Evidence-Based Medicine for Student Health Services Robert J. Flaherty, MD Swingle Student Health Service Montana State University Bozeman, MT 59717  

Allergic Rhinintis 
  

Etiology	Monitoring
Epidemiology	Prognosis
Diagnosis	Prevention
Treatment	Patient Education

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Etiology   No evidence is cited.       Epidemiology   No evidence is cited.       Diagnosis   Clinical Diagnosis  No evidence is cited.          Laboratory/X-ray Diagnosis  No evidence is cited.        Treatment    Pharmacotherapy     Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, and total nasal symptoms.  Caveats Age group studied: Unknown Type/size: Meta-analysis of 16 studies (2267 subjects) Population characteristics: Unknown Outcome measures: Nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, eye symptoms and global ratings Citations Weiner JM, Abramson MJ, Puy RM, Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials, BMJ 1998 Dec 12;317(7173): 1624-9 - From PubMed   The clinical profile of nedocromil sodium (Tilade) 1% nasal spray in seasonal allergic rhinitis demonstrates fast relief of existing symptoms, sustained efficacy with four times daily use during peak pollen challenge, and a reduced need for concomitant symptomatic therapies. Nedocromil sodium 1% nasal spray is well tolerated, with minimal side-effects, and is acceptable to a wide age-range of patients. Laboratory studies have shown that nedocromil sodium has a more wide-ranging pharmacological antiinflammatory profile than sodium cromoglycate. (Note: Not available in US yet.)  Caveats Age group studied: Adults and children Type/size: Meta-analysis (964 patients) Population characteristics: Unknown Outcome measures: Reduced symptoms of rhinitis, side effects Authors are affiliated with a pharmaceutical company Citations  Knottnerus IG, Riley PA, A clinical overview of Tilarin, Allergy 1996;51(28 Suppl):28-34 - From PubMed      Immunotherapy   Allergen immunotherapy with specific, standardized allergenic materials, administered in high-dose schedules, is effective in patients with an allergy to insect stings or allergic rhinoconjunctivitis, and in some patients with asthma, who have been correctly diagnosed through a meticulous history corroborated by positive results of skin tests and for whom avoidance of the allergen and drug therapy are not sufficiently effective.   Caveats Age group studied: Unknown Type/size: Systematic review (57 studies) Population characteristics: Patients for whom allergen avoidance and drug therapy have not been sufficiently effective Outcome measures: Clinical evaluation of symptoms, objective measurement of reactions to nasal or bronchial allergen challenge, immunologic changes as a result of allergen immunotherapy and, among patients with anaphylactic reactions to stinging insects, clinical outcome of intentional sting challenge Citations Guidelines for the use of allergen immunotherapy - Reviewed by the CMA-CPG Database        Monitoring  No evidence is cited.     Prognosis    No evidence is cited.        Prevention   No evidence is cited.       Patient Education  The following patient education materials are consistent with the available evidence.  Allergies - From the MSU Student Health Service Treating Allergic Conjunctivitis - From AAFP Allergy Shots: Could They Help Your Allergies? - From AAFP Avoiding Dust, Molds, and Mildew - From the Virtual Hospital Basic Dust and Dander Control Instructions - From the Virtual Hospital What to Do About Dust Mites in the Home - From AAFP  Rev. 7/5/99

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