Rhinitis 2020: A practice parameter update

Chief Editor(s):, Joint Task Force on Practice Parameters:, Workgroup Contributors

Research output: Contribution to journalArticle

Abstract

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.

Original languageEnglish (US)
Pages (from-to)721-767
Number of pages47
JournalJournal of Allergy and Clinical Immunology
Volume146
Issue number4
DOIs
StatePublished - Oct 2020

Keywords

  • allergen immunotherapy
  • Allergic rhinitis
  • corticosteroids
  • decongestants
  • food allergy antihistamines
  • ipratropium
  • local allergic rhinitis
  • nonallergic rhinitis
  • vasomotor rhinitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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  • Cite this

    Chief Editor(s):, Joint Task Force on Practice Parameters:, & Workgroup Contributors (2020). Rhinitis 2020: A practice parameter update. Journal of Allergy and Clinical Immunology, 146(4), 721-767. https://doi.org/10.1016/j.jaci.2020.07.007