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.


DATA SOURCES
Pubmed, EMBASE, and the Cochrane library.


REVIEW 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%.


CONCLUSION AND RECOMMENDATION
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.
['Frerichs|Kristine A|KA|', 'Nigten|Gea|G|', 'Romeijn|Kalynda|K|', 'Kaper|Nina M|NM|', 'Grolman|Wilko|W|', 'van der Heijden|Geert J M G|GJ|']
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 D012221:Rhinitis, Allergic, Perennial D012852:Sinusitis
allergic rhinitis acute rhinosinusitis chronic rhinosinusitis evidence based medicine prognosis prolonged rhinosinusitis