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Allergic rhinitis is the most common chronic disease of childhood and the fifth most common chronic disease in the United States. 1,2 It is an immunoglobulin E (IgE)–mediated process, and a clinical diagnosis is made based on common signs and symptoms, physical examination findings, and family and social history. This rapid evidence review highlights current literature and research on the diagnosis and treatment of allergic rhinitis.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
It is reasonable to diagnose and begin empiric treatment for allergic rhinitis based on history and physical examination alone. 2 C Guideline recommendation from the American Academy of Otolaryngology–Head and Neck Surgery Foundation
If needed, skin allergen testing should be performed instead of blood serum testing for most patients because it is more sensitive, less expensive, and provides immediate results. 17–21 A Consistent, good-quality patient-centered evidence, including a meta-analysis
Sinonasal imaging should not be performed routinely unless there are other clinical indications (e.g., evidence of acute or chronic sinusitis, nasal polyps, suspicion for neoplasm). 2,9 C Guideline recommendation from the American Academy of Otolaryngology–Head and Neck Surgery Foundation
Intranasal corticosteroids are first-line treatment for allergic rhinitis. 25–29 A Consistent results from randomized controlled trials for continuous and as-needed use
High-efficiency particulate air (HEPA) filters are ineffective at decreasing allergy symptoms. 41,42 A Consistent, well-designed studies, including a randomized, double-blind, clinical controlled trial

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Epidemiology and Pathophysiology

  1. Approximately 15% to 30% of people in the United States have allergic rhinitis. Estimates of the direct economic burden range from $2 billion to $5 billion annually. 2,3

  2. Allergic rhinitis is caused by IgE-mediated reactions against inhaled allergens. IgE-mediated cross-linking activates mast cells and basophils, releasing histamine and leukotrienes that cause edema, vasodilation, nasal obstruction, and central nervous system reflexes that cause sneezing. 1

  3. In the United States, patients with allergic rhinitis are commonly sensitized to grass, dust mites, and ragweed allergens. 4

  4. Allergic rhinitis is the most common medical reason employees miss time from work and is associated with the largest productivity loss for employers. 5

  5. In...

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