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Cited by 557Allergic Rhinitis and SensitizationFood Allergy and Anaphylaxis ResearchAsthma and respiratory diseases

The DOI matches its Crossref record; 2,059 of the 2,094 references it cites were found in a registry or an index; 407 of the 1,778 sources its claims cite were checked for support.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Open access
Wise, Sarah K., Lin, Sandra Y., Toskala, Elina, Orlandi, Richard R., Akdis, Cezmi A., Alt, Jeremiah A., Azar, Antoine, Baroody, Fuad M., Bachert, Claus, Canonica, G. Walter, Chacko, Thomas, Cingi, Cemal, Ciprandi, Giorgio, Corey, Jacquelynne, Cox, Linda S., Creticos, Peter Socrates, Custovic, Adnan, Damask, Cecelia, DeConde, Adam, DelGaudio, John M., Ebert, Charles S., Eloy, Jean Anderson, Flanagan, Carrie E., Fokkens, Wytske J., Franzese, Christine, Gosepath, Jan, Halderman, Ashleigh, Hamilton, Robert G., Hoffman, Hans Jürgen, Hohlfeld, Jens M., Houser, Steven M., Hwang, Peter H., Incorvaia, Cristoforo, Jarvis, Deborah, Khalid, Ayesha N., Kilpeläinen, Maritta, Kingdom, Todd. T., Krouse, Helene, Larenas‐Linnemann, Desiree, Laury, Adrienne M., Lee, Stella E., Levy, Joshua M., Luong, Amber U., Marple, Bradley F., McCoul, Edward D., McMains, K. Christopher, Melén, Erik, Mims, James W., Moscato, Gianna, Mullol, Joaquim, Nelson, Harold S., Patadia, Monica, Pawankar, Ruby, Pfaar, Oliver, Platt, Michael P., Reisacher, William, Rondón, Carmen, Rudmik, Luke, Ryan, Matthew, Sastre, Joaquin, Schlosser, Rodney J., Settipane, Russell A., Sharma, Hemant P., Sheikh, Aziz, Smith, Timothy L., Tantilipikorn, Pongsakorn, Tversky, Jody R., Veling, Maria C., Wang, De Yun, Westman, Marit, Wickman, Magnus, Zacharek, Mark·2018·International Forum of Allergy & Rhinology
DOI 10.1002/alr.22073PMC PMC7286723
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Abstract

BACKGROUND: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Overview

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Crossref · 10.1002/alr.22073

Cites

2059 of 2059 references verified0 citation errors · 0 not checkable

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Claims the paper makes

648 No full text of the sources · 182 No basis given · 159 Own interpretation · 158 Partly supported · 89 Supported · 81 Own method · 67 Supported so far · 60 Not checked yet · 27 Sources not found · 22 Own result · 14 Couldn’t confirm · 6 Not supported · 1 Mixed support · accuracy not yet measured

Show all 827 claims

  • It may state two separate claims as one. 539
  • Probably not a substantial claim. 227
  • The quote only partly states this claim. 12
687 of 687

  • The paper relies on this without support.

    Examining the quality and validity of AR literature is required to improve understanding and apply knowledge in clinical care.

    “Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient.”

  • The paper relies on this without support.

    Updating recommendations as evidence changes will improve patient outcomes.

    “With new evidence, recommendations will undergo necessary revisions and better patient outcomes should result.”

  • The paper relies on this without support.

    Larger chemical particles are typically responsible for chemical rhinitis, while smaller particles usually pass to the lower airways.

    “Larger chemical particles are typically the culprit in this form of rhinitis as smaller particles usually pass through to the lower airways.”

  • The paper relies on this without support.

    Smoke-induced rhinitis does not appear to be driven by IgE-mediated hypersensitivity.

    “but smoke-induced rhinitis does not appear to be driven by IgE-mediated hypersensitivity”

  • The paper relies on this without support.

    Altered mucociliary clearance results from tobacco smoke exposure.

    “In addition, altered mucociliary clearance (MCC) resulting from tobacco smoke exposure has been demonstrated.”

  • The paper relies on this without support.

    Dark or purulent rhinorrhea alone is not pathognomonic for bacterial rhinitis or rhinosinusitis.

    “Taken in isolation, dark or purulent rhinorrhea is not pathognomonic for bacterial rhinitis/rhinosinusitis.”

  • The paper relies on this without support.

    Rhinitis of pregnancy does not usually require therapy and does not respond well to standard allergy medications.

    “Rhinitis of pregnancy does not usually require therapy, nor does it respond well to standard allergy medications.”

  • The paper relies on this without support.

    Certain food ingestions may cause rhinitis through a nonimmunologic reaction and are therefore not allergy.

    “Certain food ingestions may result in rhinitis based on a nonimmunologic reaction, and therefore are not characterized as an allergy.”

  • The paper relies on this without support.

    NARES pathophysiology involves eosinophilic, self-perpetuating inflammation with nonspecific histamine release.

    “The pathophysiology of NARES is not well understood, but a key component involves an eosinophilic, self-perpetuating inflammation, with nonspecific histamine release.”

  • The paper relies on this without support.

    ENS has repeatedly been described erroneously in the literature as a form or subset of atrophic rhinitis.

    “In the literature, ENS has repeatedly been described erroneously as a form or subset of atrophic rhinitis.”

  • The paper relies on this without support.

    The nose acts as a filter and air conditioner that protects the lower airways.

    “The nose acts as a filter and air conditioner, protecting the lower airways.”

  • The paper relies on this without support.

    Mouth breathing is independently associated with asthma morbidity.

    “Mouth breathing is independently associated with asthma morbidity, indicating that air conditioning can be of major importance.”

  • The paper relies on this without support.

    The efficacy of the nasal filter depends on the size of inhaled particles.

    “The efficacy of the nasal filter depends on the size of the inhaled particles.”

  • The paper relies on this without support.

    Small molecules such as molds and cat dander are more associated with increased risk for asthma, whereas larger molecules such as tree and grass pollen are primarily associated with upper airway symptoms.

    “Small molecules, such as molds and cat dander, are more associated with an increased risk for asthma, whereas larger molecules, such as tree and grass pollen, are primarily associated with upper airway symptoms.”

  • The paper relies on this without support.

    Nasal allergen challenge can be blocked with a vasoconstrictor but not with lidocaine.

    “Nasal allergen challenge can be blocked with a vasoconstrictor but not with lidocaine.”

  • The paper relies on this without support.

    The heritability of allergic rhinitis is as high as 70% to 80%.

    “The estimated heritability of AR has been suggested to be as high as 70% to 80%.”

  • The paper relies on this without support.

    No single gene or polymorphism accounts for the hereditary effect on allergic rhinitis; instead, many genes and several variants, each with small effects, contribute to disease initiation, persistence, and severity.

    “Like many complex diseases, no single gene or polymorphism accounts for the hereditary effect on AR. Instead, many genes and several variants, each with small effects, are believed to contribute to disease initiation, persistence, and severity.”

  • The paper relies on this without support.

    Toll-like receptors play a crucial role in immune regulation.

    “TLRs play a crucial role in immune regulation and SNPs in different TLRs have been associated with AR in both GWASs (TLR1, TLR6, TLR10)486,487 and candidate gene studies (TLR8), as discussed in the”

  • The paper relies on this without support.

    Sensitization to a specific allergen requires a primitive exposure to that allergen.

    “Sensitization is a complex phenomenon, regulated by genetic and environmental factors, requiring a primitive exposure to a specific allergen. If a subject is never exposed to an allergen, sensitization to that allergen cannot occur.”

  • The paper relies on this without support.

    Without sensitization, allergy cannot exist, but sensitization can exist without allergy.

    “Without sensitization allergy cannot exist, but not vice versa.”

  • The paper relies on this without support.

    Among subjects sensitized to pet allergens, exposure tends to exacerbate symptoms.

    “Among subjects sensitized to pet allergens, exposure tends to exacerbate symptoms.”

  • The paper relies on this without support.

    Allergic rhinitis is the most common chronic disorder in the pediatric population.

    “AR is the most common chronic disorder in the pediatric population.”

  • The paper relies on this without support.

    Every medical diagnosis requires a clinical history and physical examination.

    “However, the lack of higher level evidence is not surprising as a clinical history and physical examination is essential to any medical diagnosis and randomized studies would require participants to receive an intervention without a clinical history.”

  • The paper relies on this without support.

    Randomized diagnostic studies would need participants to receive an intervention without any clinical history.

    “However, the lack of higher level evidence is not surprising as a clinical history and physical examination is essential to any medical diagnosis and randomized studies would require participants to receive an intervention without a clinical history.”

  • The paper relies on this without support.

    Where resources are scarce, SPT and lab testing may be unavailable.

    “Furthermore, in regions where resources are scarce, SPT and laboratory testing may not be as readily available.”

  • The paper relies on this without support.

    Some drugs and skin disorders can interfere with skin testing.

    “Certain medications and skin conditions may interfere with skin testing.”

  • The paper relies on this without support.

    SPT has absolute or relative contraindications: uncontrolled/severe asthma, severe/unstable cardiovascular disease, beta-blockers, and pregnancy.

    “Absolute or relative contraindications to SPT include uncontrolled or severe asthma, severe or unstable cardiovascular disease, concurrent beta-blocker therapy, and pregnancy.”

  • The paper relies on this without support.

    Clinical practices differ widely in how many and which antigens they use for SPT.

    “The number and choice of antigens used in testing varies considerably between clinical practices.”

  • The paper relies on this without support.

    For some instruments a high score means worse disease; for others it means better symptom control.

    “It is important to note that some tools use a higher score to indicate severe disease whereas other tools use a higher score to indicate better control of symptoms.”

  • The paper relies on this without support.

    On RCAT, ARCT, and CARAT10, higher values reflect better allergic symptom control.

    “For example, a high score on the RCAT, ARCT, and CARAT10 indicate good control of allergic symptoms.”

  • The paper relies on this without support.

    The wheal and flare reaction in allergy skin testing depends on histamine released from mast cells upon degranulation.

    “The wheal and flare reaction seen in allergy skin testing depends upon the physiologic actions of histamine released from mast cells upon degranulation.”

  • The paper relies on this without support.

    The usefulness of allergy skin testing depends on the ability to detect a Type I hypersensitivity reaction after allergen introduction into the skin.

    “The usefulness of allergy skin testing depends upon the ability to detect a Type I hypersensitivity reaction after allergen introduction into the skin.”

  • The paper relies on this without support.

    The physical trauma of prick/puncture or intradermal testing may induce a local inflammatory response.

    “Additionally, the physical trauma of prick/puncture or intradermal testing may induce a local inflammatory response.”

  • The paper relies on this without support.

    The amount of allergen administered during nasal provocation testing typically exceeds natural exposure levels.

    “while the allergen amounts administered during an NPT usually exceed natural exposure levels, sometimes to a large extent.”

  • The paper relies on this without support.

    Locally produced IgE cannot currently be measured in routine clinical settings.

    “Despite the introduction of techniques to detect IgE in the nose in the 1970s,1078 the ability to measure locally-present IgE in the clinic setting is not currently available.”

  • The paper relies on this without support.

    Clinical validation of allergen challenge chambers remains imperfect.

    “they have been reluctant to approve them in pivotal phase III studies because the clinical validation is still imperfect.”

  • The paper relies on this without support.

    Histamine is a major mediator associated with the symptomatology of allergic rhinitis.

    “Histamine is a major mediator associated with the symptomatology of AR.”

  • The paper relies on this without support.

    Oral H1 antihistamines block the action of histamine by binding the histamine H1 receptor and thereby inhibiting the proinflammatory effects of histamine.

    “Oral H1 antihistamines block the action of histamine by binding the histamine H1 receptor, thereby inhibiting the proinflammatory effects of histamine.”

  • The paper relies on this without support.

    First-generation antihistamines are lipophilic, readily cross the blood-brain barrier, and cause sedation, drowsiness, fatigue, impaired concentration and memory, and antimuscarinic effects.

    “The older first-generation agents (ie, diphenhydramine, chlorpheniramine, brompheniramine) were lipophilic and readily crossed the blood-brain barrier. This caused unwanted side effects such as sedation, drowsiness, fatigue, and impaired concentration, and memory as well as anti-muscarinic effects.”

  • The paper relies on this without support.

    First-generation antihistamines inhibit CYP2D6 hepatic enzymes.

    “First-generation antihistamines are also inhibitors of the CYP2D6 hepatic enzymes.”

  • The paper relies on this without support.

    Newer-generation antihistamines are highly selective for the H1 receptor, lipophobic, and have limited penetration across the blood-brain barrier.

    “They are highly selective for the H1 receptor, lipophobic, and have limited penetration across the blood-brain barrier.”

  • The paper relies on this without support.

    Newer-generation antihistamines, except cetirizine, levocetirizine, bilastine, and fexofenadine, are metabolized by the hepatic cytochrome P450 CYP3A4 system.

    “Newer-generation antihistamines, except for cetirizine, levocetirizine, bilastine, and fexofenadine, are metabolized by the hepatic cytochrome P450 CYP3A4 system.”

  • The paper relies on this without support.

    Direct costs of newer-generation antihistamines are similar because many are available as over-the-counter medications.

    “Direct costs of newer-generation antihistamines are similar given the availability of many of these drugs as over-the-counter medications.”

  • The paper relies on this without support.

    The cost of prescription-only formulations of levocetirizine and desloratadine is much higher.

    “In contrast, the cost of prescription-only formulations (levocetirizine and desloratadine) is much higher.”

  • The paper relies on this without support.

    Omalizumab is not currently approved by the FDA for the treatment of AR.

    “omalizumab is not currently approved by the FDA for the treatment of AR”
    “as omalizumab is not currently approved by the FDA for AR treatment”

  • The paper relies on this without support.

    Elevated histamine levels after allergen challenge are associated with bronchoconstriction responses in acute asthma episodes.

    “elevated histamine levels after allergen challenge are associated with bronchoconstriction responses in acute asthma episodes.”

  • The paper relies on this without support.

    Allergen immunotherapy has long-lasting effects even after treatment is discontinued, unlike pharmacotherapy.

    “AIT also appears to have long-lasting effects even after discontinuing treatment, unlike pharmacotherapy.”

  • The paper relies on this without support.

    Omalizumab has a substantially higher cost than conventional therapy for asthma and allergic rhinitis.

    “Cost: Substantially higher cost than conventional therapy for asthma and AR.”

  • The paper relies on this without support.

    Allergen immunotherapy has increased cost compared with standard therapy for allergic rhinitis and asthma.

    “Cost: Increased cost compared to standard therapy for AR and asthma”

  • The paper relies on this without support.

    The neurophysiology of the vagus nerve in guinea pigs is closest to that in humans.

    “since the neurophysiology of the vagus nerve in the guinea pig is thought to be closest to humans.”
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3 of 3

Citations

Cites

Research works printed but not linked: 13

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  2. Bralow L, 2004, Vicks Sinex PDR
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  6. Jan RH, 2011, Is the effect of probiotics on allergic rhnitis confined to Dermatophagoides farinae, Dermatophagoides pteronyssinus, or dust‐sensitive children? A randomized prospective double‐blind controlled trial, Ci Ji Yi Xue Za Zhi, 23, 51
  7. Circassia Pharmaceuticals.Circassia Announces Top‐Line Results from Cat Allergy Phase III Study. Press release. Oxford UK: Circassia Pharmaceuticals; June 20 2016.http://www.circassia.com/media/press-releases/circassia-announces-top-line-results-from-cat-allergy-phase-iii-study/. Accessed December 19 2017.
  8. Circassia Pharmaceuticals.Circassia Announces Top‐Line Results from House Dust Mite Allergy Field Study. Press release. Oxford UK: Circassia Pharmaceuticals; April 18 2017.http://www.circassia.com/media/press-releases/circassia-announces-top-line-results-from-house-dust-mite-allergy-field-study/. Accessed December 19 2017.
  9. British guideline on the management of asthma, 2016, Edinburgh: UK: Scottish Intercollegiate Guidelines Network
  10. 10.1016/j.jaci.2007.09.029 · DOI · Paper page
  11. Krouse JH, 2002, Allergy and Immunology: An Otolaryngic Approach
  12. Tomonaga K, 1998, The role of nasal allergy in otitis media with effusiom, Acta Otolaryngol, 458, s41
  13. 10.1016/S0194-59989670204-8 · DOI

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Metadata

Authors
Wise, S. K., Lin, S. Y., Toskala, E., Orlandi, R. R., Akdis, C. A., Alt, J. A., Azar, A., Baroody, F. M., Bachert, C., Canonica, G. W., Chacko, T., Cingi, C., Ciprandi, G., Corey, J., Cox, L. S., Creticos, P. S., Custovic, A., Damask, C., DeConde, A., DelGaudio, J. M., Ebert, C. S., Eloy, J. A., Flanagan, C. E., Fokkens, W. J., Franzese, C., Gosepath, J., Halderman, A., Hamilton, R. G., Hoffman, H. J., Hohlfeld, J. M., Houser, S. M., Hwang, P. H., Incorvaia, C., Jarvis, D., Khalid, A. N., Kilpeläinen, M., Kingdom, T. T., Krouse, H., Larenas‐Linnemann, D., Laury, A. M., Lee, S. E., Levy, J. M., Luong, A. U., Marple, B. F., McCoul, E. D., McMains, K. C., Melén, E., Mims, J. W., Moscato, G., Mullol, J., Nelson, H. S., Patadia, M., Pawankar, R., Pfaar, O., Platt, M. P., Reisacher, W., Rondón, C., Rudmik, L., Ryan, M., Sastre, J., Schlosser, R. J., Settipane, R. A., Sharma, H. P., Sheikh, A., Smith, T. L., Tantilipikorn, P., Tversky, J. R., Veling, M. C., Wang, D. Y., Westman, M., Wickman, M., & Zacharek, M.
Affiliations
  • Emory University (US)
  • Johns Hopkins University (US)
  • Temple University (US)
  • University of Utah (US)
  • Allergy/Asthma Swiss Institute of Allergy and Asthma Research Switzerland
  • University of Chicago (US)
  • Ghent University (BE)
  • Humanitas University (IT)
  • Allergy/Immunology Private Practice USA
  • Eskişehir Osmangazi University (TR)
  • Ospedale Policlinico San Martino (IT)
  • Pediatric Allergy Imperial College London UK
  • Otolaryngology Private Practice USA
  • University of California San Diego (US)
  • Otolaryngology University of North Carolina USA
  • Rutgers New Jersey Medical School (US)
  • University of Amsterdam (NL)
  • University of Missouri (US)
  • Helios Dr. Horst Schmidt Kliniken Wiesbaden (DE)
  • The University of Texas Southwestern Medical Center (US)
  • Aarhus University (DK)
  • Medizinische Hochschule Hannover (DE)
  • Case Western Reserve University (US)
  • Stanford Medicine (US)
  • Allergy/Immunology ASST Pini/CTO Milan Italy
  • Imperial College London (GB)
  • Harvard University (US)
  • Turku University Hospital (FI)
  • University of Colorado Denver (US)
  • The University of Texas Rio Grande Valley (US)
  • Pediatric Allergy Hospital Medica Sur Mexico
  • Brooke Army Medical Center (US)
  • University of Pittsburgh (US)
  • The University of Texas Health Science Center at Houston (US)
  • Ochsner Medical Center (US)
  • Uniformed Services University of the Health Sciences (US)
  • Karolinska Institutet (SE)
  • Wake Forest University (US)
  • University of Pavia (IT)
  • Hospital Clínic de Barcelona (ES)
  • National Jewish Health (US)
  • Loyola University Chicago (US)
  • Nippon Medical School (JP)
  • Heidelberg University (DE)
  • Boston University (US)
  • Cornell University (US)
  • Hospital Regional Universitario de Málaga (ES)
  • University of Calgary (CA)
  • Hospital Universitario Fundación Jiménez Díaz (ES)
  • Medical University of South Carolina (US)
  • Brown University (US)
  • Children's National (US)
  • University of Edinburgh (GB)
  • Oregon Health & Science University (US)
  • Mahidol University (TH)
  • National University of Singapore (SG)
  • University of Michigan (US)
Corresponding author
Wise, Sarah K.
ORCID
Venue
International Forum of Allergy & Rhinology
Publisher
Wiley
Published
2018-02
Volume
8
Issue
2
Pages
108-352
ISSN
  • 2042-6976 (ISSN-L)
  • 2042-6984
DOI
10.1002/alr.22073
PMC
PMC7286723
OpenAlex
W2793898214
Semantic Scholar
d0b355b79ea4db54ec1de68bd2761f99776781aa
Cited by
557
References
2,094
Citations by year
2026: 16 · 2025: 58 · 2024: 74 · 2023: 72 · 2022: 101 · 2021: 88 · 2020: 64 · 2019: 59 · 2018: 22
FWCI
51.90
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 12 d)
Locations
  • International Forum of Allergy & Rhinology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ScholarWorks @ UTRGV (The University of Texas Rio Grande Valley) (submittedVersion, other-oa)
  • UTUPub (University of Turku) (submittedVersion, other-oa)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion)
  • Publikationsdatenbank der Fraunhofer-Gesellschaft (Fraunhofer-Gesellschaft) (submittedVersion)
  • Fraunhofer-Publica (Fraunhofer-Gesellschaft) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Spiral (Imperial College London) (submittedVersion)
  • UTUPub (University of Turku) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders
American Academy of Otolaryngic Allergy Foundation
Topics
  • Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
  • Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Keywords
allergic rhinitis, diagnosis, pathophysiology, disease burden, risk factors, allergy testing, treatment, comorbidities, research gaps
MeSH terms
Saline Solution, Adrenal Cortex Hormones, Allergens, Complementary Therapies, Biological Products, Diagnosis, Differential, Drug Therapy, Combination, Endoscopy, Environmental Exposure, Epidemiologic Methods, Histamine Antagonists, Humans, Immunoglobulin E, Occupational Diseases, Physical Examination, Quality of Life, Risk Factors, Skin Tests, Socioeconomic Factors, Nasal Decongestants, Cytokines, Probiotics, Respiratory Mucosa, Microbiota, Rhinitis, Allergic

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