Position paper Consensus statement* on the treatment of allergic rhinitis P. van Cauwenberge (Belgium) C. Bachert (Belgium) G. Passalacqua (Italy) J. Bousquet (France) G. W. Canonica (Italy) S. R. Durham (UK) W. J. Fokkens (Netherlands) P. H. Howarth (UK) V. Lund (UK) H.-J. Malling (Denmark) N. Mygind (Denmark) D. Passali (Italy) G. K. Scadding (UK) D.-Y. Wang (Singapore) Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium Prof. P. van Cauwenberge Department of Otorhinolaryngology Ghent University Hospital De Pintelaan 185 B-9000 Ghent Belgium Accepted for publication 12 October 1999 1. Introduction Allergic rhinitis (AR) is a high-prevalence disease in many developed countries, affecting about 10–20% of the general population (1–5). Several studies based on questionnaire and objective testing or medical exam- ination indicate an increasing prevalence of AR in European countries over the last decades (6, 7). AR is characterized by nasal itching, sneezing, watery rhinorrhoea, and nasal obstruction. Additional symp- toms such as headache, impaired smell, and conjunc- tival symptoms can be associated. According to the time of exposure, AR can be subdivided into perennial, seasonal, and occupational disease. Perennial AR (PAR) is most frequently caused by dust mites and animal dander. Seasonal AR (SAR) is related to a wide variety of pollen allergens including grasses, Parietaria, Ambrosia, Artemisia, birch, olive, hazelnut, and cypress. The morbidity of SAR obviously depends on the geographic region, the pollen season of the plants, and the local climate. Several other conditions can cause similar symptoms and are referred to as nonallergic (noninfectious) rhinitis: NARES (nonallergic rhinitis with eosinophilia syndrome); aspirin sensitivity; endocrine, occupational, postinfectious, and side-effects of systemic drugs; abuse of topical decongestants (rhinitis medicamentosa); and idiopathic rhinitis. Furthermore, diseases such as nasal polyposis, chronic sinusitis, cystic fibrosis, Wegener’s disease, benign or malignant tumours, etc. have to be excluded carefully. Therefore, current guidelines (4) emphasize the importance of an accurate diagnosis of patients presenting with rhinitis symptoms. In fact, several causes may commonly coexist in the same *European Academy of Allergology and Clinical Immunology. Allergy 2000: 55: 116–134 Printed in UK. All rights reserved Copyright # Munksgaard 2000 ALLERGY ISSN 0105-4538 116