BACKGROUND: Allergic rhinitis (AR) is an important disease in
South Africa. The South African Allergic Rhinitis Working Group
(SAARWG) has published previous guidelines for AR diagnosis
and management. Areas of concern have arisen that require
additional information, including the management of AR in
infancy, appropriate and inappropriate allergy testing, cost of AR
management, diagnosis and distinguishing the condition from
sinusitis, use of over-the-counter medications, and the concept of
the ‘united airway’.
RECOMMENDATIONS: Clinicians should consider the possibility of
AR in infants with recurrent nasal symptoms. Allergy testing should
be used wisely and based on local allergens. Total IgE testing is not
routinely required to prove allergy. Acute and chronic sinusitis
should be considered in conjunction with AR; treatment of rhinitis
will improve these conditions. Over-the-counter medications
should be used sparingly and with caution. Concern for long-term
use of topical decongestants must be noted. Asthma should always
be considered in AR diagnosis. Immunotherapy is available in SA
and may be extremely useful in selected AR patients.
CONCLUSION: The SAARWG proposed an algorithm for the
diagnosis and management of rhinitis in South Africa. AR is
common, important and troubling to patients; therefore, every
effort should be made to target therapy correctly. Patient education
is important in the management of AR.