Allergic rhinitis: Difference between revisions

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'''Allergic rhinitis''', also called '''seasonal allergic rhinitis''' is defined as "[[rhinitis]] that occurs at the same time every year. It is characterized by acute conjunctivitis with lacrimation and itching, and regarded as an allergic condition triggered by specific [[allergen]]s."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?field=uid&term=D006255 |title=Allergic rhinitis|author=National Library of Medicine |accessdate=2007-11-08 |format= |work=}}</ref>
'''Allergic rhinitis''', also called '''seasonal allergic rhinitis''' is defined as "[[rhinitis]] that occurs at the same time every year. It is characterized by acute conjunctivitis with lacrimation and itching, and regarded as an allergic condition triggered by specific [[allergen]]s."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?field=uid&term=D006255 |title=Allergic rhinitis|author=National Library of Medicine |accessdate=2007-11-08 |format= |work=}}</ref>


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[[Clinical practice guideline]]s by written by authors with [[conflict of interest]]s address the treatment.<ref name="pmid18662584">{{cite journal |author=Wallace DV, Dykewicz MS, Bernstein DI, ''et al'' |title=The diagnosis and management of rhinitis: an updated practice parameter |journal=J. Allergy Clin. Immunol. |volume=122 |issue=2 Suppl |pages=S1–84 |year=2008 |month=August |pmid=18662584 |doi=10.1016/j.jaci.2008.06.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0091-6749(08)01123-8 |issn=}}</ref>
[[Clinical practice guideline]]s by written by authors with [[conflict of interest]]s address the treatment.<ref name="pmid18662584">{{cite journal |author=Wallace DV, Dykewicz MS, Bernstein DI, ''et al'' |title=The diagnosis and management of rhinitis: an updated practice parameter |journal=J. Allergy Clin. Immunol. |volume=122 |issue=2 Suppl |pages=S1–84 |year=2008 |month=August |pmid=18662584 |doi=10.1016/j.jaci.2008.06.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0091-6749(08)01123-8 |issn=}}</ref>


===Environmental measures===
It is not clear whether control of dust and mites is helpful.<ref name="pmid20614426">{{cite journal| author=Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP| title=House dust mite avoidance measures for perennial allergic rhinitis. | journal=Cochrane Database Syst Rev | year= 2010 | volume= 7 | issue=  | pages= CD001563 | pmid=20614426 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20614426 | doi=10.1002/14651858.CD001563.pub3 }} </ref>
===Medications===
Among [[alpha adrenergic receptor agonist]]s, [[pseudoephedrine]] may be better than [[phenylephrine]] in the improvement of nasal congestion.<ref name="pmid19230461">{{cite journal |author=Horak F, Zieglmayer P, Zieglmayer R, ''et al'' |title=A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber |journal=Ann. Allergy Asthma Immunol. |volume=102 |issue=2 |pages=116–20 |year=2009 |month=February |pmid=19230461 |doi= |url= |issn=}}</ref>
Among [[alpha adrenergic receptor agonist]]s, [[pseudoephedrine]] may be better than [[phenylephrine]] in the improvement of nasal congestion.<ref name="pmid19230461">{{cite journal |author=Horak F, Zieglmayer P, Zieglmayer R, ''et al'' |title=A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber |journal=Ann. Allergy Asthma Immunol. |volume=102 |issue=2 |pages=116–20 |year=2009 |month=February |pmid=19230461 |doi= |url= |issn=}}</ref>
The most effective treatment is intranasal [[corticosteroid]]s according to [[systematic review]]s of [[randomized controlled trial]]s.<ref name="pmid20143641">{{cite journal| author=Benninger M, Farrar JR, Blaiss M, Chipps B, Ferguson B, Krouse J et al.| title=Evaluating approved medications to treat allergic rhinitis in the United States: an evidence-based review of efficacy for nasal symptoms by class. | journal=Ann Allergy Asthma Immunol | year= 2010 | volume= 104 | issue= 1 | pages= 13-29 | pmid=20143641
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20143641 }} </ref><ref name="pmid9848901">{{cite journal| author=Weiner JM, Abramson MJ, Puy RM| title=Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. | journal=BMJ | year= 1998 | volume= 317 | issue= 7173 | pages= 1624-9 | pmid=9848901
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=9848901 | pmc=PMC28740 }} </ref>


===Combination treatment===
===Combination treatment===
[[Azelastine]] nasal spray and [[fluticasone]] nasal spray in combination may be more effective than either used alone according to a [[randomized controlled trial]].<ref name="pmid18254486">{{cite journal |author=Ratner PH, Hampel F, Van Bavel J, ''et al'' |title=Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis |journal=Ann. Allergy Asthma Immunol. |volume=100 |issue=1 |pages=74–81 |year=2008 |pmid=18254486 |doi= |issn=}}</ref> However, mometasone monotherapy may be as effective as mometasone combined with loratadine.<ref name="pmid18426147">{{cite journal| author=Anolik R, Mometasone Furoate Nasal Spray With Loratadine Study Group| title=Clinical benefits of combination treatment with mometasone furoate nasal spray and loratadine vs monotherapy with mometasone furoate in the treatment of seasonal allergic rhinitis. | journal=Ann Allergy Asthma Immunol | year= 2008 | volume= 100 | issue= 3 | pages= 264-71 | pmid=18426147
For nocturnal symptoms, intranasal [[corticosteroid]]s can be combined with nightly [[oxymetazoline]], an [[adrenergic alpha-agonist]], without risk of rhinitis medicamentosa.<ref name="pmid21377716">{{cite journal| author=Baroody FM, Brown D, Gavanescu L, Detineo M, Naclerio RM| title=Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. | journal=J Allergy Clin Immunol | year= 2011 | volume= 127 | issue= 4 | pages= 927-34 | pmid=21377716 | doi=10.1016/j.jaci.2011.01.037 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377716  }} </ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=18426147 }} </ref>
 
Intranasal [[corticosteroid]] can be combined with [[histamine H1 antagonist]]s:
* Intranasal [[histamine H1 antagonist]]s may help. [[Azelastine]] nasal spray and [[fluticasone]] nasal spray in combination may be more effective than either used alone according to a [[randomized controlled trial]] that was not registered and had [[conflict of interest]].<ref name="pmid18254486">{{cite journal |author=Ratner PH, Hampel F, Van Bavel J, ''et al'' |title=Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis |journal=Ann. Allergy Asthma Immunol. |volume=100 |issue=1 |pages=74–81 |year=2008 |pmid=18254486 |doi=10.1016/S1081-1206(10)60408-5 |issn=|url=http://www.annallergy.org/article/S1081-1206%2810%2960408-5/fulltext}}</ref>
* However oral [[histamine H1 antagonist]]s may not help.<ref name="pmid16650054">{{cite journal| author=Barnes ML, Ward JH, Fardon TC, Lipworth BJ| title=Effects of levocetirizine as add-on therapy to fluticasone in seasonal allergic rhinitis. | journal=Clin Exp Allergy | year= 2006 | volume= 36 | issue= 5 | pages= 676-84 | pmid=16650054
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=16650054 | doi=10.1111/j.1365-2222.2006.02478.x }} </ref><ref name="pmid9722799">{{cite journal| author=Ratner PH, van Bavel JH, Martin BG, Hampel FC, Howland WC, Rogenes PR et al.| title=A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, for the treatment of seasonal allergic rhinitis. | journal=J Fam Pract | year= 1998 | volume= 47 | issue= 2 | pages= 118-25 | pmid=9722799
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=9722799 }} </ref><ref name="pmid7998664">{{cite journal| author=Simpson RJ| title=Budesonide and terfenadine, separately and in combination, in the treatment of hay fever. | journal=Ann Allergy | year= 1994 | volume= 73 | issue= 6 | pages= 497-502 | pmid=7998664
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=7998664 }} </ref><ref name="pmid14987306">{{cite journal| author=Di Lorenzo G, Pacor ML, Pellitteri ME, Morici G, Di Gregoli A, Lo Bianco C et al.| title=Randomized placebo-controlled trial comparing fluticasone aqueous nasal spray in mono-therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis. | journal=Clin Exp Allergy | year= 2004 | volume= 34 | issue= 2 | pages= 259-67 | pmid=14987306
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=14987306 }} </ref><ref name="pmid18426147">{{cite journal| author=Anolik R, Mometasone Furoate Nasal Spray With Loratadine Study Group| title=Clinical benefits of combination treatment with mometasone furoate nasal spray and loratadine vs monotherapy with mometasone furoate in the treatment of seasonal allergic rhinitis. | journal=Ann Allergy Asthma Immunol | year= 2008 | volume= 100 | issue= 3 | pages= 264-71 | pmid=18426147 |doi=10.1016/S1081-1206(10)60452-8
| url=http://www.annallergy.org/article/S1081-1206%2810%2960452-8/fulltext}} </ref>


==References==
==References==
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==External links==
==External links==
* {{MedlinePlus|Allergic rhinitis}}
* {{MedlinePlus|Allergic rhinitis}}[[Category:Suggestion Bot Tag]]

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Allergic rhinitis, also called seasonal allergic rhinitis is defined as "rhinitis that occurs at the same time every year. It is characterized by acute conjunctivitis with lacrimation and itching, and regarded as an allergic condition triggered by specific allergens."[1]

Cause / etiology

Allergic rhinitis may be associated with bronchial hyperreactivity.[2]

Diagnosis

Treatment

Clinical practice guidelines by written by authors with conflict of interests address the treatment.[3]

Environmental measures

It is not clear whether control of dust and mites is helpful.[4]

Medications

Among alpha adrenergic receptor agonists, pseudoephedrine may be better than phenylephrine in the improvement of nasal congestion.[5]

The most effective treatment is intranasal corticosteroids according to systematic reviews of randomized controlled trials.[6][7]

Combination treatment

For nocturnal symptoms, intranasal corticosteroids can be combined with nightly oxymetazoline, an adrenergic alpha-agonist, without risk of rhinitis medicamentosa.[8]

Intranasal corticosteroid can be combined with histamine H1 antagonists:

References

  1. ↑ National Library of Medicine. Allergic rhinitis. Retrieved on 2007-11-08.
  2. ↑ Shaaban R, Zureik M, Soussan D, et al (2007). "Allergic rhinitis and onset of bronchial hyperresponsiveness: a population-based study". Am. J. Respir. Crit. Care Med. 176 (7): 659–66. DOI:10.1164/rccm.200703-427OC. PMID 17615387. Research Blogging.
  3. ↑ Wallace DV, Dykewicz MS, Bernstein DI, et al (August 2008). "The diagnosis and management of rhinitis: an updated practice parameter". J. Allergy Clin. Immunol. 122 (2 Suppl): S1–84. DOI:10.1016/j.jaci.2008.06.003. PMID 18662584. Research Blogging.
  4. ↑ Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP (2010). "House dust mite avoidance measures for perennial allergic rhinitis.". Cochrane Database Syst Rev 7: CD001563. DOI:10.1002/14651858.CD001563.pub3. PMID 20614426. Research Blogging.
  5. ↑ Horak F, Zieglmayer P, Zieglmayer R, et al (February 2009). "A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber". Ann. Allergy Asthma Immunol. 102 (2): 116–20. PMID 19230461. [e]
  6. ↑ Benninger M, Farrar JR, Blaiss M, Chipps B, Ferguson B, Krouse J 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.". Ann Allergy Asthma Immunol 104 (1): 13-29. PMID 20143641.
  7. ↑ Weiner JM, Abramson MJ, Puy RM (1998). "Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials.". BMJ 317 (7173): 1624-9. PMID 9848901. PMC PMC28740.
  8. ↑ Baroody FM, Brown D, Gavanescu L, Detineo M, Naclerio RM (2011). "Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis.". J Allergy Clin Immunol 127 (4): 927-34. DOI:10.1016/j.jaci.2011.01.037. PMID 21377716. Research Blogging.
  9. ↑ Ratner PH, Hampel F, Van Bavel J, et al (2008). "Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis". Ann. Allergy Asthma Immunol. 100 (1): 74–81. DOI:10.1016/S1081-1206(10)60408-5. PMID 18254486. Research Blogging.
  10. ↑ Barnes ML, Ward JH, Fardon TC, Lipworth BJ (2006). "Effects of levocetirizine as add-on therapy to fluticasone in seasonal allergic rhinitis.". Clin Exp Allergy 36 (5): 676-84. DOI:10.1111/j.1365-2222.2006.02478.x. PMID 16650054. Research Blogging.
  11. ↑ Ratner PH, van Bavel JH, Martin BG, Hampel FC, Howland WC, Rogenes PR et al. (1998). "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 47 (2): 118-25. PMID 9722799.
  12. ↑ Simpson RJ (1994). "Budesonide and terfenadine, separately and in combination, in the treatment of hay fever.". Ann Allergy 73 (6): 497-502. PMID 7998664.
  13. ↑ Di Lorenzo G, Pacor ML, Pellitteri ME, Morici G, Di Gregoli A, Lo Bianco C et al. (2004). "Randomized placebo-controlled trial comparing fluticasone aqueous nasal spray in mono-therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis.". Clin Exp Allergy 34 (2): 259-67. PMID 14987306.
  14. ↑ Anolik R, Mometasone Furoate Nasal Spray With Loratadine Study Group (2008). "Clinical benefits of combination treatment with mometasone furoate nasal spray and loratadine vs monotherapy with mometasone furoate in the treatment of seasonal allergic rhinitis.". Ann Allergy Asthma Immunol 100 (3): 264-71. DOI:10.1016/S1081-1206(10)60452-8. PMID 18426147. Research Blogging.

External links

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