UPDATES IN THE MANAGEMENT OF SEASONAL ALLERGIC RHINITIS

FCAAIA Notes: This article is a concise review of medication options for treating nasal allergies. It does not go in to the specifics of one medication as compared to another.  The one glaring omission is that there is no discussion of immunotherapy, a potential cure for allergies.

(Source: http://www.medscape.com/viewarticle/872714?src=wnl_tp10j_170317_mscpedit&uac=112079PK&impID=1310119&faf=1 March 17, 2017. For Medscape articles: User name: FCAAIA, Password: Allergies. Adapted from US Pharmacist. 2016;41(7):30-34.)

Abstract

Seasonal allergic rhinitis is an inflammatory response to seasonal allergens in the nasal mucosa that produces symptoms of rhinorrhea, sneezing, and nasal itching and/or congestion. The treatment of seasonal allergic rhinitis consists of a variety of options, including nonpharmacologic therapies, oral antihistamines, intranasal antihistamines, intranasal corticosteroids, oral leukotriene receptor antagonists, and mast cell stabilizers. At this time, intranasal corticosteroids and oral antihistamines remain the mainstay of treatment for seasonal allergic rhinitis. Evidence of the efficacy of the combination of intranasal corticosteroids and oral antihistamines is lacking; therefore, the simultaneous use of these agents is not recommended.

Introduction

In the United States, it is estimated that 15% to 30% of people have allergic rhinitis. Approximately 19 million U.S. adults were diagnosed with allergic rhinitis in 2014, representing about 8% of the population. Allergies are the sixth leading cause of chronic illness in the U.S. In one study, allergic rhinitis was the most causative chronic condition associated with productivity loss, at an estimated cost of $593 per employee per year. The healthcare cost of allergic rhinitis, when combined with allergic conjunctivitis, is estimated to exceed $6 million annually.

Allergic rhinitis, often called hay fever, is an inflammatory response to an allergen that is mediated by immunoglobulin E. The inflammatory response occurs in the nasal mucosa and produces symptoms of anterior or posterior rhinorrhea, nasal congestion and/or itching, and sneezing. Diagnosis of allergic rhinitis is not typically made until around age 3 or 4 years owing to the multitude of viral respiratory infections that occur in young children. During the first year of life, infants begin to become sensitized to inhaled allergens, starting with indoor allergens, then outdoor.

Allergic rhinitis is classified according to pattern of exposure, frequency of symptoms, and severity of symptoms. The pattern of exposure can be categorized as seasonal, perennial, or episodic; the frequency of symptoms can be classified as intermittent or persistent, and the symptom severity can be mild or moderate-to-severe. Treatment of allergic rhinitis depends on the classification. Table 1 summarizes the classification criteria for allergic rhinitis.

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