Beyond Algorithms: Clinical Judgement in the Management of Allergic Rhinitis

Di Lorenzo G, Melluso M, Seidita A. Clin Exp Allergy. 2026 Feb 17. doi: 10.1111/cea.70254.

From disease to illness in allergic rhinitis

Allergic rhinitis affects 10%–40% of the global population and represents one of the most frequently managed conditions in allergy and internal medicine practice. International guidelines, particularly ARIA (Allergic Rhinitis and its Impact on Asthma), have successfully standardised diagnosis and treatment through evidence-based algorithms that constitute an undeniable scientific advance. However, after 40 years of outpatient allergy practice, it becomes clear that daily clinical reality reveals a complexity that transcends standardised recommendations. This patient-centred perspective is not new—it echoes the Hippocratic emphasis on studying the patient rather than the disease, on careful observation and on allowing sufficient time to combine contradictory findings.

This editorial does not intend to criticise clinical guidelines, whose value is unquestionable. Rather, it aims to explore what guidelines, by their very nature, cannot fully teach: the clinical complexity emerging from the individual patient, the diagnostic ambiguity that escapes algorithms, the variability of therapeutic response and the relational dimension of care.

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