Allergic RhinitisAllergic Rhinitis according to one study may afflict up to 24% of the general population. The economic implications are enormous. Direct medical costs are estimated to be about $1.2 billion with another $1.2 billion attributed to indirect medical costs. Inclusion of associated diseases such as asthma, chronic sinusitis, otitis media with effusion and nasal polyps, all associated with allergic rhinitis bring the cost close to a staggering $10 billion.
It has been shown that the combination of physical and functional impairments linked with allergic rhinitis can profoundly affect quality of life in both adults and adolescents. As with asthma, patients with chronic allergic rhinitis have a major component of inflammation as a result of the Late Phase reaction.. Efforts hence should be directed not only towards treating acute symptoms as a result of the early phase allergic reaction with antihistamines but also chronic symptoms due to the late phase reaction, with anti inflammatory medications such as topical nasal steroids and of course environmental controls. Allergy immunotherapy may prove beneficial in patients with severe persistent symptoms.
Indications for Referral of Rhinitis Patients to the Allergist ConsultantWhen the condition or its treatment is interfering with a patients performance or causing significant loss of school or work.
When a patient's quality of life is significantly affected.
When there are complications of rhinitis (allergies) such as sinusitis, otitis media (ear infections), hearing loss, asthma or bronchitis.
When a patient requires oral corticosteroids to control their disease.
The Allergist Consultant should provide to the Referring PhysicianIdentification of specific allergens or other triggers for the patients condition, and education in ways to avoid these triggers.
Clarification of allergic or other causes for the patients condition.
Assistance in the developing an effective treatment plan, including allergy avoidance, pharmacotherapy and if necessary immunotherapy (allergy shots).
Provision for specialized services, such as preparation of extracts and provision for immunotherapy.
Indications for Referral of Sinusitis Patients to the Allergist ConsultantWhen the condition or its treatment is interfering with a patient's performance or causing significant loss of school or work on a chronic or a recurrent basis or when the patient's quality of life is significantly affected.
When there are complications of sinusitis, such as otitis, asthma or bronchitis.
When there are considerations for an allergic or immunologic basis for the sinusitis.
When the condition becomes chronic, or persists for several months, or recurs 2-3 times per year, despite treatment by the primary care physician.
What the Consultant should provide to the referring physician.Clarification of allergic or other etiologic basis for the patients condition.
Identification of specific allergens or other triggers for the patients condition, and education in ways to avoid these triggers.
Assistance in developing of an effective treatment plan, including allergy avoidance, pharmacotherapy, antibiotic therapy and immunotherapy if appropriate.
Provision of specialized services, such as preparation of extracts and provision of immunotherapy.
Adapted from The Joint Commission on Practice Parameters. Practice Parameter on Cooperative Asthma Management. JACI, in press. (Presented by M. Kaliner, MD, New Orleans 3/96)