A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023

Sarah K. Wise, Cecelia Damask, Matthew Greenhawt, John Oppenheimer, Lauren T. Roland, Marcus S. Shaker, Dana V. Wallace, David M. Lang

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations


An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.

Original languageEnglish
Pages (from-to)773-796
Number of pages24
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number3
StatePublished - Mar 2023


  • Allergen immunotherapy—subcutaneous
  • Allergic rhinitis—epidemiology
  • Unmet needs
  • pathophysiology diagnosis
  • sublingual
  • treatment


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