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Rhinitis April 10, 2006 THE NOSE CT of THE NOSE The inside of THE NOSE Therapeutic Options Allergic Rhinitis • Antihistamines • Decongestants • Anticholinergics • Corticosteroids AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy Therapeutic Options Allergic Rhinitis • Antihistamines • Decongestants • Anticholinergics • Corticosteroids AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy Pseudoephedrine and HR Pseudoephedrine and SBP Pseudoephedrine and DBP Every Patient is Different Therapeutic Options Allergic Rhinitis • Antihistamines • Decongestants • Anticholinergics • Corticosteroids AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy Intranasal Corticosteroids in Allergic Rhinitis: An Overview Benefits Drawbacks • Are first-line therapy for persistent allergic rhinitis • May cause nasal irritation and/or bleeding • Relieve all symptoms – Sneezing – Nasal itching – Rhinorrhea • Patient compliance • Patient concerns about steroids – Nasal congestion • Minimal side effects Urval KR. Primary Care. 1998;25(3):649-662. Suonpaa J. Ann Med. 1996;28:17-22. Dykewicz MS, Fineman S. Ann Allergy Asthma Immunol. 1998;81:463-468. INS or NSA Therapeutic Options Allergic Rhinitis • Antihistamines • Decongestants • Anticholinergics • Corticosteroids AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy LTRA in Allergic Rhinitis All Evidence is Not the Same Therapeutic Options Allergic Rhinitis • Antihistamines • Decongestants • Anticholinergics • Corticosteroids AAAAI. The Allergy Report. 2000. Dykewicz M et al. Ann Allergy Asthma Immunol. 1998;81:478–518. Cromones/mast cell stabilizers Leukotriene receptor antagonists Immunotherapy Subcutaneous Immunotherapy (Hyposensitization) • Mechanism of action = Unknown (may shift immune response from TH2- to TH1-response to allergen) • Efficacy: Demonstrated in AR Only disease-modifying therapy for AR • Usage: In patients who do not respond adequately to pharmacotherapy • Side effects: local reactions, anaphylaxis AAAAI. The Allergy Report. 2000. Available at: http://www.theallergyreport.org/reportindex.html Types of Rhinitis • Allergic – Seasonal or Perennial – Intermittent or Persistent • Non Allergic – Vasomotor – Infectious • Viral or Bacterial – Drug induced • Antihypertensives, Afrin – Hormonal • Pregnancy, Hypothyroid – NARES, Atrophic, Anatomic