title: Practical clinical management strategies for the allergic patient with chronic rhinosinusitis.
abstract: OBJECTIVE
  Allergic rhinitis often coexists with chronic rhinosinusitis (CRS). The purpose of this review is to provide a practical algorithm for the treatment of patients with allergic rhinitis and CRS.
  
  
  RESULTS
  Despite conflicting literature on the causative association of allergic rhinitis with CRS, recent research shows a higher incidence of allergic rhinitis in CRS patients refractory to medical therapy. Local IgE is hypothesized to play a role in the inflammation characteristic of both disorders, even in patients who test negative for inhalant allergies.
  
  
  CONCLUSIONS
  As allergic rhinitis and CRS symptoms overlap, medications appropriate for one disorder may also be appropriate for the other. The exception would be allergen immunotherapy in the absence of allergy and antibiotics in the absence of infection. Given these principles, we have developed and provide a personalized management strategy for patients with symptoms of allergic rhinitis and CRS based on the individual's response to therapy.
authors.affiliation: Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. lees6@upmc.edu
authors.forename: Stella
authors.initials: S
authors.lastname: Lee
authors.forename: Summit
authors.initials: S
authors.lastname: Kundaria
authors.forename: Berrylin J
authors.initials: BJ
authors.lastname: Ferguson
mesh_terms: D000465:Algorithms; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D003888:Desensitization, Immunologic; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D057285:Precision Medicine; D011379:Prognosis; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D012852:Sinusitis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents; D000900:Anti-Bacterial Agents; D007073:Immunoglobulin E