Pharmacologic rationale for treating allergic and nonallergic rhinitis - 18/08/11

Doi : 10.1016/j.jaci.2006.06.029

Alexander N. Greiner, MD ^⁎ , Eli O. Meltzer, MD
From Allergy and Asthma Medical Group and Research Center and the University of California San Diego School of Medicine

Reprint requests: Alexander N. Greiner, MD, Allergy and Asthma Medical Group and Research Center, 9610 Granite Ridge Dr, Suite B, San Diego, CA 92123.

San Diego, CalifThis activity is available for CME credit. See page 34A for important information.

Abstract

Allergic rhinitis (AR) and perennial nonallergic rhinitis (PNAR) represent conditions affecting millions of individuals across the world. Although the diagnosis of AR might be presumptively based on the types of symptoms and the history of allergen triggers, confirmation requires documentation of specific IgE reactivity. In contrast, PNAR is a condition with similar symptomatology but in which the patient has no identifiable specific allergic sensitivities. This review presents the diverse options of currently available pharmacologic agents for the treatment of AR and PNAR, including intranasal corticosteroids, H1-antihistamines, decongestants, cromolyn sodium, antileukotrienes, anticholinergics, capsaicin, anti-IgE, and intranasal saline. Furthermore, appropriate stepped-up, stepped-down pharmacotherapeutic algorithms are described for the various forms of rhinitis.

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Key words : Allergic rhinitis, nonallergic rhinitis, nonallergic rhinitis with eosinophilia syndrome, perennial nonallergic rhinitis, pharmacotherapy, H1-antihistamines, intranasal corticosteroids, antileukotrienes, capsaicin, cromolyn sodium

Abbreviations used : AR, INS, NARES, OTC, PNAR, VMR

Plan

(Supported by an unrestricted educational grant from Genentech, Inc. and Novartis Pharmaceuticals Corporation)
Series editor: Harold S. Nelson, MD
Disclosure of potential conflict of interest: A. N. Greiner has received grant support from Alcon, Allux, Altana, AstraZeneca, Clay-Park Labs, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffman-La Roche, Medicinova, MedPointe, Merck, Novartis, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, and Wyeth and is on the speakers’ bureau for AstraZeneca KOS, Pfizer, and Sanofi-Aventis. E. O. Meltzer has received grant support from Alcon, Allux, AstraZeneca, Clay-Park Labs, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffmann-La Roche, Medicinova, MedPointe, Merck, Novartis, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, and Wyeth; has consultant arrangements with Abbott, Adelphi, Alcon, Allux, Altana, Amgen, AstraZeneca, Capnia, Critical Therapeutics, Dey, Evolutec, Genentech, GlaxoSmithKline, Greer, Inspire, KOD, MedPointe, Merck, Novartis, Pfizer, Rigel, Sanofi-Aventis, Schering-Plough, Shionogi, Verus, and Wyeth; and is on the speakers’ bureau for AstraZeneca, Alcon, Altana, Genentech, Genesis, GlaxoSmithKline, MedPointe, Merck, Novartis, Pfizer, Sanofi-Aventis, Schering-Plough, and Verus.