Archives of Hellenic Medicine

Last update:

29-Apr-2026

Arch Hellen Med, 43(4), July-August 2026, 535-543

SPECIAL ARTICLE

Algorithm for the management of patients with possible allergic rhinitis in primary health care – Referral indications

N. Papanikolaou,¹ A. Tatsioni,² I. Tsiligianni,³ X. Aggelidis,⁴ S. Vasileiadou,⁵ D. Vourdas,⁶ M.V. Dimou,⁵ M. Gkagka,⁷ C. Grigoreas,⁸
J. Kapsali,⁸ F. Kapsouli,⁹ M. Katotomichelakis,¹⁰ I. Konstantinidis,¹¹ J. Constantinidis,¹² S. Loukidis,¹³ P. Maggina,⁵ M. Makris,⁴
E. Manousakis,⁵ P. Maragoudakis,¹⁴ N. Mikos,¹⁵ D. Mitsias,⁵ P. Bakakos,¹⁶ A. Pagkalos,¹⁷ V. Papanikolaou,¹⁸ E. Paraskakis,¹⁹
G. Paraskevopoulos,²⁰ E. Prokopakis,²¹ N. Rovina,¹⁶ K. Samitas,⁷ A. Sinaniotis,⁹ S. Stamataki,²² N. Stratidakis,²³ E. Stefanaki,²⁴
A. Syrigou,²⁵ P. Fragkos,²⁶ F. Psarros,²⁷ P. Xepapadaki,⁵ J. Bousquet,^28–31 N.G. Ppadopoulos⁵
¹"Hippocrates" Association of General Practice/Family Medicine of Greece, Athens,
²Department of General Medicine and Primary Health Care Research, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina,
³Clinic of Social and Family Medicine, Division of Social Medicine, Medical School, University of Crete, Heraklion, Crete,
⁴"D. Kalogeromitros" Allergy Unit, Second Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens,
⁵Allergy and Clinical Immunology Unit, Second Pediatric Clinic, "P. & A. Kyriakou" General Children's Hospital, National and Kapodistrian University of Athens, Athens,
⁶Department of Allergy, 251 Air Force General Hospital, Athens,
⁷Seventh Department of Respiratory Medicine, "Sotiria" General Hospital for Chest Diseases, Athens,
⁸Private Practice for Allergy, Athens,
⁹Department of Allergy, "Sotiria" General Hospital for Chest Diseases, Athens,
¹⁰Department of Otorhinolaryngology (ENT), University General Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis,
¹¹Second Department of ENT, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki,
¹²Department of ENT-Head and Neck Surgery, Aristotle University of Thessaloniki, "AHEPA" Hospital, Thessaloniki,
¹³Second Department of Respiratory Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens,
¹⁴Second Department of ENT, National and Kapodistrian University of Athens, Medical School, "Attikon" University Hospital, Athens,
¹⁵Department of Allergy, "Laikon" General Hospital of Athens, Athens,
¹⁶First Department of Respiratory Medicine, "Sotiria" General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, Athens,
¹⁷ENT Private Practice, Agios Nikolaos, Crete,
¹⁸First ENT Clinic, National and Kapodistrian University of Athens, Athens,
¹⁹Pediatric Respiratory Unit, Pediatric Department, University of Crete, Heraklion, Crete,
²⁰Department of Allergy, 401 Military General Hospital of Athens, Athens,
²¹Department of ΕΝΤ, Medical School, University of Crete, Heraklion, Crete,
²²ENT Clinic, "Children's Euroclinic", Athens,
²³Division of Pharmaceutical Technology, School of Pharmacy, National and Kapodistrian University of Athens, Athens,
²⁴Pediatric Clinic, "Venizeleio Pananeio" General Hospital of Heraklion, Heraklion, Crete,
²⁵Unit of Allergology and Clinical Immunology, Third Department of Internal Medicine, National and Kapodistrian University of Athens, Athens,
²⁶Panhellenic Pharmaceutical Association, Private Pharmacy, Athens,
²⁷Department of Allergology, Naval Hospital of Athens, Athens, Greece,
²⁸ARIA, Montpellier,
²⁹MASK-air, Montpellier, France,
³⁰Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin,
³¹Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany

Allergic rhinitis (AR) is one of the most common chronic conditions worldwide, with a significant prevalence in Greece as well. Despite its frequency, it is often underdiagnosed and undertreated. It burdens both patients and the healthcare system, as many individuals resort to self-medication, which is often ineffective. Diagnosis of AR is primarily based on typical symptoms and their duration. Classification according to the ARIA guidelines supports management by distinguishing between intermittent or persistent forms and mild or moderate-to-severe intensity. Although a phenotypic approach can offer greater precision, it is not essential in primary health care (PHC). Treatment involves allergen avoidance, pharmacotherapy (mainly intranasal corticosteroids and antihistamines), and, when indicated, specific immunotherapy. Patient adherence to treatment is generally low, which complicates disease control. Supportive measures, such as nasal irrigation, can help alleviate symptoms. Monitoring treatment response is done using the Visual Analog Scale. The Greek ARIA group aims to bridge the gap between international guidelines and Greek clinical practice, promoting shared care pathways and algorithms to improve management. A key strategic goal is to strengthen the role of PHC and general practitioners in the holistic and effective management of AR.

Key words: Allergic rhinitis, Primary health care, Rhinitis, Rhinitis diagnosis, Rhinitis treatment.