This guideline was compiled by members of a standing committee of the American Academy of Otolaryngic Allergy. The intent of this guideline is to provide practitioners, referring physicians, patients, third-party payers, and cognizant government authorities with the fundamental principles involved in the diagnosis and treatment of the patient with allergic rhinitis. Although developed solely through the American Academy of Otolaryngic Allergy, the statements and recommendations are drawn from the entire spectrum of English-speaking literature from the United States and Europe. Articles were independently reviewed by members of the Committee, many of whom sit on editorial review boards for major professional publications. A grading system was used to categorize individual articles to demonstrate the format used to arrive at conclusions. The grade is recorded at the end of each article reference. The grading scale follows: Grade A: A study involving prospective or well-selected retrospective patient populations. The conclusions drawn are well supported by the scientific work. Little controversy relating to these conclusions would be expected. Grade B: A scientific study executed without major flaws. Limitations may exist such that the conclusions drawn remain subject to controversy. Grade C: An anecdotal or case report study.

This study investigated the clinical usefulness of the intracutaneous provocative-neutralization food test (IPFT). Thirty-seven patients were tested for five identical food allergies by eight physicians in different geographical locations. Throughout the study, comparison was made between the IPFT when interpreted by skin response (IPFT SK) and when interpreted by symptom provocation (IPFT PR). Double-blind IPFT results were compared with those of previously accomplished oral challenge food tests (OCFT). IPFT reliability was determined by a double-blind comparison of the initial IPFT, with two subsequent IPFTs performed 7 days apart. Correlation of the IPFT SK and IPFT PR with the OCFT provided validity coefficients of 0.78 and 0.61 respectively, both significant beyond the 0.01 level of confidence. Reliability of the IPFT SK and IPFT PR was shown to be 0.68 and 0.40, respectively. The IPFT SK was significant beyond the 0.01 level of confidence and the IPFT PR was significant beyond the 0.05 level of confidence.

With the oral challenge food test (OCFT) used as the standard for delayed-cyclic food hypersensitivity diagnosis, blinded comparison studies were accomplished with 175 in vitro food specific IgE and 180 IgG radioallergosorbent tests, 180 food enzyme-linked immune complex assays, and 155 in vivo Multi-Test prick tests. The study was multi-centered, eight physicians and 37 patients participating. All of the compared tests were shown to be approximately 50% efficient when compared with the OCFT results, and, thus, nonefficacious.