J Korean Med Assoc.  2016 Apr;59(4):300-308. 10.5124/jkma.2016.59.4.300.

Current trends in treatment of allergic rhinitis

Affiliations
  • 1Department of Otorhinolaryngology-Head & Neck Surgery, Korea University College of Medicine, Seoul, Korea. doctorth@korea.ac.kr

Abstract

Allergic rhinitis is an IgE-mediated disease, leading to inflammation of the nasal mucosa. Typical symptoms of allergic rhinitis are nasal congestion, rhinorrhea, sneezing, and/or nasal itching. Allergic rhinitis is a major health problem worldwide that causes illness and disability in daily life, affecting social life, sleep, school, and work. The economic cost of allergic rhinitis is substantial. Management of allergic rhinitis can be categorized largely into allergen avoidance, pharmacotherapy, immunotherapy, and surgical treatment. Although the general consensus is that allergen avoidance should lead to an improvement of symptoms, it is nearly impossible to completely avoid all allergens in real life. The importance of allergen avoidance is that minimizing allergen exposure can decrease medication dosage. Pharmacotherapy of allergic rhinitis may include any of histamine antagonist, topical/oral corticosteroid, leukotriene antagonist, decongestant, mast cell stabilizer, and cholinergic antagonist alone or in combination. Oral and intranasal spray of these medications are the main routes of administration. Immunotherapy is the medical procedure that uses controlled exposure to known allergens to reduce the severity of allergic disease. There are two ways of administering this treatment: subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Surgical treatment of the allergic rhinitis patient aims to resolve nasal obstruction by performing septoplasty or turbinoplasty.

Keyword

Allergic rhinitis; Allergen avoidance; Pharmacotherapy; Immunotherapy; Surgical treatment

MeSH Terms

Allergens
Cholinergic Antagonists
Consensus
Drug Therapy
Estrogens, Conjugated (USP)
Histamine
Humans
Immunotherapy
Inflammation
Mast Cells
Nasal Mucosa
Nasal Obstruction
Pruritus
Rhinitis*
Sneezing
Sublingual Immunotherapy
Allergens
Cholinergic Antagonists
Estrogens, Conjugated (USP)
Histamine

Reference

1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Ait-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, OHehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. World Health Organization. GA(2)LEN. AllerGen. LEN; AllerGen. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 86:Suppl 86. 8–160.
2. Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2010; (7):CD001563.
Article
3. Anderson MC, Baer H, Ohman JL Jr. A comparative study of the allergens of cat urine, serum, saliva, and pelt. J Allergy Clin Immunol. 1985; 76:563–569.
Article
4. Luczynska CM, Li Y, Chapman MD, Platts-Mills TA. Airborne concentrations and particle size distribution of allergen derived from domestic cats (Felis domesticus): measurements using cascade impactor, liquid impinger, and a two-site monoclonal antibody assay for Fel d I. Am Rev Respir Dis. 1990; 141:361–367.
Article
5. Spitzauer S, Rumpold H, Ebner C, Schweiger C, Valenta R, Gabl F, Anrather J, Breitenbach M, Scheiner O, Kraft D. Allergen profiles of dog hair and dander, body fluids and tissues as defined by immunoblotting. Int Arch Allergy Appl Immunol. 1991; 94:346–348.
Article
6. Horner WE, Helbling A, Salvaggio JE, Lehrer SB. Fungal allergens. Clin Microbiol Rev. 1995; 8:161–179.
Article
7. Korean Rhinologic Society. Guidelines for allergic rhinitis. Seoul: Korean Rhinologic Society;2012.
8. Secher C, Kirkegaard J, Borum P, Maansson A, Osterhammel P, Mygind N. Significance of H1 and H2 receptors in the human nose: rationale for topical use of combined antihistamine preparations. J Allergy Clin Immunol. 1982; 70:211–218.
Article
9. Wang D, Clement P, Smitz J. Effect of H1 and H2 antagonists on nasal symptoms and mediator release in atopic patients after nasal allergen challenge during the pollen season. Acta Otolaryngol. 1996; 116:91–96.
Article
10. Simons FE. Advances in H1-antihistamines. N Engl J Med. 2004; 351:2203–2217.
Article
11. Vermeeren A, Ramaekers JG, O'Hanlon JF. Effects of emedastine and cetirizine, alone and with alcohol, on actual driving of males and females. J Psychopharmacol. 2002; 16:57–64.
Article
12. Mosges R, Konig V, Koberlein J. The effectiveness of modern antihistamines for treatment of allergic rhinitis: an IPD meta-analysis of 140,853 patients. Allergol Int. 2013; 62:215–222.
13. Horak F, Zieglmayer UP, Zieglmayer R, Kavina A, Marschall K, Munzel U, Petzold U. Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy. Curr Med Res Opin. 2006; 22:151–157.
Article
14. Kaliner MA, Berger WE, Ratner PH, Siegel CJ. The efficacy of intranasal antihistamines in the treatment of allergic rhinitis. Ann Allergy Asthma Immunol. 2011; 106:2 Suppl. S6–S11.
Article
15. Mygind N, Dahl R, Pedersen S, Thestrup-Pedersen K. Essential allergy. London: Blackwell Science;1996.
16. Patel D, Garadi R, Brubaker M, Conroy JP, Kaji Y, Crenshaw K, Whitling A, Wall GM. Onset and duration of action of nasal sprays in seasonal allergic rhinitis patients: olopatadine hydrochloride versus mometasone furoate monohydrate. Allergy Asthma Proc. 2007; 28:592–599.
Article
17. Patel P, D'Andrea C, Sacks HJ. Onset of action of azelastine nasal spray compared with mometasone nasal spray and placebo in subjects with seasonal allergic rhinitis evaluated in an environmental exposure chamber. Am J Rhinol. 2007; 21:499–503.
Article
18. Korean Society of Otorhinolaryngology-Head and Neck Sugery. Otorhinolaryngology head and neck surgery. Seoul: Ilchokak;2009.
19. Rosenblut A, Bardin PG, Muller B, Faris MA, Wu WW, Caldwell MF, Fokkens WJ. Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis. Allergy. 2007; 62:1071–1077.
Article
20. Lanier B, Kai G, Marple B, Wall GM. Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol. 2007; 99:473–479.
Article
21. Fowler PD, Gazis AG, Page SR, Jones NS. A randomized double-blind study to compare the effects of nasal fluticasone and betamethasone on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis. Clin Otolaryngol Allied Sci. 2002; 27:489–493.
Article
22. Gazis AG, Homer JJ, Henson DB, Page SR, Jones NS. The effect of six weeks topical nasal betamethasone drops on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis. Clin Otolaryngol Allied Sci. 1999; 24:495–498.
Article
23. Wolthers OD, Pedersen S. Knemometric assessment of systemic activity of once daily intranasal dry-powder budesonide in children. Allergy. 1994; 49:96–99.
Article
24. Allen DB, Meltzer EO, Lemanske RF Jr, Philpot EE, Faris MA, Kral KM, Prillaman BA, Rickard KA. No growth suppression in children treated with the maximum recommended dose of fluticasone propionate aqueous nasal spray for one year. Allergy Asthma Proc. 2002; 23:407–413.
25. Skoner DP, Gentile DA, Doyle WJ. Effect on growth of long-term treatment with intranasal triamcinolone acetonide aqueous in children with allergic rhinitis. Ann Allergy Asthma Immunol. 2008; 101:431–436.
Article
26. Ernst P, Baltzan M, Deschenes J, Suissa S. Low-dose inhaled and nasal corticosteroid use and the risk of cataracts. Eur Respir J. 2006; 27:1168–1174.
Article
27. Christodoulopoulos P, Cameron L, Durham S, Hamid Q. Molecular pathology of allergic disease. II: upper airway disease. J Allergy Clin Immunol. 2000; 105(2 Pt 1):211–223.
28. Rodrigo GJ, Yanez A. The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials. Ann Allergy Asthma Immunol. 2006; 96:779–786.
Article
29. Papadopoulos NG, Philip G, Giezek H, Watkins M, Smugar SS, Polos PG. The efficacy of montelukast during the allergy season in pediatric patients with persistent asthma and seasonal aeroallergen sensitivity. J Asthma. 2009; 46:413–420.
Article
30. Storms WW, Bodman SF, Nathan RA, Chervinsky P, Banov CH, Dockhorn RJ, Jarmoszuk I, Zeitz HJ, McGeady SJ, Pinnas JL, Greenstein S. SCH 434: a new antihistamine/decongestant for seasonal allergic rhinitis. J Allergy Clin Immunol. 1989; 83:1083–1090.
Article
31. Min YG, Kim HS, Suh SH, Jeon SY, Son YI, Yoon S. Paranasal sinusitis after long-term use of topical nasal decongestants. Acta Otolaryngol. 1996; 116:465–471.
Article
32. Meltzer EO. NasalCrom Study Group. Efficacy and patient satisfaction with cromolyn sodium nasal solution in the treatment of seasonal allergic rhinitis: a placebo-controlled study. Clin Ther. 2002; 24:942–952.
Article
33. Bousquet J, Lockey R, Malling HJ, Alvarez-Cuesta E, Canonica GW, Chapman MD, Creticos PJ, Dayer JM, Durham SR, Demoly P, Goldstein RJ, Ishikawa T, Ito K, Kraft D, Lambert PH, Lowenstein H, Muller U, Norman PS, Reisman RE, Valenta R, Valovirta E, Yssel H. Allergen immunotherapy: therapeutic vaccines for allergic diseases. World Health Organization. American academy of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998; 81:401–405.
34. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schunemann HJ. Global Allergy and Asthma European Network. Grading of Recommendations Assessment. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:466–476.
Article
35. Bousquet J, Demoly P, Michel FB. Specific immunotherapy in rhinitis and asthma. Ann Allergy Asthma Immunol. 2001; 87:1 Suppl 1. 38–42.
Article
36. Zuberbier T, Bachert C, Bousquet PJ, Passalacqua G, Walter Canonica G, Merk H, Worm M, Wahn U, Bousquet J. GA2 LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma. Allergy. 2010; 65:1525–1530.
Article
37. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, Nelson M, Weber R, Bernstein DI, Blessing-Moore J, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011; 127:1 Suppl. S1–S55.
38. Canonica GW, Bousquet J, Casale T, Lockey RF, Baena-Cagnani CE, Pawankar R, Potter PC, Bousquet PJ, Cox LS, Durham SR, Nelson HS, Passalacqua G, Ryan DP, Brozek JL, Compalati E, Dahl R, Delgado L, van Wijk RG, Gower RG, Ledford DK, Filho NR, Valovirta EJ, Yusuf OM, Zuberbier T, Akhanda W, Almarales RC, Ansotegui I, Bonifazi F, Ceuppens J, Chivato T, Dimova D, Dumitrascu D, Fontana L, Katelaris CH, Kaulsay R, Kuna P, Larenas-Linnemann D, Manoussakis M, Nekam K, Nunes C, O'Hehir R, Olaguibel JM, Onder NB, Park JW, Priftanji A, Puy R, Sarmiento L, Scadding G, Schmid-Grendelmeier P, Seberova E, Sepiashvili R, Sole D, Togias A, Tomino C, Toskala E, Van Beever H, Vieths S. Sub-lingual immunotherapy: World Allergy Organization Position Paper 2009. Allergy. 2009; 64:Suppl 91. 1–59.
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