Diagnosis and management of allergic rhinitis: An Indian expert consensus by otorhinolaryngologists

Abstract

Background: The prevalence of allergic rhinitis (AR) has increased progressively over the past several years. One of the vital objectives of management of AR is to provide satisfactory symptom control that improves the patient's quality of life. Several classes of drugs, such as antihistamines, intranasal corticosteroids, decongestants, leukotriene receptor antagonists, and immunotherapy, have been developed over the past decades for more effective management of AR. Combinations of pharmacotherapies have also been advocated to treat AR.

Objective: To develop clinical practice-relevant consensus statements from experts in the field of otorhinolaryngology after giving due consideration to the real-world clinical dilemmas, current evidence, and preferences of both physicians and patients.

Methods: Expert otorhinolaryngologists (n = 61) from India were invited to develop the consensus statements based on the modified Delphi method.

Results: Several consensus statements were framed based on evidence from clinical trials and expert insights and experience. One crucial statement was regarding the additional subgrouping of patients with intermittent or persistent AR, or mild, moderate or severe AR into "sneeze-runners" (sneezing, anterior rhinorrhea, itchy nose, and itchy eyes; more sensitization to pollens) and "blockers" (severe nasal blockage and thick nasal mucus which often leads to postnasal drip and breathlessness; higher sensitization to polyvalent house dust, house dust mites and fungi) since they have distinct clinical profiles and different treatment approach. Another critical consensus was on the use of the fixed-dose combination of fluticasone furoate and oxymetazoline hydrochloride nasal spray for the persistent and moderate-severe blocker phenotype of AR.

Conclusion: This expert consensus will help physicians in their clinical practice and complement effective diagnosis and management of AR.

Keywords: Allergic rhinitis; antihistamines; expert consensus; fluticasone furoate; intranasal corticosteroids; intranasal saline; modified Delphi; nasal decongestants; oxymetazoline; rhinitis.