New Guideline on Diagnosing, Treating Allergic Rhinitis

by Karen Appold •

While panel members looked at herbal therapies, they didn’t make any recommendations regarding their use due to limited knowledge of herbal medicines and concern about the quality of standardization and safety.

The guideline concludes with a listing of 15 areas in which more research is needed. While many of the key action statements were supported by Grade A-level evidence, review of the evidence profile for other statements revealed knowledge gaps and the need for further research.

Karen Appold is a freelance medical writer based in Pennsylvania.

Abstracts from The Laryngoscope

Incremental Healthcare Utilization and Expenditures for Allergic Rhinitis in the United States

Objective: Determine incremental increases in healthcare expenditures and utilization associated with allergic rhinitis (AR).

Methods: Patients reporting a diagnosis of AR were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. AR patients were then compared to non-AR patients determining differences in healthcare utilization: office visits, emergency facility visits, and prescriptions filled, as well as differences in healthcare expenditures: total healthcare costs, office-based costs, prescription medication costs, and self-expenditures using demographically and comorbidity adjusted multivariate models.

Results: An estimated 17.8 ± 0.72 million adult patients reported AR in 2007 (7.9 ± 0.3% of the U.S. population). The additional incremental healthcare utilizations associated with AR relative to non-AR patients for office visits, emergency facility visits, and number of prescriptions filled were 3.25 ± 0.40, 0.01 ± 0.02, and 8.95 ± 0.80, respectively (P < .001, .787, and <.001, respectively). Similarly, additional healthcare expenditures associated with AR for total healthcare expenses, office-based visit expenditures, prescription expenditures, and self-expenditures were $1,492 ± 346, $461 ± 122, $876 ± 126, and $168 ± 25, respectively (all P < 0.001).

Conclusions: AR is associated with substantial incremental increases in healthcare utilization and expenditures due to increases in office-based visits and prescription expenditures. As a commonly prevalent and costly disease, AR would be a prime target for guideline development and standardization of care (Laryngoscope. 2011;121:1830-1833).

Effectiveness of Subcutaneous Immunotherapy for Allergic Rhinoconjunctivitis and Asthma: A Systematic Review

Objectives/hypothesis: To systematically review the effectiveness and safety of subcutaneous immunotherapy (SCIT) for treatment of allergic rhinoconjunctivitis and asthma, using formulations currently approved in the United States.

Study design: We searched the following databases up to May 21, 2012: MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials.

Methods: We included randomized controlled trials published in English comparing SCIT to placebo, pharmacotherapy, or other SCIT regimens that reported clinical outcomes of interest. Studies of adults or mixed age populations were included. Studies were excluded if the diagnosis of allergy and/or asthma was not confirmed with objective testing. Paired reviewers selected articles for inclusion and extracted data. We assessed the risk of bias for each study and graded the strength of evidence for each outcome as high, moderate, or low.