The nose as gatekeeper of the respiratory tract is continually required to react to environmental change and to rebuff external assault from a variety of agents. Exaggeration or perversion of this defensive response produces the familiar symptoms of rhinitis. With evidence of an increasing prevalence of the disease in its many forms, it was felt to be an appropriate moment to develop guidelines for the management of the condition, which although not life-threatening impacts heavily on quality of life.
Inflammation of the nasal mucosa, characterised symptomatically by congestion, rhinorrhoea, sneezing and itching, is the major pathological process in a range of conditions that must be differentiated from other conditions affecting the sinonasal tract. From an increasing array of investigative techniques, a careful history remains the most important factor in diagnosis. Research into the mechanisms of rhinitis has elucidated not only the symptomatology but the pharmacological basis of treatment, providing an extensive menu of therapeutic strategies. This includes oral and topical antihistamines, topical and systemic corticosteroids, sodium cromoglycate (cromolyn sodium) and anticholinergics, as well as immunotherapy and allergen avoidance. The treatment choice should be tailored to the individual patient, taking into account age and other special circumstances, and will reflect national differences in approach.
A working party of leading clinicians and researchers in the fields of allergy and otorhinolaryngology, representing 12 countries, has put together a consensus document on the diagnosis and management of rhinitis. The therapeutic options have been formulated into an incremental approach to treatment, which attempts to accommodate clinical variation and the philosophical differences that exist around the world. The guidelines offer practical advice on the management of rhinitis and hopefully will stimulate further discussion and research in this important area.