Dr Allen E Gale allenegale@ozemail.com.au

Some points of interest from the recent scientific meeting of the Australasian Society of Clinical Immunology & Asthma (ASCIA) in Adelaide.

ARIA www.whiar.com

ASCIA www.allergy.org.au

ASCIA 14th Annual Scientific Meeting October 10-13 2003 Melbourne



Contents of the ARIA Pocket guide as listed on the internet:- ThePreface; Recommendations*: Definition and classification: Triggers of allergic rhinitis: Mechanisms of allergic rhinitis: Co-morbidities (Asthma, Others): Symptoms of allergic rhinitis: Diagnosing allergic rhinitis: Management: Recommendations are evidence-based: Select medications: Pharmacological treatment: Glossary of medications: Consider immunotherapy*: Treat in a stepwise approach (adolescents and adults): Treatment of concomitant rhinitis and asthma: Paediatric aspects: Special considerations (Pregnancy, Ageing): Adapting guidelines for developing countries: Adapting guidelines for local use.

Page 4 *Recommendations

1. Classification of allergic rhinitis as a major chronic respiratory disease due to its: prevalence, impact on quality of life, impact on work/school performance and productivity, economic burden, links with asthma, association with sinusitis and other co-morbidities such as conjunctivitis.

2. Along with other known risk factors, allergic rhinitis should be considered as a risk factor for asthma.

3. A new subdivision of allergic rhinitis has been made: intermittent, persistent

4. The severity of allergic rhinitis is classified as "mild" or "moderate/severe"depending on the severity of symptoms and quality of life outcomes.

5. Depending on the subdivision and severity of allergic rhinitis, a stepwisetherapeutic approach is outlined.

6. The treatment of allergic rhinitis should combine: allergen avoidance (when possible): pharmacotherapy: immunotherapy.

7. Environmental and social factors should be optimised to allow the patient to lead a normal life.

8. Patients with persistent allergic rhinitis should be evaluated for asthma by history, by chest examination, and if possible, by the assessment of airflow obstruction before and after a bronchodilator.

9. Patients with asthma should be appropriately evaluated (history and physical examination) for rhinitis.

10. A combined strategy should ideally be used to treat coexistant upper and lower airway diseases in terms of efficacy and safety.

11. In developing countries, a specific strategy may be needed depending on available treatments and interventions, and their cost.

Page 17 Consider immunotherapy*:

* In patients insufficiently controlled by conventional pharmacotherapy.

* In patients in whom oral H1-antihistamines and intranasal pharmacotherapy insufficiently control symptoms.

* In patients who do not wish to be on pharmacotherapy.

* In patients in whom pharmacotherapy produces undesirable side effects.

* In patients who do not want to receive long-term pharmacological treatment.

High dose nasal and sublingual-swallow specific immunotherapy.

* May be used with doses at least 50 to 100 times greater than those used for subcutaneous immunotherapy.

* In patients who had side effects or refused subcutaneous immunotherapy.

* The indications follow those of subcutaneous injections.

In children, specific immunotherapy is effective. However, it is not recommended to commence immunotherapy in children under 5 years of age.


I particularly enjoyed the "Gems" of wisdom that were scattered through the Stallergenes product manual:-

"Nothing great was ever achieved without enthusiasm". Georg WF Hegel

"What is now proven was once only imagined" William Blake

""Never accept anything that you cannot first check". Rudyard Kipling

"Society is like a ship; everyone must help to steer her". Henrik Ibsen

"It is not enough to take the steps that will one day lead us to our goal. Each step must constitute a goal in itself while helping to carry us forward". JW von Goethe

"I am neither Athenian nor Greek but a citizen of the world" Socrates

& the last GEM I quote comes from our Wine Centre where we held our Annual Dinner:-

"Wine is sunlight held together by water" Attributed to Galileo Galilei

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