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Practical clinical management strategies for the allergic patient with chronic rhinosinusitis

Lee, Stella; Kundaria, Summit; Ferguson, Berrylin J.

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2012 - Volume 20 - Issue 3 - p 179–187
doi: 10.1097/MOO.0b013e328352b839
ALLERGY: Edited by Sandra Lin

Purpose of review Allergic rhinitis often coexists with chronic rhinosinusitis (CRS). The purpose of this review is to provide a practical algorithm for the treatment of patients with allergic rhinitis and CRS.

Recent findings Despite conflicting literature on the causative association of allergic rhinitis with CRS, recent research shows a higher incidence of allergic rhinitis in CRS patients refractory to medical therapy. Local IgE is hypothesized to play a role in the inflammation characteristic of both disorders, even in patients who test negative for inhalant allergies.

Summary As allergic rhinitis and CRS symptoms overlap, medications appropriate for one disorder may also be appropriate for the other. The exception would be allergen immunotherapy in the absence of allergy and antibiotics in the absence of infection. Given these principles, we have developed and provide a personalized management strategy for patients with symptoms of allergic rhinitis and CRS based on the individual's response to therapy.

Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Correspondence to S. tella Lee, MD, Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Mercy Building D, Suite 2100, 1400 Locust Street, Pittsburgh, PA 15219, USA. Tel: +1 412 232 8989; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.