BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

Alfred Hospital and Monash University Melbourne Australia

Allergy and Respiratory Diseases IRCCS San Martino IST University of Genoa Genoa Italy

Allergy and Respiratory Research Group Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh United Kingdom

Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece; Division of Infection Immunity and Respiratory Medicine University of Manchester Manchester United Kingdom

Allergy Unit Department of Dermatology University Hospital of Zürich and Christine Kühne Center for Allergy Research and Education CK CARE Davos Switzerland

Asthma and Allergy Clinic Humanitas University Rozzano Milan Italy

Asthma and Inflammation National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Md

Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh United Kingdom

Center of Rhinology and Allergology Wiesbaden Germany

CINTESIS Center for Health Technology and Services Research Faculdade de Medicina Universidade do Porto and Allergy CUF Porto Hospital and Instituto Porto Portugal

Department of Allergy and Rheumatology Ajou University School of Medicine Suwon Korea

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; Department of Family Medicine McMaster University Hamilton Ontario Canada

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; Department of Pediatrics University of Antioquia Medellin Colombia

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; Dirección de Investigación e Innovación Sanitaria Departamento de Salud Gobierno Vasco Eusko Jaurlaritza Vitoria Gasteiz Spain

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; Division of Clinical Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; Division of General Internal Medicine Department of Medicine McMaster University Hamilton Ontario Canada

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; School of Medicine University of Antioquia Medellín Colombia

Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton Ontario Canada; School of Medicine University of Toronto Toronto Ontario Canada

Department of Dermatology and Allergy Charité Universitätsmedizin Berlin Berlin Germany

Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University Prague Prague Czech Republic

Department of Lung Diseases and Clinical Immunology University of Turku and Allergy Clinic Terveystalo Turku Turku Finland

Department of Medicine Royal College of Surgeons in Ireland Medical School Dublin Ireland

Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital and Beijing Institute of Otolaryngology Beijing China

Department of Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands

Department of Otorhinolaryngology University Hospitals Leuven and the Department of Otorhinolaryngology Academic Medical Center Amsterdam The Netherlands

Department of Paediatrics Oslo University Hospital University of Oslo Oslo Norway

Department of Pediatrics Division of Allergy and Immunology University of California San Diego Calif

Department of Pediatrics Nippon Medical School Tokyo Japan

Department of Pediatrics Sachs' Children's Hospital South General Hospital and Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden

Department of Pneumology and Allergy Immunoallèrgia Respiratòria Clínica 1 Experimental Barcelona Spain

Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland

Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands

Department of Women and Child Health and Food Allergy Referral Centre Veneto Region University of Padua Padua Italy

Division of Allergy and Immunology University of South Florida Tampa Fla

Division of Clinical Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada

Division of Internal Medicine Asthma and Allergy Faculty of Medicine Medical University of Lodz Lodz Poland

Faculty of Medicine Transylvania University Brasov Romania

HIV STI Surveillance Research Center and World Health Organization Collaborating Center for HIV Surveillance Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran

Hospital Médica Sur Mexico City Mexico

Institute of Family Medicine and Public Health University of Tartu Tartu Estonia

Life and Health Sciences Research Institute School of Health Sciences University of Minho Braga and ICVS 3B's PT Government Associate Laboratory Braga Guimarães Portugal

National Hospital Organization Tokyo National Hospital Kiyose city Tokyo Japan

Nova Southeastern University Fort Lauderdale Fla

ProAR Center of Excellence for Asthma Federal University of Bahia Salvador Brazil

Section of Allergy and Immunology Department of Internal Medicine Saint Louis University School of Medicine St Louis Mo

Unitat de Rinologia i Clínica de l'Olfacte Servei d'ORL Hospital Clínic Clinical and Experimental Respiratory Immunoallergy IDIBAPS Barcelona Spain

University Clinic of Pulmonary and Allergic Diseases Golnik Golnik Slovenia

University Hospital Montpellier France

University Hospital of Montpellier Montpellier and Sorbonne Universités UPMC Paris 06 UMR S 1136 IPLESP Equipe EPAR Paris France

University of Aberdeen Aberdeen United Kingdom

Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium

Vilnius University Clinic of Children's Diseases and Public Health Institute Vilnius and the European Academy of Paediatrics Brussels Belgium

Woolcock Institute University of Sydney Sydney Australia

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