Evidence-to-Recommendation Framework for 2026 ACE Clinical Guideline on allergic rhinitis — diagnosis and management

This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the diagnosis and management of allergic rhinitis (AR), providing justifications for its recommendations. Allergic rhinitis is highly prevalent in Singapore, with most cases being moderate to severe. While AR is not associated with severe outcomes, poorly controlled or untreated AR can lead to complications, such as asthma, sinusitis or otitis media with effusion. The ACG covers the diagnosis and management of perennial AR, which is the predominant local form of AR and is largely attributed to house dust mites. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop four evidence-based recommendations that cover diagnosis, role of allergy testing, and management through pharmacological interventions and allergen avoidance. This EtR framework summarises factors that have informed the direction and strength of the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability. The ACG can be found at https://go.gov.sg/acg-ar.