An online survey of clinical practice for allergic rhinitis among the Asia-Pacific representatives

Ming Zheng,^1† Xiangdong Wang,^1,2,3,4† Amir Hamzah Abdul Latiff,⁵ Ashok Shah,⁶ Duy Le Pham,⁷ Dong Young Kim,⁸ Jae Won Oh,⁹ Jiu Yao Wang,¹⁰ Kiat Ruxrungtham,¹¹ Marysia Recto,¹² Niken Lestari Poerbonegoro,¹³ Narantsetseg Logi,¹⁴ Sonomjamts Munkhbayarlakh,¹⁴ Ting Fan Leung,¹⁵ Takeshi Shimizu,¹⁶ Wen Chin Chiang,¹⁷ Wasu Kamchaisatian,¹⁸ Ruby Pawankar,¹⁹ Luo Zhang^1,2,3,4

¹ Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
² Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
³ Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otorhinolaryngology, Beijing, China
⁴ Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
⁵ Allergy & Immunology Centre, Pantai Hospital, Kuala Lumpur, Malaysia
⁶ Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
⁷ Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
⁸ Division of Infectious Diseases, Department of Inernal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
⁹ Department of Pediatrics, Hanyang University Guri Hospital, Gyunggi-Do, Korea
¹⁰ Research Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Children’s Hospital, Taichung, Taiwan
¹¹ Chula Vaccine Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
¹² Adult and Pediatric Division of Allergy and Immunology, University of the Philippines – Philippine General Hospital, Manila, Philippenes
¹³ Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
¹⁴ Department of Pulmonology and Allergology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
¹⁵ Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong China
¹⁶ Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
¹⁷ Allergy Service, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore
¹⁸ Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
¹⁹ Department of Pediatrics, Nippon Medical School, Tokyo, Japan

^†These authors contributed equally to this work.

Abstract

Background: Physicians’ knowledge and practice which are consistent with evidence-based guidelines can improve allergic rhinitis (AR) patients’ care. Compared with western countries, the available literature about Asian doctors’ perceptions and clinical practices regarding Allergic Rhinitis and its Impacts on Asthma (ARIA) guidelines is limited.
Objective: To collect detailed information about the practical management patterns specific for AR patients and investigate compliance with ARIA in the clinical practice of Asian physicians and elucidate the possible inadequacy in the existing ARIA guidelines.
Methods: An e-mail with a structured questionnaire was sent to members of the Asia-Pacific Association of Allergy, Asthma and Clinical Immunology. The questionnaire consisted of doctors’ characteristics, environment of medical practice, routine clinical practice following ARIA guidelines and patients’ adherence to the prescription.
Results: Physicians from 14 countries and regions sent valid questionnaires back, 94.12% of whom were senior doctors with more than 10 years of experience. 88.24% of doctors diagnosed AR depending on the history combined with allergy tests. 82.35% of participants employed the classification criteria by ARIA. 94.12%, 88.24% and 41.8% of respondents recommended intranasal corticosteroids, oral antihistamines and leukotriene receptor antagonists as first-line medications. 5.88% treated perennial AR by intranasal corticosteroids alone. 11.76% of clinicians recommended no allergen immunotherapy (AIT) or biologics and 58.82% of interviewees reported AR patients occasionally or sometimes agreed with the recommendation of AIT.
Conclusion: There was high compliance with ARIA guidelines in Asian senior physicians’ actual notion and practice in the management of AR. New-generation ARIA guidelines are imperative for unmet needs.
Key words: Allergic rhinitis, guideline, ARIA, clinical practice, compliance