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Choosing Wisely Canada

Canadian Society of Allergy and Clinical Immunology

Abnormal images of the sinuses cannot stand alone as diagnostic evidence of bacterial rhinosinusitis. Radiologic changes such as mucosal thickening are present in most cases of acute viral infections of the upper respiratory tract when sensitive detection methods such as CT scanning are used. Incidental findings of mucosal thickening can also be seen in a high percentage of asymptomatic individuals.

Choosing Wisely Canada

Canadian Society of Allergy and Clinical Immunology

Viral infections are the primary cause of acute rhinosinusitis, whereby only 0.5% to 2% develop into bacterial infections. Most cases of clinically diagnosed acute rhinosinusitis improve without treatment within two weeks. For those with uncomplicated acute rhinosinusitis, who have a mild illness, observation without use of antibiotics is recommended. If a decision is made to treat, clinicians should prescribe amoxicillin as first-line antibiotic therapy for most cases of acute rhinosinusitis.

Choosing Wisely Canada

Canadian Society of Allergy and Clinical Immunology

Findings on a patient’s history and physical exam such as cough, wheeze and dyspnea may be caused by many conditions, including asthma. When the diagnosis of current or persistent asthma is suspected it must be confirmed with objective testing, as up to one third of patients with suspected asthma show no objective evidence when later tested and may have went into sustained clinical remission or never had asthma. Misdiagnosis leads to delayed treatment of the underlying condition and ...

Choosing Wisely Canada

Canadian Society of Allergy and Clinical Immunology

Epinephrine is the drug of choice to treat anaphylaxis. Overuse of antihistamines in anaphylaxis is associated with increased morbidity. H1 antagonists serve as second-line treatment for cutaneous non-life-threatening symptoms such as urticaria but should not be used in place of epinephrine. They do not alleviate or prevent cardiovascular or respiratory symptoms of anaphylaxis and can delay the administration of epinephrine, increasing the risk of potential consequences such as disability or ...

Choosing Wisely Canada

Canadian Society of Allergy and Clinical Immunology

Specific IgE to foods may be detectable when the patient is clinically tolerant. Frequent false positives lead to incorrect diagnosis of food allergies and unnecessary dietary restrictions. Appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient’s clinical history of signs and symptoms to optimize both cost effectiveness and patient care.