Allergic rhinitis in South Africa: 2012 guidelines

Area of Science:

• Allergy and Immunology
• Otorhinolaryngology

Background:

• Allergic rhinitis (AR) is a significant health concern in South Africa.
• Previous guidelines by the South African Allergic Rhinitis Working Group (SAARWG) require updates.
• Key areas needing clarification include infant AR management, allergy testing, cost-effectiveness, differential diagnosis with sinusitis, and over-the-counter medication use.

Purpose of the Study:

• To provide updated guidance on the diagnosis and management of allergic rhinitis in South Africa.
• To address specific concerns not adequately covered in previous guidelines.
• To propose an updated algorithm for AR diagnosis and management.

Main Methods:

• Review and synthesis of current knowledge and clinical concerns regarding AR.
• Development of an updated diagnostic and management algorithm.
• Consideration of local South African context, including allergen prevalence and available treatments.

Main Results:

• AR is common, impactful, and requires targeted therapy.
• Recurrent nasal symptoms in infants may indicate AR.
• Allergy testing should be judiciously applied, focusing on local allergens; total IgE is not routinely necessary.
• Sinusitis and asthma should be considered alongside AR.
• Over-the-counter medications require cautious use, with particular attention to topical decongestants.
• Immunotherapy is a viable option for selected patients in South Africa.

Conclusions:

• Clinicians must consider AR in infants with persistent nasal symptoms.
• Judicious use of allergy testing based on local allergens is recommended.
• Integrated management of AR with sinusitis and asthma is crucial.
• Patient education is vital for successful AR management.
• An updated algorithm for AR diagnosis and management is proposed for South Africa.