Practical clinical management strategies for the allergic patient with chronic rhinosinusitis

Allergic rhinitis often coexists with chronic rhinosinusitis (CRS). The purpose of this review is to provide a practical algorithm for the treatment of patients with allergic rhinitis and CRS.

Despite conflicting literature on the causative association of allergic rhinitis with CRS, recent research shows a higher incidence of allergic rhinitis in CRS patients refractory to medical therapy. Local IgE is hypothesized to play a role in the inflammation characteristic of both disorders, even in patients who test negative for inhalant allergies.

As allergic rhinitis and CRS symptoms overlap, medications appropriate for one disorder may also be appropriate for the other. The exception would be allergen immunotherapy in the absence of allergy and antibiotics in the absence of infection. Given these principles, we have developed and provide a personalized management strategy for patients with symptoms of allergic rhinitis and CRS based on the individual's response to therapy.