Perennial rhinitis

Respiratory inhalant use asthma Intranasal use seasonal or perennial rhinitis, prevention of recurrence of nasal polyps after surgical removal... 

These agents are an excellent choice for perennial rhinitis and can be useful in seasonal rhinitis, especially if begun in advance of symptoms. Some authorities recommend nasal steroids as initial therapy over antihistamines because of their high degree of efficacy when used properly along with allergen avoidance. 

In perennial rhinitis, the effects may not be seen for 2 to 4 weeks antihistamines or decongestants may be needed during this initial phase of therapy. 

Dust has been recognised as a trigger for asthma for many years and the allergens are present in the faeces of the house dust mite, of genus Dermatophagoides. They are members of the order Arachnida (close relatives of ticks and spiders). They live off human skin that has been shed and hence are present in bedding and carpets. Since they are not visible to the naked eye and are difficnlt to control, they can be overlooked as the canse of this distressing disease. They may also be a cause of perennial rhinitis and atopic dermatitis. 

Perennial rhinitis (0.03% nasal spray) - Symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in patients 6 years of age or older. 

Maintenance dose - After desired clinical effect is obtained, reduce maintenance dose to smallest amount necessary to control symptoms. Some patients with perennial rhinitis may be maintained on 1 spray in each nostril/day. 

Mecfianism of Action An adrenocorticosteroid that prevents or controls inflamma-tion by controllingthe rate of protein synthesis decreasing migration of polymorphonuclear leukocytes and fibroblasts and reversing capillary permeability Therapeutic Effect Inhalation Inhibits bronchoconstriction, produces smooth muscle relaxation, decreases mucus secretion. Intranasal Decreases response to seasonal and perennial rhinitis. 

Mechanism of Action An adrenocorticosteroid that inhibits the release of inflammatory cells into nasal tissue, preventing early activation of the allergic reaction. Therapeutic Effect Decreases response to seasonal and perennial rhinitis. Pharmacokinetics Undetectable in plasma. Protein binding 98%-99%. The swallowed portion undergoes extensive metabolism. Excreted primarily through bile and, to a lesser extent, urine. Half-life 5.8 hr (nasal). 

Topical administration to the nose The safety of nasal glucocorticoids in the treatment of allergic rhinitis has been reviewed (434,435). The local application of glucocorticoids for seasonal or perennial rhinitis often results in systemic adverse effects. The use of nasal sprays containing a glucocorticoid that has specific topical activity (such as beclomethasone dipropionate or flunisolide) seems to reduce the systemic adverse effects, but they can nevertheless occur, even to the extent of suppression of basal adrenal function in children (436). Local adverse effects include Candida infection, nasal stinging, epistaxis, throat irritation (437), and, exceptionally, anosmia (438). 

Guez S, Vatrinet C, Fadel R, Andre C House dust mite SLIT in perennial rhinitis A double blind placebo controlled study. Allergy 2000 55 369-375. 

Rowe-Jones JM The link between the nose and lung, perennial rhinitis and asthma Is it the same... 

La Rosa M, Ranno C, Andre C, Carat F, Tosca MA, Canonica GW Double-blind placebo-controlled evaluation of sublingual swallow immunotherapy with standardized Parietaria judaica extract in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 1999 104 425 432. Guez S, Vatrinet C, Fadel R, Andre C House dust mite sublingual swallow immunotherapy in perennial rhinitis A double-blind placebo-controlled study. Allergy 2000 55 369-375. 

Perennial rhinitis is common in both adults and children and is usually treated with intranasal corticosteroids, intranasal ipratropium bromide, antihistamines, intranasal cromones, and decongestants. Treatment-related adverse effects are common and monotherapy is often inadequate. There are few published studies of the comparative efficacy of rhinitis treatments. 

Ipratropium bromide (42 micrograms per nostril bd) has been compared with budesonide (84 micrograms per nostril bd) for 6 months in a randomized, double-blind trial in 146 children with perennial rhinitis (4). Both treatments resulted in significant improvements in rhinorrhea, sneezing, and congestion (as rated by both patients and... 

Dockhorn R, Aaronson D, Bronsky E, Chervinsky P, Cohen R, Ehtessabian R, Finn A, Grossman J, Howland W, Kaiser H, Pearhnan D, Sublet J, Ratner P, Settipane G, Sim T, Storms W, Webb R, Drda K, Wood C. Ipratropium bromide nasal spray 0.03% and beclometha-sone nasal spray alone and in combination for the treatment of rhinorrhea in perennial rhinitis. Ann Allergy Asthma Immunol 1999 82(4) 349-59. 

Brompton Hospital/Medical Research Conned Collaborative Trial. A controlled trial of oxatomide in the treatment of asthma with or withont perennial rhinitis. Chn Allergy 1981 ll(5) 483-90. 

Intranasal beclometasone dipropionate in a dose as low as 200 / g daily is a useful addition to the therapy of perennial rhinitis. Considerable attention is being paid to the delivery by the... 

Intranasal glucocorticoids Used to treat seasonal and perennial rhinitis... 

Inhibits early-phase allergic reaction and migration of inflammatory cells into nasal tissue and decreases response to seasonal and perennial rhinitis. 

Inhalation Control of bronchial asthma in those requiring chronic steroid therapy. Intranasal Relief of seasonal/perennial rhinitis prevention of nasal polyps from recurring after surgical removal treatment of nonallergic rhinitis. Nasal Prophylaxis of seasonal rhinitis. 

Aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an attack in up to 20% of adults with asthma. The mechanism is related to cyclooxygenase inhibition, and 5-hpoxygenase inhibition can prevent the symptoms. The prevalence increases with age. The greatest frequency occurs in severe corticosteroid-dependent asthmatics in their fourth and fifth decades who also have perennial rhinitis and nasal polyposis (presence of several polyps). Other drugs that do not precipitate bronchospasm but which prevent its reversal are the 8-blocking agents. ... 

For seasonal allergic rhinitis, an option when congestion is present. Must begin therapy before allergen exposure. Excellent choice for perennial rhinitis. 

Prevents symptoms therefore, for seasonal allergic rhinitis, use before offending allergen s season starts. For perennial rhinitis, improvement may not be seen for up to 1 month. 

For seasonal rhinitis, treatment with cromolyn sodium should be initiated just before the usual start of the offending allergen s season and continued throughout the season. In perennial rhinitis, the effects may not be seen for 2 to 4 weeks therefore antihistamines or decongestants may be needed during this initial phase of therapy. As cromolyn sodium begins to work, the need for these medications should decrease. 

The effectiveness of immunotherapy for seasonal allergic rhinitis appears to be better than that seen with perennial rhinitis, in part because it is more difficult to determine which allergen is responsible for perennial symptoms, and it is more due to multiple sensitizations. Effectiveness has been shown in a number of clinical studies using a variety of pollen extracts, even in patients with severe disease resistant to pharmacotherapy." " Specific immunotherapy for house dust mites has had good results in appropriately selected patients, while several studies have described marked improvement in patients with allergy to cats. Data indicate that in some patients 3 years of immunotherapy may be sufficient to give lasting benefit." ... 

Verdiani P, Di CS, Baronti A. Different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis. J Allergy Clin Immunol 1990 86 576-582. 

There are three types of decongestants. These are nasal decongestants that provide quick relief to the patient systemic decongestants that provide a longer lasting relief from congestion and intranasal glucocorticoids that are used to treat seasonal and perennial rhinitis. 

Among 23 patients in a double-blind experiment with disodium cromoglycate and placebo (lactose) treated for perennial rhinitis, the distribution of side effects showed a significantly higher incidence with placebo (16 ) (Table 2). 

A nasally administered placebo consisting of 0.01% benzalkonium chloride (BKC) and 0.01% EDTA produced nasal irritation in 9 out of 49 patients, and headache, eczema and tiredness in 1 patient each (23 ). These two examples of the reaction to nasally administered placebo in the patients affected by perennial rhinitis suggest that allergically hypersensitive persons might react to otherwise pharmacologically inert substances. 

Blair, H. and Viner, A. S. (1975) A double blind trial of a 2% solution of sodium cromogly-cate in perennial rhinitis. Clin. Allergy, 5, 139. 

Copenhagen, Denmark age 14-71 years Asthma and perennial rhinitis 14... 

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