Original Research Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group

Guy A. Richards, Marinda McDonald, Claudia L. Gray, Pieter de Waal, Ray Friedman, Maurice Hockman, Sarah J. Karabus, Cornelia M. Lodder, Tshegofatso Mabelane, Sylvia M. Mosito, Ashen Nanan, Jonny G. Peter, Traugott H.C. Quitter, Riaz Seedat, Sylvia van den Berg, Andre van Niekerk, Eftyhia Vardas, Charles Feldman

South African Family Practice | Vol 65, No 1 : Part 4| a5806 | DOI: https://doi.org/10.4102/safp.v65i1.5806 | © 2023 Guy A Richards, Marinda McDonald, Claudia Liesel Gray, Pieter de waal, Ray Friedman, Maurice Hockman, Sarah Jane Karabus, Cornelia Magdelena Lodder, Tshegofatso Mabelane, Sylvia Motlalepule Mosito, Ashen Nanan, Jonny G Peter, Traugott Herman Christian Quitter, Riaz Seedat, Sylvia van den Berg, Andre van Niekerk, Eftyhia Vardas, Charles Feldman | This work is licensed under CC Attribution 4.0
Submitted: 02 August 2023 | Published: 30 October 2023

About the author(s) Guy A. Richards, Department of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Marinda McDonald, The Allergy Clinic, Blairgowrie, Johannesburg, South Africa
Claudia L. Gray, Department of Paediatric Allergy, Faculty of Child Health, University of Cape Town, Cape Town; and, Department of Paediatric Allergy, Private Practice, Vincent Palotti Hospital, Cape Town, South Africa
Pieter de Waal, Department of Allergy, Pulmonology and Immunology, Faculty of Health Sciences, University of the Free State, Bloemfontein; and, Private Practice, Mediclinic Panorama, Cape Town, South Africa
Ray Friedman, Department of Otorhinolaryngology, Private Practice, Mediclinic Sandton, Sandton, South Africa
Maurice Hockman, Johannesburg Cochlear Implant Programme, Netcare Linksfield Hospital, Johannesburg, South Africa
Sarah J. Karabus, Allergy Division, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Cornelia M. Lodder, Department of Allergy and Asthma Clinic, Private Practice, George, South Africa
Tshegofatso Mabelane, Department of Internal Medicine, Faculty of Health Sciences, Sefako Makgato Health Sciences University, Pretoria, South Africa
Sylvia M. Mosito, Department of Otolaryngology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Ashen Nanan, Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Jonny G. Peter, Department of Medicine, Faculty of Health sciences, University of Cape Town, Cape Town, South Africa
Traugott H.C. Quitter, Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Riaz Seedat, Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
Sylvia van den Berg, Department of Immunology, Ampath Laboratories, Pretoria; and Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Andre van Niekerk, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria; Departments of Inborn Errors of Immunity and Allergology, Faculty of Sciences, University of Pretoria, Pretoria; and Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Eftyhia Vardas, Department of Clinical Virology, Faculty of Health Sciences, University of Stellenbosch, Stellenbosch; and Department of Virology Allergy and Immunology, Lancet Laboratories, Johannesburg, South Africa
Charles Feldman, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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.

Keywords

allergic rhinitis; intranasal corticosteroids; antihistamines; immunotherapy; saline rinse

Sustainable Development Goal

Goal 3: Good health and well-being

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