The diagnosis and management of allergic rhinitis: Summary of recommendations by the south African Allergic Rhinitis Working Group (SAARWG) 2015

Background: Allergic rhinitis (AR) is a common chronic condition which is often unsatisfactorily diagnosed or treated. Relevant allergens are area-specific hence the need for careful selection for relevance and cost-effectiveness. In this document, the South African Allergic Rhinitis Working Group (SAARWG) aims to address several diagnostic and therapeutic issues related to AR in the South African context. Recommendations: The diagnosis of AR relies on a sound clinical assessment together with laboratory tests for allergic sensitisation. Tailored screening panels for relevant allergens in South Africa have been devised and are discussed. X-rays and CT scans are generally unnecessary in uncomplicated AR. Component testing can differentiate between allergen-specific and cross-reactive components and aid in the selection of suitable patients for immunotherapy. Management: The management of AR entails allergen reduction, pharmacotherapy and immunotherapy. Intranasal corticosteroids are the pharmacological treatment of choice for AR and alleviate immediate as well as delayed symptoms. The role of second generation antihistamines and montelukast as add-on treatment for AR is discussed. First generation antihistamines are generally discouraged owing to their unfavourable side-effect profile. Systemic steroids and food restrictions are not recommended in the routine management of AR. Referral to an ear, nose and throat surgeon is recommended in treatment-resistant or complex cases to rule out anatomical or inflammatory complicating factors. Immunotherapy is the only treatment modality which can alter the natural course of the disease, but is currently unlicensed in South Africa and supply issues remain a concern.