The literature search for this update began with the results of the literature search performed for the 2002 version of this guideline. A search for literature published since that time was performed. The search on Medline was conducted prospectively for literature published from 1/1/99 to 7/31/06 using the major keywords of: allergic rhinitis, human (adult and pediatric), English language, clinical guidelines, avoid, clinical trials – phase IV, cohort studies, controlled clinical trials, multicenter studies, randomized controlled trials, observational trial, meta analysis. Separate searches were performed for: history (inciting factors, seasonality, family history, severity & severity scoring), physical exam, signs, symptoms (nasal exam for changes in mucosa, conjunctival changes), laboratory (nasal smear for presence of eosinophyls, skin testing; avoid: radioallergosorbent test [RAST]), Diagnosis – other references, avoid or control triggers, corticosteroids (intra-nasal, ocular), antihistamines (intra-nasal, oral, ocular), leukotriene inhibitors/modulators, decongestants (intra-nasal, ocular, oral), mast cell stabilizers (intra-nasal, ocular), nonsteroidal anti-inflammatory (ocular), anticholinergics (intra-nasal), omalizumab, saline irrigation to remove allergens (nasal spray, eye wash), immunotherapy/allergy shots or inhaler, turbinate reduction surgery, integrative/alternative/ complementary medicine [9/1/05 – 7/31/06 only], pregnancy & lactation), treatment or management – other references.
The search was conducted in components each keyed to a specific causal link in a formal problem structure (available upon request). The search was supplemented with recent clinical trials known to expert members of the panel. Negative trials were specifically sought. The search was a single cycle.