An allergic rhinitis treatment is carried out by an allergist who has a long-term treatment practice. Consequently it is necessary to consult with a doctor-specialist for the diagnosis and treatment.
Treatment of allergic rhinitis is always individually tailored to the severity of a particular patient’s disease and a combination of symptoms. The following general principles of treatment and prevention of allergic respiratory diseases are distinguished: patient training, allergen removal, medication, allergen-specific immunotherapy (Bousquet et al., 2001).
Nowadays, treatment of allergic rhinitis consists of short-acting or long-acting medications eliminating or alleviating symptoms. Such treatment is always recommended alongside regulation of the patient’s environmental conditions; i.e., elimination of allergy-causing allergen. Pharmacological treatment possibilities depend on the symptoms of allergic rhinitis and include (among others) antihistamines, glucocorticoids and anti-leukotrienes.
Histamine is considered to be one of the most important mediators of immune response, and, therefore, pharmaceutical treatment is mostly orientated to suppression of the effect of histamine. Antihistamines, mostly over-the-counter drugs, are the most widely used drugs for treatment of allergic rhinitis. Treatment with antihistamines usually starts with oral medications. Often, such treatment is initiated by the patient himself, since many of these medicines are available without prescriptions. Due to the relatively rapid onset of action, antihistamines may be used on an as-needed basis. This type of medication can also be prescribed as nasal sprays, but they are less acceptable to patients due to bitter taste (Lee, Pickard, 2007). The effect of preparations on symptoms, especially nasal congestion, is nevertheless small (Benninger, 2010, etc.).
Antihistamines can be combined with oral decongestants: then the inhalation of the air flow through the nose significantly improves (Corren et al., 1998; Nathan et al., 2006). Practice shows that treatment with antihistamines is not always effective providing proper help to the patient, and then you may need to choose other medicines (corticosteroids, etc.) or treatments.
Glucocorticoids are the most effective pharmacological therapy for seasonal allergic rhinitis, but their overall efficiency is moderate (Bende et al., 2002; Benninger et al., 2010). Although the clinical effect is formed during 24 hours, in case of perennial rhinitis the maximum effect may not be achieved even in a few weeks (Bende et al., 2002). So far, there is insufficient data on the efficiency and superiority of various nasal glucocorticoids when compared to antihistamines in the treatment of persistent allergic rhinitis (Benninger et al., 2010). Nasal glucocorticoids reduce eye allergy symptoms as efficiently as oral antihistamines.
The effect of leukotriene receptor antagonists on the symptoms of allergic rhinitis is similar or slightly less than that of oral antihistamines. Besides, some random sampling studies have shown that leukotriene receptor antagonists supplemented with antihistamines result in greater effect. On the other hand, no significant benefit of combining leukotriene receptor antagonists with nasal glucocorticoids has been identified (Rodrigo, Yañez, 2006; Carr et al., 2012).
The goal of allergen immunotherapy is to restore normal reaction of the body to the allergen. Allergen-specific immunotherapy can be explained in a simplified way by the principle of vaccination. Patients to whom allergen-specific immunotherapy is prescribed get the gradually increasing dose of the identified irritant – allergen. This way the organism becomes accustomed to a particular allergen, and the immune system stops producing specific antibodies. Following this treatment, the organism begins to tolerate the allergen, the symptoms of an allergic disease reduce, and the risk of developing asthma is stopped (Zuberbier et al., 2010).
References:
Bende, M., Carrillo, T., Vona, I., da Castel-Branco, M. G., Arheden, L. (2002). A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis. Annals of Allergy, Asthma & Immunology 88, 617–623.
Benninger, M., Farrar, J. R., Blaiss, M., et al. (2010). Evaluating approved medications to treat allergic rhinitis in the United States: an evidence-based review of efficacy for nasal symptoms by class. Annals of Allergy, Asthma & Immunology, 104, 13–29.
Bousquet, J., Van Cauwenberge, P., Khaltaev, N., Aria Workshop Group, World Health Oraganization (2001). Allergic Rhinitis and its Impact on Asthma. Journal of Allergy and Clinical Immunology, 108 (Suppl 5), 147–334.
Carr, W., Bernstein, J., Lieberman, P., et al. (2012). A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. Journal of Allergy and Clinical Immunology, 129, 1282–1289.
Corren, J., Harris, A. G., Aaronson, D., et al. (1998). Efficacy and safety of loratadine plus pseudoephedrine in patients with seasonal allergic rhinitis and mild asthma. Journal of Allergy and Clinical Immunology, 100, 781–788.
Lee, T. A., Pickard, A. S. (2007). Meta-analysis of azelastine nasal spray for the treatment of allergic rhinitis. Pharmacotherapy, 27, 852–859.
Nathan, R. A., Finn, A. F . Jr., LaForce, C., et al. (2006). Comparison of cetirizine-pseudoephedrine and placebo in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma: randomized, double-blind study. Ann Allergy Asthma Immunol, 97, 389–396.
Rodrigo, G. J., Yañez, A. (2006). The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials. Annals of Allergy, Asthma & Immunology, 96, 779–786.
Zuberbier, T., Bachert, C., Bousquet, J., Passalacqua, G., Walter Canonica, G., Merk H., Worm, M., Wahn, U., Bousquet, J. (2010). GA²LEN/EAACI pocket guide for allergenspecific immunotherapy for allergic rhinitis and asthma. Allergy, 65 (12), 1525–1530.