Inconclusive evidence for allergic rhinitis to predict a prolonged or chronic course of acute rhinosinusitis.
OBJECTIVE
To systematically review the evidence on allergic rhinitis as a predictor for a prolonged or chronic course in adult patients with acute rhinosinusitis.


METHODS
Pubmed, EMBASE, and the Cochrane library.


METHODS
A systematic literature search was performed on March 15, 2013. During screening of title and abstract, 3 authors independently selected studies on allergic rhinitis as a predictor for the course of acute rhinosinusitis in adults. The reported study design was assessed for directness of evidence and risk of bias. We aimed to extract prior and posterior probabilities for a prolonged or chronic course of acute rhinosinusitis.


RESULTS
Of 13,202 retrieved articles, 2 articles were eligible for study assessment. They provided a high directness of evidence but carried a high risk of bias. The studies showed an incidence of a prolonged and chronic course of, respectively, .19 (95% confidence interval [CI] .16-.23) and .05 (95% CI, .02-.13). In patients with allergic rhinitis, the incidence was .25 (95% CI, .18-.35) and .14 (95% CI, .04-.34), so the added value of allergic rhinitis to predict a prolonged course is 6% and to predict a chronic course 8%.


CONCLUSIONS
While the 2 included studies suggest that allergic rhinitis adds little to the prediction of a prolonged or chronic course in patients with acute rhinosinusitis, they carry a high risk of bias. As the available evidence does not provide grounds for different management of patients with and without allergic rhinitis, namely, according to clinical practice guidelines, both can be managed with expectant observation and symptomatic treatment.
Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Kristine A
KA
Frerichs
Gea
G
Nigten
Kalynda
K
Romeijn
Nina M
NM
Kaper
Wilko
W
Grolman
Geert J M G
GJ
van der Heijden
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000503:physiopathology*; D012221:Rhinitis, Allergic, Perennial / Q000150:complications*; D012852:Sinusitis / Q000503:physiopathology*
acute rhinosinusitis; allergic rhinitis; chronic rhinosinusitis; evidence based medicine; prognosis; prolonged rhinosinusitis