Allergic rhinitis therapy

Decongestants are used to treat the congestion associated with rhinitis, hay fever, allergic rhinitis, sinusitis, and the common cold. In addition, they are used in adjunctive therapy of middle ear infections to decrease congestion around the eustachian tube Nasal inhalers may relieve ear block and pressure pain during air travel. Many can be administered orally as well as topically, but topical application is more effective than the oral route. 

Antihistamines and intranasal corticosteroids are considered first-line therapy for allergic rhinitis, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options. 

Complementary and alternative medicine therapies, such as acupuncture, biofeedback, chiropractic manipulation, dietary supplements, herbal therapy, and homeopathic preparations, are used by individuals with allergic rhinitis.29,30 Use of bromelain, gingko, ginseng, licorice, quercetin, and Urtica dioica has been reported, but large-scale studies documenting efficacy are lacking.31,32 Caregivers should inquire routinely about patients use of alternative therapies and counsel patients about the lack of validated data to support such practices.12... 

Intranasal corticosteroids are the most effective treatment for allergic rhinitis during pregnancy. Beclomethasone and budesonide have been used most. Nasal cromolyn and first-generation antihistamines (chlorpheniramine, tripelennamine, and hydroxyzine) are also considered first-line therapy. Loratadine and cetirizine have not been as extensively studied. 

Holm AF, Fokkens WJ, Godthelp T, Mulder PG, Vroom TM, Rijntjes E Effect of 3 months nasal steroid therapy on nasal T cells and Langerhans cells in patients suffering from allergic rhinitis. Allergy 1995 50 204-209. 

Uses Asthma in pts requiring chronic steroid therapy relieve seasonal/perennial allergic rhinitis Action Topical steroid Dose Adults. Met-dose inhal 2 inhal bid (max 8/d) Nasal 2 sprays/nostril bid (max 8/d) Peds >6y. Met-dose inhal 2 inhal bid (max 4/d) Nasal 1-2 sprays/nostril bid (max 4/d) Caution [C, ] w/ adrenal insuff Contra Status asdimaticus, viral, TB, fungal, bacterial Infxn Disp Inhaler SE Tach, bitter taste, local effects, oral candidiasis EMS Not for acute asthma, use inhaled [3-agonists OD Unlikely... 

Scadding GK, Brostoff J Low dose sublingual therapy in patients with allergic rhinitis and asthma due to house dust mite. Clin Allergy 1986 16 483-491. 

Allergic rhinitis with a 20% incidence which is constantly increasing in relation to environmental (smog, cigarette smoke) and climatic factors is today considered a systemic disease with the nose as the shock organ [1], This trend has, consequently, resulted in an increase in social and economic expenditure on the disease arousing interest in prevention and, particularly, in specific immunosensitizing therapy administered subcutaneously or locally [2],... 

The efficacy of subcutaneous SIT has been clearly shown in a metaanalysis of 43 double-blind placebo-controlled trials in allergic rhinitis as well as another meta-analysis of 16 double-blind placebo-controlled studies in asthma patients [13]. The mean clinical improvement was 45% reduction in symptoms and medication compared with placebo in rhinitis and 40% in asthma patients, which exceeds the effects of drug therapy. A recent meta-analysis also confirmed that asthma responds favorably to SIT [14], However, recently it could also be demonstrated that SIT is effective in patients with house dust mite allergy, allergic rhinitis and asthma [15]. Immunotherapy in these patients not only reduced rhinitis and asthma symptoms as well as rescue medication, but also had an impact on bronchial hyperreactivity over the 3-year follow-up period. 

Joos GF, Brusselle GG, Van Hoecke H, et al. Positioning of glucocorticosteroids in asthma and allergic rhinitis guidelines (versus other therapies). Immunol Allergy Clin North Am. 2005 25 597-612. 

Second-generation antihistamines have proved to be important therapeutic tools in the treatment of atopic disease, including both seasonal and perennial allergic rhinitis, urticaria, and atopic dermatitis (20). Several studies have shown that the use of second-generation antihistamines as adjunctive therapy can benefit patients whose allergic asthma co-exists with allergic rhinitis (21). 

Berger WE, Fineman SM, Lieberman P, Miles RM. Double-bhnd trials of azelastine nasal spray monotherapy versus combination therapy with loratadine tablets and beclomethasone nasal spray in patients with seasonal allergic rhinitis. Rhinitis Study Groups. Ann Allergy Asthma Immunol 1999 82(6) 535-41. 

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