Continuing Medical Education (CME)

Allergic Rhinitis in Adults and Children

Introduction to this self-study CME activity

Purpose

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.

New information in this revision: 

• 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).

Audience

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.

Authors

Team Leader
	David A. DeGuzman, MD     General Medicine
Team Members
	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 Relationship Company 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)

Other Acknowledgements

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

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in October 2007. CME credit may be awarded for a maximum of three years from its release date, specifically from October 2007 through September 1, 2010. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

1. View the web pages. You may print the self-study text to read off-line.
2. Complete the on-line learning assessment test.  It will be electronically scored and the correct answers returned immediately for your review.
3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
4. Print the certificate of participation for your personal records.

 

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