Allergic rhinitis, treatment

Goals of allergic rhinitis treatment are to reduce the patient s symptoms, minimize adverse effects, and increase patient productivity (i.e., reduce lost school and work days). 

The anti-inflammatory actions of intranasal corticosteroids make them highly effective agents for allergic rhinitis treatment, especially as first-line treatment for patients presenting with persistent or moderate to severe allergic rhinitis. 

Fundueanu, G, Constantin, M., Dalpiaz, A., Bortolotti, F., Cortesi, R., Ascenzi, P., and Menegatti, E. (2004), Freparation and characterization of starch/cyclodextrin bioadhesive microspheres as platform for nasal administration of Gabexate Mesylate (Foy(r)) in allergic rhinitis treatment, Biomaterials, 25,159-170. 

Leave one out cross-validation for 3300 kinds of biological activity and 117 332 substances provides the estimate of PASS prediction accuracy during the training procedure. The average accuracy of prediction is about 94.7% according to the LOO CV estimation, while that for particular kinds of activity varies from 65% [System lupus erythematosus treatment, Immunomodulator (HIV)] to 99.9% (Allergic rhinitis treatment, histone acetylation inducer). The estimated accuracy of prediction for all kinds of biological activity predicted by PASS is presented at the web site. " ... 

Direct-to-consumer advertising for prescription-only allergic rhinitis treatment options has also increased significantly. Indirect costs related to missed school or work days and loss of productivity may approach the amount for the direct costs. ... 

Cetirizine competitively antagonizes histamine at the Hi-receptor site and is indicated in the symptomatic relief of symptoms (e.g., nasal, nonnasal) associated with seasonal and perennial allergic rhinitis treatment of uncomplicated skin manifestations of chronic idiopathic urticaria. Histamine is a potent vasodilator, bronchial smooth-muscle constrictor, and stimnlant of nociceptive itch nerves. In addition to histamine, mnltiple chemical itch mediators can act as pruritogens on C-fibers, including neuropeptides, prostaglandins, serotonin, acetylcholine, and bradykinin. Furthermore, new receptor systems such as vanilloid, opioid, and canna-binoid receptors on cutaneous sensory nerve fibers that may modulate itch offer novel targets for antipruritic therapy. 

Bender BG (2015) Motivating patient adherence to allergic rhinitis treatments. Curr Allergy Asthma Rep 15 10... 

Ramatroban is a PG receptor antagonist in use for the treatment of allergic rhinitis in Japan. This compound was initially identified as a TP receptor antagonist, although more recently it has been determined that it is also antagonizes the CRTH2 (DP2) receptor. 

The corticosteroids are used in the management and prophylactic treatment of the inflammation associated with chronic asthma or allergic rhinitis. 

Intal, Nasalcrom Prophylaxis of severe bronchial asthma prevention of exercise-induced asthma (BA) Nasal preparations prevention and treatment of allergic rhinitis Dizziness, headache, nausea, dry and irritated throat, rash, joint swelling and pain... 

Recommend appropriate treatment for patients with allergic rhinitis. 

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. 

FIGURE 59-2. Treatment algorithm for allergic rhinitis. (From DiPiro JT, Talbert RL, Yee GC,... 

Baena-Cagnani CE. Safety and tolerability of treatments for allergic rhinitis in children. Drug Safety 2004 27 883-898. 

Transgrund AJ, Whitaker AL, Small RE. Intranasal corticosteroids for allergic rhinitis. Pharmacotherapy 2002 22 1458-1467. van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. Allergy 2000 55 116-134. 

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. 

Cromolyn sodium (Nasalcrom), a mast cell stabilizer, is available as a nonprescription nasal spray for symptomatic prevention and treatment of allergic rhinitis. 

Montelukast (Singulair) is a leukotriene receptor antagonist approved for treatment of seasonal allergic rhinitis. It is effective alone or in combination with an antihistamine. 

Flunisolide is a fast-acting corticoid designed for the treatment of allergic rhinitis, asthma, and other allied respiratory disorders in humans. As the quantum of drug delivered by inhalation (/. e., the usual route of administration of the drug), is invariably small, the plasma-levels attained can also be fairly small. Hence, there is a dire need for a sensitive method of plasma concentration evaluation which is satisfied by radioimmunoassay. 

Baena-Cagnani CE, Passalacqua G, Gomez M, Zernotti ME, Canonica GW New perspectives in the treatment of allergic rhinitis and asthma in children. Curr Opin Allergy Clin Immunol 2007 7 201-206. 

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