V Brazilian Consensus on Rhinitis - 2024

Abstract

Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

Keywords: Allergic rhinitis; Consensus; Epidemiology; Evidence-based medicine; Phenotypes; Rhinitis; Treatment.

Fig. 1

Mechanisms of the innate and adaptive allergic rhinitis response activation. TSLP, Thymic Stromal Lymphopoietin; IL, Interleukin; ILC2, Group 2 innate lymphoid cells; Eos, Eosinophil; Bas., Basophil; CD, Dendritic Cells. Adapted from Berstein JA.

Fig. 2

Systemic mechanisms; allergic rhinitis comorbidities and clinical manifestations. Mast., Mastocytes; Bas, basophil; Eos, eosinophil; Cell T, T-Cells. Adapted from Berstein JA.

Fig. 3

Types of rhinitis according to etiology.

Fig. 4

Simplified schematic representation of the coughing mechanism in allergic rhinitis.

Fig. 5

Chronic rhinitis diagnostic algorithm. Prick Test, Immediate Hypersensitivity Skin test; CRS, Chronic Rhinosinusitis; sNPT, Specific Nasal Provocation Test; TAB, Basophil Activation Test. Adapted from Eguiluz-Gracia I.