info - Allergic Rhinitis

[Guest guest]

http://tinyurl.com/2as9lqw

>

>

>

>

>

>

>

>

>

>

> info -

>

>

>

> Effects of montelukast on quality of life in patients with persistent allergic

rhinitis

>

>

>

>

>

>

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6WP4-4YX161Y-8 & _user=1\

0 & _coverDate=05%2F31%2F2010 & _rdoc=8 & _fmt=high & _orig=browse & _srch=doc-info(%23toc\

%236980%232010%23998579994%231906684%23FLA%23display%23Volume) & _cdi=6980 & _sort=d\

& _docanchor= & _ct=35 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=1d2\

5318778c282b007e7cefdbcc78f23

>

>

>

>

>

>

> Alana

>

[Guest guest]

info -

Management of Allergic Rhinitis Reviewed

http://www.medscape.com/viewarticle/724035

From Medscape Medical News

Management of Allergic Rhinitis Reviewed

Laurie Barclay, MD

June 23, 2010 — Allergic rhinitis is a common chronic respiratory illness

affecting quality of life, productivity, and comorbid conditions such as asthma,

according to the results of a study reported in the June 15 issue of American

Family Physician.

" Allergic rhinitis is an immunoglobulin E–mediated disease, thought to occur

after exposure to indoor and outdoor allergens such as dust mites, insects,

animal danders, molds, and pollens, " write K. Sur, MD, and

Scandale, MD, from the Geffen School of Medicine, University of

California, Los Angeles. " Symptoms include rhinorrhea, nasal congestion,

obstruction, and pruritus. Optimal treatment includes allergen avoidance,

targeted symptom control, immunotherapy, and asthma evaluation, when

appropriate. "

Treatment Strategies

Patient age and symptom severity should guide treatment of allergic rhinitis.

Physicians should educate patients about the condition and counsel them to avoid

known allergens. First-line treatment of mild to moderate disease is intranasal

corticosteroids, which is the most effective treatment available.

Onset of action of intranasal corticosteroids is 30 minutes, with peak activity

at several hours. However, this treatment may take 2 to 4 weeks to reach maximal

effect. In several studies, symptom scores were similar for intranasal

corticosteroids vs oral and intranasal antihistamines, but quality of life was

better with intranasal corticosteroids.

The various intranasal corticosteroids appear to be comparably effective to one

another, but only budesonide has a category B safety rating and is approved by

the US Food and Drug Administration (FDA) for use during pregnancy. The only

intranasal corticosteroid with a delivery device recognized by the National

Arthritis Foundation for ease of use is mometasone.

Adverse effects of intranasal corticosteroids may include headache; nosebleeds;

and irritation, stinging, burning, and dryness of the throat and nasal passages.

The FDA warns that long-term use of any intranasal corticosteroid may limit

skeletal growth in children, although evidence to date is conflicting.

For patients with moderate to severe allergic rhinitis refractory to intranasal

corticosteroids, second-line treatments include antihistamines, decongestants,

intranasal cromolyn, leukotriene receptor antagonists, intranasal

anticholinergics, and nonpharmacologic interventions such as nasal irrigation.

Although second-generation antihistamines are effective for relieving some nasal

and ocular symptoms, they are mostly ineffective for nasal congestion. Except

for cetirizine, second-generation antihistamines are less likely to sedate

patients and to impair their performance.

For patients with unsatisfactory response to usual therapy, immunotherapy should

be considered. Anaphylaxis is the most severe adverse event potentially

associated with immunotherapy. Allergen-specific vaccines have been developed

with use of recombinant DNA technology. These may significantly relieve symptoms

of allergic rhinitis while reducing skin sensitivity and use of other

medications.

Use of mite-proof impermeable covers, air filtration systems, or delayed

exposure to solid foods in infancy is not supported by evidence to date.

Nonpharmacologic therapies of varying benefit in some cases include acupuncture,

probiotics, and herbal preparations. Because of lack of evidence documenting

efficacy, these are not currently recommended.

" In 2001, Allergic Rhinitis and Its Impact on Asthma guidelines were published

in cooperation with the World Health Organization, suggesting that the treatment

of allergic rhinitis make use of a combination of patient education, allergen

avoidance, pharmacotherapy, and immunotherapy, " the review authors write. " In

contrast with previous guidelines, these recommendations are based on symptom

severity and age, rather than the type or frequency of seasonal, perennial, or

occupational exposures. "

Key Recommendations

Key clinical recommendations for practice, and their accompanying level of

evidence rating, are as follows:

•For mild to moderate allergic rhinitis, an intranasal corticosteroid alone

should be the initial treatment. For moderate to severe disease, second-line

treatments should be used (level of evidence, A).

•Compared with first-generation antihistamines, second-generation antihistamines

have less sedation and a better adverse effect profile (with the exception of

cetirizine; level of evidence, A).

•As first-line or second-line therapy for allergic rhinitis, intranasal

antihistamines are of limited use because of adverse effects, higher cost, and

decreased efficacy vs intranasal corticosteroids (level of evidence, A).

•Intranasal cromolyn is safe for general use for allergic rhinitis, but it is

not considered first-line treatment because of its lower efficacy for symptom

relief and its inconvenient dosing schedule (level of evidence, C).

•The symptoms of chronic rhinorrhea may respond to nasal saline irrigation,

which may be used alone or as adjuvant therapy (level of evidence, .

•Despite the high prevalence of dust mite allergies, mite-proof impermeable

mattress and pillow covers have not been shown to be effective against allergic

rhinitis in any studies (level of evidence, A).

•Breast-feeding, delayed exposure to solid foods in infancy, and the use of air

filtration systems have no documented efficacy in preventing allergic rhinitis

(level of evidence, .

" The International Primary Care Respiratory Group, British Society for Allergy

and Clinical Immunology, and American Academy of Allergy Asthma and Immunology

recommend initiating therapy with an intranasal corticosteroid alone for mild to

moderate disease and using second-line therapies for moderate to severe

disease, " the review authors conclude. " Patients with moderate to severe disease

not responding to oral or topical treatments should be referred for

consideration of immunotherapy. "

The study authors have disclosed no relevant financial relationships.

Am Fam Physician. 2010;81:1440-1446.

Medscape Medical News © 2010 Medscape, LLC

Send press releases and comments to news@....