Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice

Abstract

The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.

Allergic rhinitis

“…Asthma should always be assessed in patients with AR by asking patients about wheezing, shortness of breath and sleep disturbance plus, if needed, an objective measurement such as spirometry 80 and vice versa in patients with asthma owing to the frequent co-occurrence of these disorders. Patients should also undergo ear inspection as otitis media with effusion (also known as glue ear) may be a co-morbidity in children with rhinitis and in adults with severe forms of rhinosinusitis 81 .…”

Impact of allergic rhinitis on the day-to-day lives of children: insights from an Australian cross-sectional study

“…Given the availability of over-the-counter allergy medicines, and high levels of self-diagnosis and self-management of AR, the principles behind these guidelines and the use of VAS scales for self-assessment have been incorporated into care pathways, algorithms and shared decision support systems for use in the community pharmacy setting. 37 39 A recent review of AR adds to this, supporting the view that shared decision-making can help to better equip patients to make appropriate decisions for optimal disease control. 40 …”

“…Increased understanding of the importance of impact and adequacy of control to sufferers has lead to a paradigm shift. 37 In recent years, the MACVIA-ARIA Sentinel NetworK has developed and validated VAS scales to evaluate the extent of AR symptom control. 3 25 Well-controlled AR has previously been defined as a VAS of score of 2 or less.…”

The Potential of Clinical Decision Support Systems for Prevention, Diagnosis, and Monitoring of Allergic Diseases

“…The ARIA consortium also underlined the importance of pharmacists for integrated care pathways of respiratory allergic diseases ( 41 ). The authors recently proposed a CDSS supporting pharmacists in monitoring the patient’s symptom control and adjusting symptomatic treatment accordingly ( 42 ) ( Figure 2 ). This comprehensive approach to supporting pharmacists in their front-line role in allergy care is a promising concept.…”