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. 

For seasonal rhinitis, treatment should be initiated just before the start of the offending allergen s season and continue throughout the season. 

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. " ... 

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. 

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. 

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... 

Nevertheless, although the nonsedating H antihistamines have substantially improved the acceptabiUty and clinical efficacy of this class of compounds, these do not provide complete rehef eye disease responds less well than nasal disease, of the rhinitis symptoms nasal congestion responds poorly, breakthrough symptoms occur at high poUen counts, and only some 70% of patients report excellent to good treatment responses. Considerable research therefore still continues in the H antihistamine field. New antihistamines are continually being introduced. 

Rhinitis is characterized by nasal stuffiness with partial or full obstmction, and itching of the nose, eyes, palate, or pharynx, sneezing, and rhinorrhoea. If left untreated it can lead to more serious respiratory diseases such as sinusitis or asthma. Although several types of dmgs are available for treatment, nasal spray topical corticosteroids are widely regarded as the reference standard in rhinitis therapy (250). 

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... 

Up to 80% of asthmatics have symptoms of rhinitis, and inflammation of the upper airways may increase AHR.1,3 Treatment of rhinitis with intranasal corticosteroids may improve asthma symptoms and is recommended for asthma patients with rhinitis. 

Rhinitis Educate the patent that this is a common adverse effect tolerance may develop to rhinitis usually it is not so severe that it requires discontinuation of treatment... 

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,... 

Systemic corticosteroids, administered orally or by depot injection, are considered last-resort options when all other treatments for SAR are inadequate. Systemic steroids may be used to control rhinitis symptoms in patients with severe PAR or nasal polyposis. Data comparing oral and parenteral steroid therapy are lacking however, oral therapy is preferred due to its low cost... 

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

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