564557
tolaryngology–Head and Neck SurgeryKrouse 2014© The Author(s) 2010
OTOXXX10.1177/0194599814564557O
Reprints and permission: sagepub.com/journalsPermissions.nav
Editorial
Allergic Rhinitis: Journeys and Experiences
In this issue, the journal is pleased to present the recently completed AAO-HNS/F clinical practice guideline on allergic rhinitis—a common illness frequently treated by otolaryngologists and other health professionals.1 Guideline chair Dr Michael Seidman and his multidisciplinary team have authored a comprehensive evidence-based article that provides a series of recommendations and options for clinicians managing adults and children with allergic rhinitis. The publication of this article is a tangible representation of our specialty’s journey in and experience with allergy as a core discipline in otolaryngology. Let me also relate a personal journey. In the early 1990s, I chose to focus my clinical interests on chronic rhinosinusitis and developed a busy and successful practice in endoscopic sinus surgery. There continued to be a number of my patients, however, who just didn’t seem to get symptomatic improvement at the level I would have anticipated yet who had no evidence of persistent infection or polypoid disease on endoscopic examination. I was presenting this perplexing clinical dilemma on a panel around 1993, and one of the more seasoned otolaryngologists in the audience came to the microscope and asked, “And how did you diagnose and treat your patients’ allergies?” I admitted that I really didn’t consider allergy in those individuals, and my inquisitor wisely stated, “How can you be treating sinus patients without treating allergy?” Hmm. Very interesting question, indeed. I started to investigate science and practice in the discipline of allergy and immunology, an area of inquiry that I learned had a rich history dating back to the late 19th century. I thought back to my residency years at Massachusetts Eye and Ear Infirmary (MEEI) and remembered the voice of one of our attendings, Dr Bruce Gordon, who was the lone person on staff who talked to us in clinic about the role of allergy in our patients. We otolaryngology residents, as true surgeons in training, looked at Bruce’s words with skepticism, seeking the surgical cure to our patients’ many maladies. Most of our faculty at MEEI were similarly skeptical. I began to participate in instructional courses offered by the American Academy of Otolaryngic Allergy and attended miniseminars and instruction courses at our AAO-HNS/F annual meetings. I did independent reading, studied the pathophysiology of allergy, learned skin-testing techniques, and began to treat patients with subcutaneous immunotherapy. I saw patients previously challenged to achieve optimal results after sinus surgery having incremental and sustained symptomatic improvement with allergy management. I was hooked!
Otolaryngology– Head and Neck Surgery 2015, V ol. 152(2) 193–194 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814564557 http://otojournal.org
Twenty years, 40 journal articles, and 3 textbooks later, I have built much of my academic career around research, education, and clinical practice in allergy. I have seen the central role of allergy in many diseases that we treat as otolaryngologists. I have facilitated discussion in the important relationship between inflammatory diseases of the upper and lower respiratory systems, commonly referred to as “The Unified Airway.” I have worked to bring asthma to the attention of otolaryngologists as an important comorbidity in our patients whom we may elect to treat in our allergy practices. In 2011, I was inducted as a Fellow in the American Academy of Allergy, Asthma, and Immunology—one of only a handful of otolaryngologists to be honored with this fellowship. It’s safe to say that my skepticism of the importance of allergy has disappeared. Thanks, Bruce, for your wise and prescient guidance! Lest you think that appreciation of the role of allergy in rhinology and otolaryngology is a relatively recent revelation, let me offer a quote that sheds some light on this relationship. Dr H. P. Merrill in the journal California and Western Medicine drew attention to this association, highlighting “the vast importance of the study of allergy to the rhinologist.”2 The year of this insight was 1929! There remains much to learn from our wise predecessors. So, with the publication of this guideline on allergic rhinitis, Dr Seidman and colleagues contribute an important article on allergy that both continues this journey and offers rich knowledge and experience. This comprehensive guideline offers current science- and evidence-based guidance for the diagnosis and treatment of our patients with allergic rhinitis. I think you will find the recommendations and options useful for your patients and look forward to sharing in the discussion that the guideline is sure to generate. Given my professional interest and journey, it is a personal thrill and honor to me to feature our guideline on allergic rhinitis in the February 2015 issue of Otolaryngology–Head and Neck Surgery. I am sure you will enjoy reading it as much as I have. John H. Krouse, MD, PhD Editor in Chief, Department of Otolaryngology/Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA Corresponding Author: John H. Krouse, MD, PhD, Temple University, Otolaryngology/HNS, 3440 N Broad St, Kresge West #300, Philadelphia, PA 19140, USA. Email: [email protected]
Downloaded from oto.sagepub.com at KAI NAN UNIV on March 8, 2015
194
Otolaryngology–Head and Neck Surgery 152(2)
References
2. Merrill HP. Allergic rhinitis. Cal West Med. 1929;20:338-342.
1. Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis. Otolaryngolol Head Neck Surg 2015;152:(1S):S1-S43.
Downloaded from oto.sagepub.com at KAI NAN UNIV on March 8, 2015
tolaryngology–Head and Neck SurgeryKrouse 2014© The Author(s) 2010
OTOXXX10.1177/0194599814564557O
Reprints and permission: sagepub.com/journalsPermissions.nav
Editorial
Allergic Rhinitis: Journeys and Experiences
In this issue, the journal is pleased to present the recently completed AAO-HNS/F clinical practice guideline on allergic rhinitis—a common illness frequently treated by otolaryngologists and other health professionals.1 Guideline chair Dr Michael Seidman and his multidisciplinary team have authored a comprehensive evidence-based article that provides a series of recommendations and options for clinicians managing adults and children with allergic rhinitis. The publication of this article is a tangible representation of our specialty’s journey in and experience with allergy as a core discipline in otolaryngology. Let me also relate a personal journey. In the early 1990s, I chose to focus my clinical interests on chronic rhinosinusitis and developed a busy and successful practice in endoscopic sinus surgery. There continued to be a number of my patients, however, who just didn’t seem to get symptomatic improvement at the level I would have anticipated yet who had no evidence of persistent infection or polypoid disease on endoscopic examination. I was presenting this perplexing clinical dilemma on a panel around 1993, and one of the more seasoned otolaryngologists in the audience came to the microscope and asked, “And how did you diagnose and treat your patients’ allergies?” I admitted that I really didn’t consider allergy in those individuals, and my inquisitor wisely stated, “How can you be treating sinus patients without treating allergy?” Hmm. Very interesting question, indeed. I started to investigate science and practice in the discipline of allergy and immunology, an area of inquiry that I learned had a rich history dating back to the late 19th century. I thought back to my residency years at Massachusetts Eye and Ear Infirmary (MEEI) and remembered the voice of one of our attendings, Dr Bruce Gordon, who was the lone person on staff who talked to us in clinic about the role of allergy in our patients. We otolaryngology residents, as true surgeons in training, looked at Bruce’s words with skepticism, seeking the surgical cure to our patients’ many maladies. Most of our faculty at MEEI were similarly skeptical. I began to participate in instructional courses offered by the American Academy of Otolaryngic Allergy and attended miniseminars and instruction courses at our AAO-HNS/F annual meetings. I did independent reading, studied the pathophysiology of allergy, learned skin-testing techniques, and began to treat patients with subcutaneous immunotherapy. I saw patients previously challenged to achieve optimal results after sinus surgery having incremental and sustained symptomatic improvement with allergy management. I was hooked!
Otolaryngology– Head and Neck Surgery 2015, V ol. 152(2) 193–194 © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814564557 http://otojournal.org
Twenty years, 40 journal articles, and 3 textbooks later, I have built much of my academic career around research, education, and clinical practice in allergy. I have seen the central role of allergy in many diseases that we treat as otolaryngologists. I have facilitated discussion in the important relationship between inflammatory diseases of the upper and lower respiratory systems, commonly referred to as “The Unified Airway.” I have worked to bring asthma to the attention of otolaryngologists as an important comorbidity in our patients whom we may elect to treat in our allergy practices. In 2011, I was inducted as a Fellow in the American Academy of Allergy, Asthma, and Immunology—one of only a handful of otolaryngologists to be honored with this fellowship. It’s safe to say that my skepticism of the importance of allergy has disappeared. Thanks, Bruce, for your wise and prescient guidance! Lest you think that appreciation of the role of allergy in rhinology and otolaryngology is a relatively recent revelation, let me offer a quote that sheds some light on this relationship. Dr H. P. Merrill in the journal California and Western Medicine drew attention to this association, highlighting “the vast importance of the study of allergy to the rhinologist.”2 The year of this insight was 1929! There remains much to learn from our wise predecessors. So, with the publication of this guideline on allergic rhinitis, Dr Seidman and colleagues contribute an important article on allergy that both continues this journey and offers rich knowledge and experience. This comprehensive guideline offers current science- and evidence-based guidance for the diagnosis and treatment of our patients with allergic rhinitis. I think you will find the recommendations and options useful for your patients and look forward to sharing in the discussion that the guideline is sure to generate. Given my professional interest and journey, it is a personal thrill and honor to me to feature our guideline on allergic rhinitis in the February 2015 issue of Otolaryngology–Head and Neck Surgery. I am sure you will enjoy reading it as much as I have. John H. Krouse, MD, PhD Editor in Chief, Department of Otolaryngology/Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA Corresponding Author: John H. Krouse, MD, PhD, Temple University, Otolaryngology/HNS, 3440 N Broad St, Kresge West #300, Philadelphia, PA 19140, USA. Email: [email protected]
Downloaded from oto.sagepub.com at KAI NAN UNIV on March 8, 2015
194
Otolaryngology–Head and Neck Surgery 152(2)
References
2. Merrill HP. Allergic rhinitis. Cal West Med. 1929;20:338-342.
1. Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis. Otolaryngolol Head Neck Surg 2015;152:(1S):S1-S43.
Downloaded from oto.sagepub.com at KAI NAN UNIV on March 8, 2015
