Treating allergic rhinitis: continuous versus on-demand regime? Executive summary of the Supportive Initiatives for the Global Management of Allergy (SIGMA): report from the Belgian Working Group

This Supportive Initiative for the Global Management of Allergy (SIGMA) initiative gathered together four multidisciplinary and inter-university groups of Belgian experts in the treatment of allergic rhinitis to review the literature and come to a consensus opinion on the global management of allergy. Their conclusions were as follows. Group 1 concluded that in children suffering from allergic rhinitis, there is sufficient expert opinion in favour of continuous treatment with both H1-antihistamines and corticosteroids for controlling symptoms during periods of allergen exposure, but not to support continuous treatment during periods when symptoms are negligible in an attempt to prevent the development of new allergic diseases. Group 2 came to similar conclusions in adults. Group 3 considered adults with concomitant asthma and stressed the crucial necessity to screen each asthmatic for allergic rhinitis and institute appropriate therapy for both conditions. Even though efficacious treatment algorithms are available for both rhinitis and asthma, an integrated management of these frequently concomitant diseases is not always prescribed even though there is a proven clinical advantage of adequate treatment of the nose of asthmatics. Group 4 concluded that for both H1-antihistamines and nasal corticosteroids, safety data indicate that continuous treatment may be given without fears of adverse consequences. With regard to the cost implications of continuous therapy versus on-demand therapy, there are indications that effective treatment of allergic rhinitis by continuous treatment reduces overall drug costs, particularly that of escape medication and indirect costs in the form of days absent from work and school