THE
EVIDENCE-BASED INTERNATIONAL GUIDELINES ON ALLERGIC RHINITIS "ARIA"
Ruby Pawankar
Dept. of Otolaryngology, Nippon Medical
School, Tokyo, Japan
Allergic rhinitis is an IgE-mediated allergic inflammation of the
nose occurring due to the interaction of allergen with IgE and resulting in the
release of a variety of mediators that induce the typical symptoms of
rhinorrhea, sneezing, itching and nasal blockage. Allergic rhinitis is a global
health problem affecting approximately 10 to 50 % of the population world-wide,
altering the quality of life of patients, affecting school learning
performance, and work productivity. Infact, allergic rhinitis and asthma are
co-morbidities, and the costs incurred by rhinitis itself are substantial. More
importantly, allergic rhinitis and asthma are major causes of morbidity and
mortality not only in the developed but also in the developing countries.
Recent knowledge on the pathophysiological mechanisms underlying
allergic rhinitis has led to the development of newer therapeutic strategies.
Several guidelines have been proposed for patients with allergic rhinitis.
However, the ARIA (allergic rhinitis and its impact on asthma) is the first
ever evidence-based guideline for the treatment of allergic rhinitis.
The ARIA initiative was developed as a state-of-the-art for the
specialist as well as for the general practitioner in order to update their
knowledge of allergic rhinitis, emphasize about the impact of allergic rhinitis
on asthma, provide an evidence-based document on the diagnostic methods and an
evidence-based revision of the presently available treatments. Finally, it
proposes a stepwise strategy for the management of the allergic rhinitis.
Moreover, a new classification is also proposed for allergic rhinitis namely
"intermittent" or "persistent" rhinitis based on the
duration of disease and "mild" and "moderate-severe" based
on the severity of symptoms and quality of life outcomes.
The strategy of management of allergic rhinitis includes allergen
avoidance, pharmacotherapy, immunotherapy and patient education. Surgery is
sometimes effective as an adjunct. A stepwise therapeutic approach has been
proposed based on the new classification of severity of disease. Finally, due to the close relationship between
rhinitis and asthma, patients with persistent rhinitis should be evaluated for
asthma, and those with asthma should be evaluated for rhinitis. The treatment
strategy should target to treat both the upper and lower airway effectively.