Adherence of doctors to clinical recommendations in the management of children and adolescents with allergic rhinitis

Introduction. The Russian Federation has adopted international and national conciliatory documents and clinical guidelines covering the diagnosis and treatment of allergic rhinitis (AR). The extent to which doctors adhere to the guidelines remains unclear.
Methods: online survey of allergists (32.7%), pediatricians (54.4%) and others (total n = 364) in 2023–2024.
Results: Most specialists (81.6%) adhere to Russian official clinical recommendation, while about 4% of respondents adhere to international guidelines. A significant part of doctors actively uses the term “seasonal/perennial” AR (75.3%), less often the indication of the severity and course of the disease is used. Pediatricians don’t use the classification more often than allergists. To determine the severity of the visual analog scale is used only in 23.0% of cases.
Among laboratory diagnostic methods, allergists are more likely to prescribe a specific examination than pediatricians (87.8% vs. 56.8%). Only 53.8% of respondents consider it mandatory to conduct an allergological examination for patients with AR.
57.4% of respondents believe that the amount of initial therapy depends on the severity of the disease. The most popular drugs for starting therapy are intranasal steroids (40.2%), antihistamines (23.5%), montelukast 4.0%, and intranasal antihistamines 4,8%. If it is necessary to use concomitant therapy 56.4% of doctors choose a fixed combination of intranasal steroid + antihistamines as a first-line therapy, and an additional 20.9% consider this option in rare cases. 
In severe cases, 16.9% of doctors prescribe oral steroids, 20.4% choose the parenteral route of corticosteroid administration, and 33.6% of respondents do not prescribe systemic corticosteroids. The majority of doctors surveyed are aware of the immunobiological therapy of AR — 73.0%, and 26.7% actively support the appointment of biological therapy for AR. Allergen-specific therapy is recommended to be considered by 61.9% of the surveyed doctors.
Conclusion: The study shows the need to train physicians facing AR problems in accordance with current clinical guidelines and international practice.

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