr.23243. Epub 2023 Aug 4. Int Forum Allergy Rhinol. 2023. PMID: 37475593 No abstract available.
Intramuscular corticosteroid injections should be an option under the policy level recommendation in the international consensus statement on allergic rhinitis.
de Ru JA, Bayoumy AB. de Ru JA, et al. Int Forum Allergy Rhinol. 2023 Sep;13(9):1834-1835. doi: 10.1002/alr.23244. Epub 2023 Aug 2. Int Forum Allergy Rhinol. 2023. PMID: 37478135 No abstract available.

References

REFERENCES

1. Wise SK, Lin SY, Toskala E, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108-352. https://doi.org/10.1002/alr.22073
1. Rudmik L, Smith TL. Development of an evidence-based review with recommendations using an online iterative process. Int Forum Allergy Rhinol. 2011;1(6):431-437. https://doi.org/10.1002/alr.20095
1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3(3):e123-e130.
1. American Academy of Pediatrics Steering Committee on Quality I, Management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874-877. https://doi.org/10.1542/peds.2004-1260
1. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147-S334. https://doi.org/10.1067/mai.2001.118891

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International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

Affiliations

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials