Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence

The selection of pharmacotherapy for patients with allergic rhinitis aims to control the disease and depends on patient empowerment, preferences, and age, prominent symptoms, symptom severity, and multimorbidity, efficacy and safety of treatment, speed of onset of action of treatment, current treatment, historic response to treatment, effect on sleep and work productivity, self-management strategies, and resource use.

This team has prepared an algorithm to step up or step down allergic rhinitis treatment based on control, which use varies depends on the availability of medications and resources. To evaluate estimates of effects, the GRADE methodology considered all types of studies and evidence on prognosis, diagnosis, values and preferences, acceptability, and feasibility or directness of findings and real-world evidence.

Different documents were considered for development of ARIA care pathways and the approach proposed confirms most GRADE recommendations for allergic rhinitis and the classification of allergic rhinitis treatments proposed by ARIA. Some conditional evidence was supported by real-world evidence:

• The combination of oral H1-antihistamines with intranasal corticosteroids was not found to be more effective than intranasal corticosteroids alone.
• The combination of intranasal H1-antihistamines with intranasal corticosteroid was found to be more effective than intranasal corticosteroids alone.
• Intranasal H1-antihistamine–containing medications are effective within minutes.