Abstract
Allergic rhinitis is a common medical condition characterized by nasal, throat, and
ocular itching; rhinorrhea; sneezing; nasal congestion; and, less frequently, cough.
The treatment of allergic rhinitis should control these symptoms without adversely
affecting daily activities or cognitive performance and should prevent sequelae such
as asthma exacerbation or sinusitis. This review describes a stepwise approach to
treatment of allergic rhinitis derived from a synthesis of clinical trial results,
patient preferences, and real-world tolerability data. Key clinical considerations
include frequency and intensity of symptoms, patient age, comorbidities, compliance
with treatment regimens (influenced by formulation, route and frequency of administration),
and effects on quality of life. Oral second-generation antihistamines, versus first-generation
agents and inhaled corticosteroids, should be considered first-line treatment because
they provide rapid relief of most allergic rhinitis symptoms without safety and tolerability
issues. Additional therapeutic agents can then be added or substituted based on individual
symptom response.
Keywords
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References
- Diagnosis and management of rhinitis.Ann Allergy Asthma Immunol. 1998; 81: 478-518
- Scope and impact of allergic rhinitis.J Am Osteopath Assoc. 2002; 102: S2-S6
- Allergic rhinitis.Clin Otolaryngol Allied Sci. 2003; 28: 291-303
- The burden of allergic rhinitis.Ann Allergy Asthma Immunol. 2002; 88: 2-7
- Treatment of allergic rhinitis.Allergy Asthma Proc. 1997; 18: 63-67
- Effects of seasonal allergic rhinitis on selected cognitive abilities.Ann Allergy Asthma Immunol. 2000; 84: 403-410
- Relationship between allergic rhinitis, disturbed cognitive functions and psychological well-being.Clin Exp Allergy. 2002; 32: 1310-1315
- Evaluation and management of allergic rhinitis.Med Clin North Am. 1999; 83: 13-25
- Patient and physician perspectives on the impact and management of perennial and seasonal allergic rhinitis.Clin Otolaryngol Allied Sci. 2000; 25: 551-557
- Link between patient preferences and treatment outcomes in seasonal allergic rhinitis.Clin Ther. 1999; 21: 268-277
Roper Public Affairs and Media. Impact of nasal congestion among allergic rhinitis sufferers. July 2004.
- Allergic rhinitis and asthma.J Allergy Clin Immunol. 1997; 99: S781-S786
- One airway, one disease.Chest. 1997; 111: 11S-16S
- Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334
- Initial and steady-state effects of diphenhydramine and loratadine on sedation, cognition, mood, and psychomotor performance.Arch Intern Med. 1997; 157: 2350-2356
- Effects of loratadine and cetirizine on actual driving and psychometric test performance, and EEG during driving.Eur J Clin Pharmacol. 1992; 42: 363-369
- Onset of action for the relief of allergic rhinitis symptoms with second-generation antihistamines.Allergy Asthma Proc. 2004; 25: 81-83
- The effect of prescribed daily dose frequency on patient medication compliance.Arch Intern Med. 1990; 150: 1881-1884
- Requirements for medications commonly used in the treatment of allergic rhinitis.Allergy. 2003; 58: 192-197
- Second-generation antihistamines.Drugs. 2005; 65: 341-384
- Efficacy and tolerability of once-daily 5 mg desloratadine, an H1-receptor antagonist, in patients with seasonal allergic rhinitis.Clin Drug Invest. 2001; 21: 25-32
- Safety and efficacy of desloratadine 5 mg in asthma patients with seasonal allergic rhinitis and nasal congestion.Ann Allergy Asthma Immunol. 2002; 89: 485-491
- Efficacy and safety of desloratadine in the treatment of perennial allergic rhinitis.J Allergy Clin Immunol. 2003; 111: 617-622
- Effect of desloratadine versus placebo on nasal airflow and subjective measures of nasal obstruction in subjects with grass pollen-induced allergic rhinitis in an allergen-exposure unit.J Allergy Clin Immunol. 2002; 109: 956-961
- Evaluation of cetirizine in patients with allergic rhinitis and perennial asthma.Ann Allergy Asthma Immunol. 1996; 76: 440-446
- Fexofenadine reduces nasal congestion in perennial allergic rhinitis.Allergy. 2001; 56: 1068-1070
- Quality of life in patients with seasonal allergic rhinitis is improved by desloratadine.Allergy. 2000; 55 ([abstract]): 191
- Once-daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 1999; 83: 311-317
- Improvement of quality of life by treatment with cetirizine in patients with perennial allergic rhinitis as determined by a French version of the SF-36 questionnaire.J Allergy Clin Immunol. 1996; 98: 309-316
- Potential cardiac toxicity of H1-antihistamines.Clin Allergy Immunol. 2002; 17: 389-419
- First do no harm.J Allergy Clin Immunol. 2003; 111: S835-S842
- Desloratadine in the treatment of seasonal allergic rhinitis.Clin Drug Invest. 2002; 22: 43-52
- A comparison of the efficacy of azelastine nasal spray and loratidine tablets in the treatment of seasonal allergic rhinitis.J Int Med Res. 1993; 21: 268-275
- A multicenter clinical study of the efficacy and tolerability of azelastine nasal spray in the treatment of seasonal allergic rhinitis.Eur Arch Otorhinolaryngol. 1995; 252: 455-458
- A placebo-controlled study comparing the efficacy of intranasal azelastine and beclomethasone in the treatment of seasonal allergic rhinitis.Eur Arch Otorhinolaryngol. 1997; 254: 236-241
- Astelin (azelastine hydrochloride) prescribing information.Med Pointe Pharmaceuticals, Montvale, NJ2000
- Overview of Allergic Diseases.American Academy of Allergy, Asthma and Immunology, Milwaukee, Wisconsin2000 (1-122)
- Allergic rhinitis and its impact on asthma (ARIA).Allergy. 2002; 57: 841-855
- Intranasal corticosteroids for allergic rhinitis.Pharmacotherapy. 2002; 22: 1458-1467
- Effects of budesonide and fluticasone propionate in a placebo-controlled study on symptoms and quality of life in seasonal allergic rhinitis.Allergy. 2002; 57: 586-591
- Relief of cough and nasal symptoms associated with allergic rhinitis by mometasone furoate nasal spray.Ann Allergy Asthma Immunol. 2003; 90: 416-421
- Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis.Ann Allergy Asthma Immunol. 1997; 79: 370-378
- Once-daily mometasone furoate aqueous nasal spray (Nasonex) in seasonal allergic rhinitis.Allergy. 1996; 51: 569-576
- Budesonide aqueous nasal spray is an effective treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours.Ann Allergy Asthma Immunol. 2002; 89: 279-284
- A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial rhinitis.Clin Exp Allergy. 1995; 25: 737-743
- A comparison of aqueous suspensions of budesonide nasal spray (128 micrograms and 256 micrograms once daily) and fluticasone propionate nasal spray (200 micrograms once daily) in the treatment of adult patients with seasonal allergic rhinitis.Am J Rhinol. 1997; 11: 323-330
- A randomized comparison of the effects of budeosinde and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis.Ann Allergy Asthma Immunol. 2002; 88: 617-623
- Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis.J Allergy Clin Immunol. 1998; 102: 902-908
- Assessment of intranasal corticosteroid use in allergic rhinitis.Am J Manag Care. 2002; 8: S335-S340
- NASONEX (mometasone furoate monohydrate) nasal spray, 50 μg.([prescribing information]) Schering-Plough Corporation, Kenilworth, NJ1999
- Changing strategies in the treatment of allergic rhinitis.Ann Allergy Asthma Immunol. 1996; 77: 255-259
- Onset of action of mometasone furoate nasal spray (NASONEX) in seasonal allergic rhinitis.Allergy. 1999; 54: 64-69
- Onset of therapeutic effect of fluticasone propionate aqueous nasal spray.Ann Allergy Asthma Immunol. 2001; 86: 286-291
- Comparative efficacy, safety, and effect on quality of life of triamcinolone acetonide and fluticasone propionate aqueous nasal sprays in patients with fall seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2002; 89: 56-62
- Double-blind trials of azelastine nasal spray monotherapy versus combination therapy with loratadine tablets and beclomethasone nasal spray in patients with seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 1999; 82: 535-541
- A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, for the treatment of seasonal allergic rhinitis.J Fam Pract. 1998; 47: 118-125
- Clinical evidence for antileukotriene therapy in the management of allergic rhinitis.Ann Allergy Asthma Immunol. 2002; 88: 23-29
- Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis.J Allergy Clin Immunol. 2000; 105: 917-922
- Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2002; 88: 592-600
- Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis.J Allergy Clin Immunol. 2002; 109: 949-955
- Leukotriene antagonists and the Churg-Strauss syndrome.Semin Arthritis Rheum. 2002; 31: 218-227
- Allergen immunotherapy.Allergy Asthma Proc. 2000; 21: 159-166
- Quality of life analysis of patients undergoing immunotherapy for allergic rhinitis.Ear Nose Throat J. 1997; 76 (534-536): 528-532
- Long-term clinical efficacy of grass-pollen immunotherapy.N Engl J Med. 1999; 341: 468-475
- The efficacy and safety of fexofenadine HCl and pseudoephedrine, alone and in combination, in seasonal allergic rhinitis.J Allergy Clin Immunol. 1999; 104: 100-106
- Efficacy of once-daily desloratadine/pseudoephedrine for relief of nasal congestion.Allergy Asthma Proc. 2002; 23: 325-330
- Loratadine/psuedoephedrine for nasal symptoms in seasonal allergic rhinitis.Ear Nose Throat J. 2000; 79 (258-260): 254
- Cetirizine and pseudoephedrine retard, given alone or in combination, in patients with seasonal allergic rhinitis.Rhinology. 1997; 35: 67-73
- Cardiovascular effects of pseudoephedrine in medically controlled hypertensive patients.Arch Intern Med. 1992; 152: 1242-1245
- Nasal congestion.Ear Nose Throat J. 2000; 79: 690-693
- The use of newer asthma and allergy medications during pregnancy.Ann Allergy Asthma Immunol. 2000; 84: 475-480
- First trimester maternal medication use in relation to gastroschisis.Teratology. 1992; 45: 361-367
- Safety of antihistamines in the treatment of allergic rhinitis in elderly patients.Arch Fam Med. 1996; 5: 464-468
- Are antihistamines useful in managing asthma?.Curr Opin Allergy Clin Immunol. 2002; 2: 53-59
- Cetirizine in patients with seasonal rhinitis and concomitant asthma.J Allergy Clin Immunol. 1995; 95: 923-932
- Comparative effects of desloratadine versus montelukast on asthma symptoms and use of β2-agonists in patients with seasonal allergic rhinitis and asthma.Int Arch Allergy Immunol. 2003; 130: 307-313
- The cost of productivity losses associated with allergic rhinitis.Am J Manag Care. 2000; 6: 373-378
- Sedation in allergic rhinitis is caused by the condition and not by antihistamine treatment.Allergy. 1996; 51: 893-906
- A comparison of the effect of diphenhydramine and desloratadine on vigilance and cognitive function during treatment of ragweed-induced allergic rhinitis.Ann Allergy Asthma Immunol. 2003; 91: 375-385
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