Keywords:
allergic rhinitis, intranasal corticosteroids, antihistamines, immunotherapy, saline rinse
Abstract
Background: Allergic rhinitis (AR) has a significant impact on the community as a whole with regard to quality of life and its relationship to allergic multi-morbidities. Appropriate diagnosis, treatment and review of the efficacy of interventions can ameliorate these effects. Yet, the importance of AR is often overlooked, and appropriate therapy is neglected. The availability of effective medications and knowledge as to management are often lacking in both public and private health systems.
Methods: This review is based on a comprehensive literature search and detailed discussions by the South African Allergic Rhinitis
Working Group (SAARWG).
Results: The working group provided up-to-date recommendations on the epidemiology, pathology, diagnosis and management of AR, appropriate to the South African setting.
Conclusion: Allergic rhinitis causes significant, often unappreciated, morbidity. It is a complex disease related to an inflammatory response to environmental allergens. Therapy involves education, evaluation of allergen sensitisation, pharmacological treatment, allergen immunotherapy (AIT) and evaluation of the success of interventions. Regular use of saline; the important role of intranasal corticosteroids, including those combined with topical antihistamines and reduction in the use of systemic steroids are key. Practitioners should have a thorough knowledge of associated morbidities and the need for specialist referral.
Contribution: This review summarises the latest developments in the diagnosis and management of AR such that it is a resource that allows easy access for family practitioners and specialists alike.
Author Biographies
GA Richards, University of the Witwatersrand
Department of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
M McDonald, The Allergy Clinic
The Allergy Clinic, Blairgowrie, South Africa
CL Gray, University of Cape Town
Department of Paediatric Allergy, Faculty of Child Health, University of Cape Town and Department of Paediatric Allergy, Private Practice, Vincent Palotti Hospital, South Africa
P de Waal, University of the Free State
Department of Allergy, Pulmonology and Immunology, Faculty of Health Sciences, University of the Free State and Private Practice, Mediclinic Panorama, South Africa
R Friedman, Mediclinic Sandton
Department of Otorhinolaryngology, Private Practice, Mediclinic Sandton, South Africa
M Hockman, Netcare Linksfield Hospital
Johannesburg Cochlear Implant Programme, Netcare Linksfield Hospital, South Africa
SJ Karabus, University of Cape Town
Allergy Division, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, South Africa
CM Lodder
Department of Allergy and Asthma Clinic, Private Practice, South Africa
T Mabelane, Sefako Makgatho Health Sciences University
Department of Internal Medicine, Faculty of Health Sciences, Sefako Makgato Health Sciences University, South Africa
SM Mosito, University of Pretoria
Department of Otolaryngology, Faculty of Health Sciences, University of Pretoria, South Africa
A Nanan, University of the Witwatersrand
Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
JG Peter, University of Cape Town
Department of Medicine, Faculty of Health sciences, University of Cape Town, South Africa
THC Quitter, University of Pretoria
Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Health Sciences, University of Pretoria, South Africa
R Seedat, University of the Free State
Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, South Africa
S van den Berg, Ampath Laboratory
Department of Immunology, Ampath Laboratories and Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
A van Niekerk, University of Pretoria
Department of Paediatrics and Child Health, Departments of Inborn Errors of Immunity and Allergology and Department of Immunology, Faculty of Health Sciences, University of Pretoria, South Africa
E Vardas, University of Stellenbosch
Department of Clinical Virology, Faculty of Health Sciences, University of Stellenbosch and Department of Virology Allergy and Immunology, Lancet Laboratories, South Africa
C Feldman, University of the Witwatersrand
Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
