Allergic rhinitis, the most common form of rhinitis, affects 20-40 million people in the United States annually, including 10-30% of adults and up to 40% of children. This CME activity addresses the diagnosis and cost-effective treatment of allergic rhinitis in children and adults. The educational material provides useful summaries on practical aspects of care, including an algorithm for steps in diagnosis and treatment, alternative diagnoses to consider, advantages and disadvantages of pharmacologic and immunotherapy, and information on most types of pharmacologic therapy commonly used.

Important new points in this update are:

• Oral second generation (non-sedating) antihistamines are recommended over first generation antihistamines due to significant side-effects of sedating antihistamines. Loratadine is available over-the-counter. It should be tried initially, as it will provide relief in most cases.
• Leukotriene inhibitors are generally recommended as second-line therapy, but could be considered first line for patients with co-morbid persistent asthma.
• Drug table (Table 6) is updated with new medications, generic status, and pricing.

Key aspects of care include:

• Avoidance of allergen exposure is the first step in treatment.
• Multiple therapies are available, with nasal corticosteroids considered the most potent medications available for treating allergic rhinitis.
• Consider referral if patients:
  • have contraindication to or have failed medical therapy
  • need testing to identify specific allergens for avoidance
  • have comorbidities (asthma, nasal polyps, recurrent sinusitis).

This self-study activity is appropriate for primary care clinicians and other health care providers involved in the diagnosis and treatment of allergic rhinitis in children and adults.

	David A. DeGuzman, MD     General Medicine Catherine M. Bettcher, MD     Family Medicine R. Van Harrison, PhD      Medical Education Christine L. Holland,MD     Allergy Cary E. Johnson, PharmD     Pharmacy Sharon Kileny, MD     Pediatrics Jeffrey Terrell, MD      Otolaryngology
Author Disclosures	Team Member Company Relationship David A. DeGuzman, MD (None) Catherine M. Bettcher, MD (None) R. Van Harrison, PhD (None) Christine L. Holland,MD (None) Cary E. Johnson, PharmD (None) Sharon Kileny, MD (None)   Jeffrey Terrell, MD Neilmed Research support (saline solution)

UMHS Guidelines Oversight Team:	William E. Chavey, MD Van Harrison, PhD
Literature search services:	Taubman Medical Library
Production of Internet format and web site maintenance:	Ellen Patrick-Dunlavey