1- Allergic testing:

Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy.

2- Imaging:

Clinicians should not routinely perform sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of AR.

3- Comorbidities:

Clinicians should assess patients with a clinical diagnosis of AR for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.

4- Pharmacologic therapy: 

Clinicians should not recommend the routine use of oral corticosteroids for AR, and should not use Omalizumab in treatment of allergic rhinitis alone.

These indicators cover aspects such as documentation, diagnostic procedures, treatment decisions, and patient education, providing a comprehensive approach to monitoring physician adherence to the clinical guidelines.

➡️Updating the guideline

To keep these recommendations up to date and  ensure  its validity it will be periodically updated. This will be done whenever a strong new evidence is available  and  necessitates updation.

➡️Research Needs

1- Controlled trials are needed comparing surgical versus medical management of inferior turbinate hypertrophy with nasal congestion in patients with AR. In addition, there is a need for further research regarding the role of septoplasty in the treatment of AR.

2- Research is needed to determine the relationship between AR and comorbid conditions such as otitis media and sinusitis. In addition, research is needed to determine the effect of AR treatment on comorbid conditions and the effect of treatment for comorbid conditions on AR.

3- More research, including basic and/or translational trials, is needed to evaluate novel forms of immunotherapy such as peptide vaccines, DNA conjugated vaccines, intradermal injections, and intralymphatic injections. These are all strategies that are hypothesized to reduce the allergenicity of extracts while maintaining or enhancing the beneficial effect on the immune system.