Effective and safe allergic rhinitis treatment
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Published:
Sep 30, 2015
Keywords:
allergic rhinitis, asthma, treatment, efficacy, safety, intranasal glucocorticosteroids, antihistamines, decongestants, antileukotrienes, allergen-specyfic immunotherapy, NNT
Main Article Content
Abstract
Allergic rhinitis – IgE-dependent inflammation of nasal mucosa – is a common chronic respiratory disease that affects millions of individuals, both children and adults, their quality of life, productivity, and other comorbid conditions, including asthma. The main symptoms are: sneezing, itchy nose, rhinorrhoea and nasal congestion (blockage). Most cases of allergic rhinitis satisfactorily respond to pharmacotherapy. Pharmacological treatment should be based on the severity and duration of symptoms, and on the patient’s age as well as concomitant diseases. Patients should be also advised to avoid known allergens and triggers, if it is possible. The pharmacological treatment should be safe, effective and easily administered as we treat patients with a chronic condition requiring long-term therapy. Intranasal glucocorticosteroids are the most effective treatment and are recommended as the first-line therapy for mild to moderate disease, both seasonal and perennial, especially if the symptoms are persistent. In meta-analyses, intranasal glucocorticosteroids are superior to the other therapeutic options, have a good safety profile, and treat all symptoms of allergic rhinitis effectively. Other therapeutic options include second-generation antihistamines or intranasal antihistamines, decongestants (in the case of severe nasal oedema) or leukotriene receptor antagonists (particularly in concomitant asthma) and some nonpharmacological procedures (e.g. nasal irrigation; in some cases – surgical procedures). Allergen-specific immunotherapy is recommended, not only to decrease the severity of nasal symptoms, but also to prevent the progression of the disease. In some allergic patients, despite the treatment, the disease becomes only partly controlled. The reasons of such a situation are definitely complex, but one reason is the lack of symptom-oriented treatment, especially the lack of inadequate anti-inflammatory treatment with intranasal glucocorticosteroids.
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Arcimowicz , M. (2015). Effective and safe allergic rhinitis treatment. Alergoprofil, 11(3), 11-22. Retrieved from https://journalsmededu.pl/index.php/alergoprofil/article/view/840
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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26. Vuurman E.F., Vuurman L.L., Lutgens I., Kremer B.: Allergic rhinitis is a risk factor for traffic safety. Allergy 2014, 69: 906-912.
27. SuV.Y., Liu C.J., Lan M.Y.: Allergic rhinitis and risk of erectile dysfunction – a nationwide population-based study. Allergy 2013, 68(4): 440-445.
28. Scarupa M.D., Kaliner M.A.: Nonallergic rhinitis, with a focus on vasomotor rhinitis: clinical importance, differential diagnosis, and effective treatment recommendations. World Allergy Organ. J. 2009, 2(3): 20-25.
29. Arcimowicz M.: Rynopatie. Alergologia Polska – Polish Journal of Allergology 2015, 2: 5-14.
30. Greiner A.N., Hellings P.W., Rotiroti G., Scadding G.K.: Allergic rhinitis. Lancet 2011, 378(9809): 2112-2222.
31. Greiner A.N., Meltzer E.O.: Overview of the treatment of allergic rhinitis and nonallergic rhinopathy. Proc. Am. Thorac Soc. 2011, 8(1): 121-131.
32. Woroń J., Porębski G., Dymura K.: Leki przeciwhistaminowe a prowadzenie pojazdów. Terapia 2011, 5(257): 7-10.
33. Woroń J.: Niekorzystne interakcje leków przeciwhistaminowych – dlaczego mają tak istotne znaczenie praktyczne, jakie są pomiędzy nimi różnice? Terapia 2015, 6(324): 39-43.
34. Nacleiro R.: Intranasal corticosteroids reduced ocular symptoms associated with allergic rhinitis. Otolaryngol. Head Neck Surgery 2008, 138: 129-139.
35. Meltzer E.O.: The role of nasal corticosteroids in the treatment of rhinitis. Immunol. Allergy Clin. North Am. 2011, 31: 545-560.
36. Scichilone N., Arrigo R., Paternò A. et al.: The effect of intranasal corticosteroids on asthma control and quality of life in allergic rhinitis with mild asthma. J. Asthma 2011, 48(1): 41-47.
37. Lohia S., Schlosser R.J., Soler Z.M.: Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis. Allergy 2013, 68(5): 569-579.
38. Agondi R.C., Machado M.L., Kalil J., Giavina-Bianchi P.: Intranasal corticosteroid administration reduces nonspecific bronchial hyperresponsiveness and improves asthma symptoms. J. Asthma 2008, 45(9): 754-757.
39. Jung Y.G., Kim H.Y., Min J.Y. et al.: Role of intranasal topical steroid in pediatric sleep disordered breathing and influence of allergy, sinusitis, and obesity on treatment outcome. Clin. Exp. Otorhinolaryngol. 2011, 4(1): 27-32.
40. Derendorf H., Meltzer E.O.: Molecular and clinical pharmacology of intranasal corticosteroids and therapeutic implications. Allergy 2008, 63: 1292-1300.
41. Schenkel E.J., Skoner D.P., Bronsky E.A. et al.: Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000, 105(2): e22.
42. Meltzer E.O.: Allergic rhinitis: managing the pediatric spectrum. Allergy Asthma Proc. 2006, 27: 2-8.
43. Ratner P.H., Meltzer E.O., Teper A.: Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis. Int. J. Pediatr. Otorhinolaryngol. 2009, 73: 651-657.
44. Tripathy I., Levy A., Ratner P. et al.: HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis. Pediatric. Allergy and Immunology 2009, 20(3): 287-294.
45. Baena-Cagnani C.E., Patel P.: Efficacy and long-term safety of mometasone furoate nasal spray in children with perennial allergic rhinitis. Curr. Med. Res. Opin. 2010, 26: 2047-2055.
46. Emin O., Fatih M., Emre D., Nedim S.: Lack of bone metabolism side effects after 3 years of nasal topical steroids in children with allergic rhinitis. J. Bone Miner. Metab. 2011, 29: 582-587.
47. Minshall E., Ghaffar O., Cameron L. et al.: Assessment by Nasal Biopsy of Long-Term Use of Mometasone Furoate Aqueous Nasal Spray (Nasonex) in the Treatment of Perennial Rhinitis. Otolaryngol. Head Neck Surg. 1998, 118: 648-654.
48. Arcimowicz M.: Glikokortykosteroidy donosowe u dzieci. Alergoprofil 2012, 8(1): 5-17.
49. Schafer T., Schnoor M., Wagenmann M. et al.: Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis. Rhinology 2011, 49(3): 272-280.
50. Sharpe S.A., Sandweiss V., Tuazon J. et al.: Comparison of the flow properties of aqueous suspension corticosteroid nasal sprays under differing sampling conditions. Drug Dev. Ind. Pharm. 2003, 29(9): 1005-1012.
51. Koźmiński M., Kupczyk M.: Tiksotropia leków donosowych – znaczenie w praktyce klinicznej. Pneumonologia i Alergologia Polska 2015, 83: 157-163.
52. Tran N.P., Vickery J., Blaiss M.S.: Management of Rhinitis: Allergic and Non-Allergic. Allergy Asthma Immunol. Res. 2011, 3(3): 148-156.
53. Baroody F.M., Brown D., Gavanescu L. et al.: Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J. Allergy Clin. Immunol. 2011, 127(4): 927-934.
54. Ciebiada M., Gorska-Ciebiada M., Barylski M. et al.: Use of montelukast alone or in combination with desloratadine or levocetirizine in patients with persistent allergic rhinitis. Am. J. Rhinol. Allergy 2011, 25(1): e1-6.
55. Cingi C., Oghan F., Eskiizmir G. et al.: Desloratadine-montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis. Int. Forum Allergy Rhinol. 2013, 3(10): 801-806.
56. Roberts P., Xatzipsalti M., Bornego L.M. et al.: Paediatric rhinitis: Position paper of the European Academy of Allergology and Clinical Immunology. Allergy 2013, 68: 1102-1116.
2. Samoliński B., Arcimowicz M. (red.): Polskie Standardy leczenia Nieżytów Nosa (PoSLeNN). Stanowisko Panelu Ekspertów PTA. Alergologia Polska 2013, S1: 1-167.
3. Samoliński B., Sybilski A.J., Raciborski F. et al.: Prevalence of rhinitis in Polish population according to ECAP (Epidemiology of Allergic Disorders in Poland) study. Otolaryngol. Pol. 2009, 63(4): 324-330.
4. Samoliński B., Sybilski A.J., Raciborski F. et al.: Występowanie astmy oskrzelowej u dzieci, młodzieży i młodych dorosłych w Polsce w świetle badania ECAP. Alerg. Astma Immun. 2009, 14: 27-34.
5. Brozek J.L., Bousquet J., Baena-Cagnani C.E. et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. Allergy Clin. Immunol. 2010, 126(3): 466-476.
6. Seidman M.D., Gurgel R.K., Lin S.Y.:Clinical practice guideline: Allergic rhinitis. Otolaryngol. Head Neck. Surg. 2015, 152(1 supl.): S1-43.
7. Scadding G., Hellings P., Alobid I. et al.: Diagnostic tools in Rhinology EAACI position paper. Clin. Transl. Allergy 2011, 1(1): 2.
8. Rondón C., Campo P., Galindo L. et al.: Prevalence and clinical relevance of local allergic rhinitis. Allergy 2012, 67(10): 1282-1288.
9. Klimek L.: Local allergic rhinitis: differences in prevalence throughout Europe. EAACI 2015, European Academy of Allergy and Clinical Immunology, 6-10 June, 2015, Barcelona.
10. Bousquet J.: A new frontier in allergic rhinitis management: meeting the challenge: Guideline challenge: time for the next generation? EAACI 2015, European Academy of Allergy and Clinical Immunology, 6-10 June, 2015, Barcelona.
11. Hellings P.: Visual analogue scale: The common communication platform. EAACI 2015, European Academy of Allergy and Clinical Immunology, 6-10 June, 2015, Barcelona.
12. Bousquet J., Annesi-Maesanow I., Caratz F. et al.: Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group. Clin. Exp. Allergy 2005; 35: 728-732.
13. Canonica G.W., Bousquet J., Mullol J. et al.: A survey of the burden of allergic rhinitis in Europe. Allergy 2007, 62(85): 17-25.
14. Valovirta E., Myrseth S.E., Palkonen S.: The voice of the patients: allergic rhinitis is not a trivial disease. Curr. Opin. Allergy Clin. Immunol. 2008, 8: 1-9.
15. Stull D.E., Schaefer M., Crespi S., Sandor D.W.: Relative strength of relationships of nasal congestion and ocular symptoms with sleep, mood and productivity. Curr. Med. Res. Opin. 2009, 25(7): 1785-1792.
16. Guerra S., Sherrill D., Martinez F., Barbee R.: Rhinitis as an independent risk factor for adult-onset asthma. J. Allergy Clin. Immunol. 2002, 109: 419-425.
17. Boulay M.E., Morin A., Laprise C., Boulet L.P.: Asthma and rhinitis: what is the relationship? Curr. Opin. Allergy Clin. Immunol. 2012, 12(5): 449-454.
18. Leynaert B., Neukirch C., Kony S. et al.: Association between asthma and rhinitis according to atopic sensitization in a population-based study. J. Allergy Clin. Immunol. 2004, 113: 86-93.
19. Linneberg A., Henrik Nielsen N., Frolund L. et al.: The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study Allergy 2002, 57: 1048-1052.
20. Braunstahl G.J., Hellings P.W.: Allergic rhinitis and asthma: the link further unraveled. Curr. Opin. Pulm. Med. 2003, 9(1): 46-51.
21. Compalati E., Ridolo E., Passalacqua G. et al.: The link between allergic rhinitis and asthma: the united airways disease. Expert Rev. Clin. Immunol. 2010, 6(3): 413-423.
22. Clatworthy J., Price D., Ryan D. et al.: The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim. Care Respir. J. 2009, 18: 300-305.
23. Fokkens W.J., Lund V.J., Mullol J. et al.: European position paper on rhinosinusitis and nasal polyps (EPOS) 2012. Rhinology 2012, (supl. 23): 1-298.
24. Benninger M.S., Benninger R.M.: The impact of allergic rhinitis on sexual activity, sleep, and fatigue. Allergy Asthma Proc. 2009, 30(4): 358-365.
25. Acar M., Cingi C., Sakallioglu O. et al.: The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis. Am. J. Rhinol. Allergy 2013; 27(4): e113-116.
26. Vuurman E.F., Vuurman L.L., Lutgens I., Kremer B.: Allergic rhinitis is a risk factor for traffic safety. Allergy 2014, 69: 906-912.
27. SuV.Y., Liu C.J., Lan M.Y.: Allergic rhinitis and risk of erectile dysfunction – a nationwide population-based study. Allergy 2013, 68(4): 440-445.
28. Scarupa M.D., Kaliner M.A.: Nonallergic rhinitis, with a focus on vasomotor rhinitis: clinical importance, differential diagnosis, and effective treatment recommendations. World Allergy Organ. J. 2009, 2(3): 20-25.
29. Arcimowicz M.: Rynopatie. Alergologia Polska – Polish Journal of Allergology 2015, 2: 5-14.
30. Greiner A.N., Hellings P.W., Rotiroti G., Scadding G.K.: Allergic rhinitis. Lancet 2011, 378(9809): 2112-2222.
31. Greiner A.N., Meltzer E.O.: Overview of the treatment of allergic rhinitis and nonallergic rhinopathy. Proc. Am. Thorac Soc. 2011, 8(1): 121-131.
32. Woroń J., Porębski G., Dymura K.: Leki przeciwhistaminowe a prowadzenie pojazdów. Terapia 2011, 5(257): 7-10.
33. Woroń J.: Niekorzystne interakcje leków przeciwhistaminowych – dlaczego mają tak istotne znaczenie praktyczne, jakie są pomiędzy nimi różnice? Terapia 2015, 6(324): 39-43.
34. Nacleiro R.: Intranasal corticosteroids reduced ocular symptoms associated with allergic rhinitis. Otolaryngol. Head Neck Surgery 2008, 138: 129-139.
35. Meltzer E.O.: The role of nasal corticosteroids in the treatment of rhinitis. Immunol. Allergy Clin. North Am. 2011, 31: 545-560.
36. Scichilone N., Arrigo R., Paternò A. et al.: The effect of intranasal corticosteroids on asthma control and quality of life in allergic rhinitis with mild asthma. J. Asthma 2011, 48(1): 41-47.
37. Lohia S., Schlosser R.J., Soler Z.M.: Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis. Allergy 2013, 68(5): 569-579.
38. Agondi R.C., Machado M.L., Kalil J., Giavina-Bianchi P.: Intranasal corticosteroid administration reduces nonspecific bronchial hyperresponsiveness and improves asthma symptoms. J. Asthma 2008, 45(9): 754-757.
39. Jung Y.G., Kim H.Y., Min J.Y. et al.: Role of intranasal topical steroid in pediatric sleep disordered breathing and influence of allergy, sinusitis, and obesity on treatment outcome. Clin. Exp. Otorhinolaryngol. 2011, 4(1): 27-32.
40. Derendorf H., Meltzer E.O.: Molecular and clinical pharmacology of intranasal corticosteroids and therapeutic implications. Allergy 2008, 63: 1292-1300.
41. Schenkel E.J., Skoner D.P., Bronsky E.A. et al.: Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000, 105(2): e22.
42. Meltzer E.O.: Allergic rhinitis: managing the pediatric spectrum. Allergy Asthma Proc. 2006, 27: 2-8.
43. Ratner P.H., Meltzer E.O., Teper A.: Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis. Int. J. Pediatr. Otorhinolaryngol. 2009, 73: 651-657.
44. Tripathy I., Levy A., Ratner P. et al.: HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis. Pediatric. Allergy and Immunology 2009, 20(3): 287-294.
45. Baena-Cagnani C.E., Patel P.: Efficacy and long-term safety of mometasone furoate nasal spray in children with perennial allergic rhinitis. Curr. Med. Res. Opin. 2010, 26: 2047-2055.
46. Emin O., Fatih M., Emre D., Nedim S.: Lack of bone metabolism side effects after 3 years of nasal topical steroids in children with allergic rhinitis. J. Bone Miner. Metab. 2011, 29: 582-587.
47. Minshall E., Ghaffar O., Cameron L. et al.: Assessment by Nasal Biopsy of Long-Term Use of Mometasone Furoate Aqueous Nasal Spray (Nasonex) in the Treatment of Perennial Rhinitis. Otolaryngol. Head Neck Surg. 1998, 118: 648-654.
48. Arcimowicz M.: Glikokortykosteroidy donosowe u dzieci. Alergoprofil 2012, 8(1): 5-17.
49. Schafer T., Schnoor M., Wagenmann M. et al.: Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis. Rhinology 2011, 49(3): 272-280.
50. Sharpe S.A., Sandweiss V., Tuazon J. et al.: Comparison of the flow properties of aqueous suspension corticosteroid nasal sprays under differing sampling conditions. Drug Dev. Ind. Pharm. 2003, 29(9): 1005-1012.
51. Koźmiński M., Kupczyk M.: Tiksotropia leków donosowych – znaczenie w praktyce klinicznej. Pneumonologia i Alergologia Polska 2015, 83: 157-163.
52. Tran N.P., Vickery J., Blaiss M.S.: Management of Rhinitis: Allergic and Non-Allergic. Allergy Asthma Immunol. Res. 2011, 3(3): 148-156.
53. Baroody F.M., Brown D., Gavanescu L. et al.: Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J. Allergy Clin. Immunol. 2011, 127(4): 927-934.
54. Ciebiada M., Gorska-Ciebiada M., Barylski M. et al.: Use of montelukast alone or in combination with desloratadine or levocetirizine in patients with persistent allergic rhinitis. Am. J. Rhinol. Allergy 2011, 25(1): e1-6.
55. Cingi C., Oghan F., Eskiizmir G. et al.: Desloratadine-montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis. Int. Forum Allergy Rhinol. 2013, 3(10): 801-806.
56. Roberts P., Xatzipsalti M., Bornego L.M. et al.: Paediatric rhinitis: Position paper of the European Academy of Allergology and Clinical Immunology. Allergy 2013, 68: 1102-1116.