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PubMed1997

Triamcinolone acetonide. A review of its pharmacological properties and therapeutic efficacy in the management of allergic rhinitis.

Triamcinolone acetonide is a synthetic glucocorticoid which has been formulated as both an aerosol and an aqueous metered-dose pump spray for nasal inhalation in the treatment of allergic rhinitis. Nasally administered triamcinolone acetonide is not significantly absorbed into the systemic circulation and does not suppress hypothalamic-pituitary-adrenal (HPA) axis function at therapeutic dosages. Clinical trials with either formulation have shown that once-daily triamcinolone acetonide 110 to 220 micrograms reduces symptoms of allergic rhinitis within the first day of administration. Once symptoms are under control, the dosage of aqueous triamcinolone acetonide may be reduced from 220 to 110 micrograms/day without loss of effect. Both aqueous and aerosol formulations of triamcinolone acetonide are significantly more effective in relieving symptoms and reducing nasal eosinophil influx than placebo. Once-daily intranasal triamcinolone acetonide 220 micrograms/day produced similar reductions from baseline in nasal symptoms of allergic rhinitis, when measured both subjectively (visual analogue scales) and objectively (anterior rhinomanometry), to those seen with beclomethasone 84 to 168 micrograms twice daily, fluticasone 200 micrograms once daily or flunisolide 100 micrograms twice daily for 3 to 12 weeks. Furthermore, triamcinolone acetonide aerosol 220 micrograms/day was significantly more effective at reducing the nasal symptoms of allergic rhinitis than the oral antihistamines loratadine and astemizole (both 10mg daily) and was equally as effective in reducing the associated ocular symptoms. The use of intranasal triamcinolone acetonide and oral loratadine in combination did not confer any additional advantage over triamcinolone acetonide alone. Triamcinolone acetonide [110 to either 220 micrograms/day (aqueous) or 440 micrograms/day (aerosol)] was well tolerated in clinical trials; headache and epistaxis were the only adverse events considered possibly or probably related to aerosol therapy in a 1-year study (110 to 440 micrograms/day). Therefore, in accordance with the recommendations from the International Rhinitis Management Working Group regarding the use of nasal glucocorticoids, triamcinolone acetonide may be considered a first-line therapy option in adults with moderately severe seasonal allergic rhinitis with predominantly nasal symptoms and also in children and adult patients with perennial allergic rhinitis.

Adult↗
PubMed1998

Intranasal azelastine. A review of its efficacy in the management of allergic rhinitis.

UNLABELLED: Azelastine, a phthalazinone compound, is a second generation histamine H1 receptor antagonist which has shown clinical efficacy in relieving the symptoms of allergic rhinitis when administered as either an oral or intranasal formulation. It is thought to improve both the early and late phase symptoms of rhinitis through a combination of antihistaminic, antiallergic and anti-inflammatory mechanisms. Symptom improvements are evident as early as 30 minutes, after intranasal administration of azelastine [2 puffs per nostril (0.56mg)] and are apparent for up to 12 hours in patients with seasonal allergic rhinitis (SAR). The effect on nasal blockage is variable: in some studies objective and/or subjective assessment showed a reduction in blockage, whereas in other studies there was no improvement. Intranasal azelastine 1 puff per nostril twice daily is generally as effective as standard doses of other antihistamine agents including intranasal levocabastine and oral cetirizine, ebastine, loratadine and terfenadine at reducing the overall symptoms of rhinitis. The relative efficacies of azelastine and intranasal corticosteroids (beclomethasone and budesonide) remain unclear. However, overall, the corticosteroids tended to improve rhinitis symptoms to a greater extent than the antihistamine. Azelastine was well tolerated in clinical trials and postmarketing surveys. The most frequently reported adverse events were bitter taste, application site irritation and rhinitis. The incidence of sedation did not differ significantly between azelastine and placebo recipients and preliminary report showed cardiovascular parameters were not significantly altered in patients with perennial allergic rhinitis (PAR). CONCLUSION: Twice-daily intranasal azelastine offers an effective and well tolerated alternative to other antihistamine agents currently recommended for the symptomatic relief of mild to severe SAR and PAR in adults and children (aged > or = 12 years in the US; aged > or = 6 years in some European countries including the UK). The rapid onset, confined topical activity and reduced sedation demonstrated by the intranasal formulation of azelastine may offer an advantage over other antihistamine agents, although this has yet to be confirmed.

Administration, Intranasal↗
PubMedDate not supplied

Effect of desloratadine on the control of morning symptoms in patients with seasonal and perennial allergic rhinitis.

The symptoms of allergic rhinitis vary in severity over the course of the day and often are worse in the morning. This review focuses on data from clinical studies of the antihistamine desloratadine to establish whether it effectively controls the morning symptoms of allergic rhinitis. Studies of desloratadine in patients with allergic rhinitis that used instantaneous scoring to assess the severity of morning symptoms were selected for inclusion from published literature (peer-reviewed articles and abstracts presented at professional meetings). When administered once daily, desloratadine is effective in alleviating the morning symptoms of allergic rhinitis, including nasal congestion. Its action is sustained over the 24-hour dosing interval. A comparison of morning and evening dosing of desloratadine revealed equivalent relief of morning symptoms, illustrating that the effect of desloratadine is independent of the time of dosing. Clinical studies indicate that desloratadine is nonsedating and well tolerated, with no evidence of adverse cardiac effects. For many patients with allergic rhinitis, symptoms are most severe in the morning. To maximize the benefits for patients, pharmacologic agents used in the management of allergic rhinitis should be effective in controlling these peak morning symptoms. The sustained 24-hour action of desloratadine and its effective control of morning symptoms make it a valuable tool for improving the quality of life of patients with allergic rhinitis.

Animals↗
PubMed1999

Clinical assessment of antihistamines in rhinitis.

The first line of treatment for allergic rhinitis must be identification and avoidance as far as possible of the relevant allergens. This is rarely completely successful and so pharmaceutical treatment is also needed. Antihistamines are effective in allergic rhinitis, which comprises approximately 80% of rhinitis found in children and 30% in adults. Antihistamines antagonize the effect of histamine at the H1 receptor and their major clinical effects are related to this. They are effective against rhinorrhoea, itch and sneezing but have little effect on nasal obstruction. Clinical trials show between 36% and 80% of patients experiencing good to excellent symptom relief (approximately twice that induced by placebo), in seasonal allergic rhinitis; between 55% and 86% of patients experience moderate to excellent symptom relief in perennial allergic rhinitis. Meta-analysis reveals that antihistamines are inferior to corticosteroids in allergic rhinitis therapy. Antihistamines are generally well tolerated, although serious cardiac dysrhythmias have occurred with terfenadine and astemizole. Their place in therapy is probably as sole agent in mild, intermittent rhinitis and in combination with topical corticosteroids in more severe disease not controlled by corticosteroids alone.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Pharmacomodulation of hypersensitivity rhinitis].

INTRODUCTION: Hypersensitive rhinitis is characterized by accumulation of mast cells and eosinophils (believed to be primary effector cells) in the nasal epithelium. Treatment of hypersensitive rhinitis is directed towards reducing either tissue accumulation of these activated cells or the end-organ effects of the released mediators. The aim of this study was to examine effects of local corticosteroid treatment on the number of eosinophils in nasal secretion of patients with isolated hypersensitive rhinitis. MATERIAL AND METHODS: A total of 55 subjects were included in a prospective controlled trial. Thirty-seven patients with hypersensitive rhinitis were included in the experimental group, and 18 patients with hypersensitive rhinitis in the control group. A local corticosteroid, beclomethasone dipropionate, aqueous nasal spray, was administrated every 12 hours (400 micrograms per day) to the experimental group during 6 weeks. Patients of both groups were regularly controlled during the study period by ENT and cytological examination of nasal secretions. RESULTS AND DISCUSSION: Very significant differences in regard to the number of eosinophils were found in the nasal secretion of experimental patients with hypersensitive rhinitis, whereas they were insignificant in patients from the control group. Strong antieosinophilic effect of beclomethasone was evident. Eosinophil apoptosis at the inflammatory site appeared to be delayed when interleukin-5 was generated by neighbouring cells, or this delay is due to autocrine production of this cytokine. CONCLUSION: Local corticosteroid treatment of hypersensitive form of chronic rhinitis significantly reduces the number of eosinophils and thus probably modulates the pathogenesis of this inflammatory process.

Administration, Topical↗
PubMed2002

A characteristic protein in nasal discharge differentiating non-allergic chronic rhinosinusitis from allergic rhinitis.

To differentiate non-allergic chronic rhinosinusitis (vasomotor rhinitis) from allergic rhinitis, a characteristic protein in the nasal discharge was studied. The subjects consisted of 10 patients with perennial allergic rhinitis to house dust, 10 patients without perennial rhinitis without antigen (clinically defined as non-allergic chronic rhinosinusitis) and 5 normal volunteers without nasal disease as a control group. The total protein in the nasal discharge was determined by Lowry's method and analysis of the protein components was made by SDS-PAGE. It was found that the nasal discharge obtained from the case with perennial allergic rhinitis contained a high concentration of albumin (25.9 micrograms/ml) and a characteristic protein band with an estimated molecular weight of 26 kilo-Daltons (kD) on a SDS-PAGE, in a concentration of 15.8 micrograms/ml. In contrast, the nasal discharge from non-allergic chronic rhinosonusitis patients contained a lower concentration of albumin (12.9 micrograms/ml) than that of the allergic rhinitis patients, and the concentration of the characteristic protein 26 kD was only 2.3 micrograms/ml. The 26 kD protein was considered to originate from the nasal glands, since its secretion could be provoked by stimulation of the nasal glands of the normal volunteers with a 1% pilocarpine spray. The low concentration of albumin and the characteristic protein 26 kD in the nasal discharge thus appeared to differentiate patients with non-allergic chronic rhinosinusitis from those with perennial allergic rhinitis.

Adolescent↗
PubMedDate not supplied

[Rhinitis, asthma and sports].

Over the last few years, the importance of sport in everyday life has rapidly increased. Asthma and allergic rhinitis are among the most common problems to be afforded in those practising sports. It is believed that allergy represents a limitation to sport activity, but many elite athletes suffer from respiratory allergy: within those participating in the Olympic Games, 49% suffered from allergic rhinitis, and 20% of winter sport athletes suffered from asthma. Exercise is a potent trigger factor for asthma both in allergic and non allergic subjects. About 70% of asthmatic patients experience asthma symptoms during exercise; skiing and running in particular can elicit bronchospasm. Swimming is usually considered a non asthmogenic sport, but the inhalation of chloride derivatives and irritants can favor asthma onset. From a pathogenic point of view, exercise induced asthma seems to be due to sudden changes of osmolarity in the mucus layer on bronchial walls induced by hyperventilation and low temperature of inspired air. Athletes also suffer from non allergic rhinitis that can influence their performance. Rhinitis in fact modify the correct ventilation and can induce lower respiratory disorders, like asthma. Recently, cold-induced rhinitis has been described in those athletes practicing winter sports, especially skiers. This rhinitis is characterized mainly by rhinorrhea, and responds to topical anti-cholinergic agents. In conclusion, sport can exacerbate or induce asthma and rhinitis but this fact does not represent a limitation to physical activity. A deep knowledge of the diseases occurring during exercise, a detailed education and a correct therapy, allow to perform sports even at high levels also in presence of respiratory allergy.

Anti-Asthmatic Agents↗
PubMed2003

Rhinitis in pregnancy.

About 30% of women suffer from nasal symptoms during pregnancy. The hormonal changes occurring during pregnancy favour per se mucosal oedema and relaxation of smooth muscles, thus contributing to nasal congestion. The most common forms of rhinitis are allergic, drug-induced, infectious and vasomotor rhinitis. In addition to the detrimental effects that rhinitis can have on quality of life, it is important to correctly treat rhinitis itself since it can influence concomitant asthma, as underlined in ARIA document. In pregnancy, the safety profile of drugs is the primary item to be considered. The American FDA pointed out that foetal damage could not be totally excluded with the majority of antirhinitis drugs. It is recommended to use "older drugs" because more data about their safety are available. Cromones are the safest drugs but, although they need multiple daily administrations. Antihistamines should be considered as second choice drugs, and their use is not recommended during the first three months of pregnancy. Topical steroids are useful in moderate-severe rhinitis, being beclometasone the most documented molecule. Topical vasoconstrictors should not be used continuously because they can induce pharmacological rhinitis. It is not recommended to start specific immunotherapy in pregnancy but it can be continued in patients who benefit from its use. Infective rhinitis should be treated with beta-lactams, cephalosporins or macrolides. Finally it is important to evaluate the cost/usefulness ratio before any drug prescription.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

[Determination of interleukins and IgG4 in patients with allergic rhinitis with and without immunotherapy].

BACKGROUND: Allergic rhinitis is the most common atopic reaction to allergens and may persist for many years if not treated. It is never lethal, though it may cause morbidity. The IgE synthesis is regulated by inheritance, antigen exposition and cytokines; specially Th2 cells, through secretions of the IL4 e IL5 that favor IgE production and inflammation rich in eosinophils. OBJECTIVE: To determine the difference of IgG4 serum levels, gamma interferon, and interleukins of patients with allergic rhinitis, with and without immunotherapy, and healthy patients. MATERIAL AND METHODS: In an observational, transversal, prospective, comparative and open study 82 (100%) patients were recruited and divided into three groups. Group 1 included 15 patients with allergic rhinitis diagnosis and positive skin tests without immunotherapy; group 2, 15 patients with allergic rhinitis diagnosis and positive skin tests with immunotherapy; group 3, 52 healthy patients. RESULTS: IL-4, IL-5, IL-6 and IL-12 values were higher in both groups of allergic rhinitis, compared with healthy group. There were differences in the IL-5 concentrations that were less in patients with allergic rhinitis and vaccine than in those without vaccine. The values of IgG4 and gamma interferon did not vary and were not found in the studied groups. CONCLUSION: The present study proved the existence of significant differences, showed increments in the interleukin values among healthy and allergic patients, despite allergic rhinitis is a local phenomenon. It is probable that the above is related to the genetic tendency to produce a Th2 cytokines pattern which is a characteristic of allergy. Allergen immunotherapy modified significantly the IL-5 levels as well as the other studied interleukins.

Adult↗
PubMed2005

Efficacy of intramuscular BCG polysaccharide nucleotide on mild to moderate bronchial asthma accompanied with allergic rhinitis: a randomized, double blind, placebo-controlled study.

BACKGROUND: Atopy is a state of allergy to common antigens and is founded on an immune disturbance of exuberant Th2 activity and IgE production. There is also epidemiological and experimental evidence that exposure to mycobacteria has the potential to suppress the development of asthma or atopy. Since Th1 and Th2 immune mechanisms are significantly antagonistic, it is hypothesized that mycobacterial exposure may moderate atopic disease by modification of immune responses. METHODS: One hundred and twenty mild to moderate persistent asthmatics accompanied with allergic rhinitis were randomly divided into four groups with one injection every other day for 18 times for group A with 1 ml of normal saline, B with 0.5 mg of Bacillus Calmette-Guérin polysaccharide nucleotide (BCG-PSN) and C with 1 mg of BCG-PSN, 36 times for group D with 0.5 mg of BCG-PSN. Markers for the severity of asthma and rhinitis including the amount of inhaled corticosteriod, bronchodilator and oral H1 blocker-loratidine being used to obtain optimal symptomatic control, symptom scores of asthma and allergic rhinitis, peak expiratory flow (PEF), histamine provocative dose that produces at least a 20% change in forced expiratory volume with in 1 second (PD20-FEV1), blood IgE levels as well as dermatophagoides pteronysinus (DP) and dermatophagoides farinae (DF) skin prick test were measured every visit for 6 months. RESULTS: There were no differences for symptom scores of asthma, daily use of bronchodilator, PEF, PD20-FEV1, blood IgE as well as DF and DP skin prick test among the four groups. Score for allergic rhinitis decreased significantly in groups B, C and D on day 36 and 72 as compared with group A (P < 0.05). Score for allergic rhinitis increased after day 72 in group B and C while it was significantly lower in group D (P < 0.05). The patients in group D used less amount of inhaled beclomethosone than other groups (P < 0.05) from day 72 after the treatment to day 180. Oral loratadine consumption in groups B, C and D was significantly less on day 36 and 72 as compared with their baseline and group A after the treatment (P < 0.05). Group D maintained significantly lower dosage of oral loratadine until day 150 comparing with its baseline and group A. CONCLUSIONS: BCG-PSN has a symptomatic effect on allergic rhinitis. BCG-PSN may reduce the dosage of non-sedative H1 blocker loratadine as well as the dosage of inhaled beclomethosone in the treatment of mild to moderate asthma and allergic rhinitis.

Adult↗
PubMed2005

[The clinical study of the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis].

OBJECTIVE: To investigate the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis. METHODS: 1120 patients with autumnal pollinosis, aged 5 - 75, excluding those with typical symptoms of seasonal rhinitis or asthma but with positive skin test and serum IgE specific to dustmite and fungi, underwent standardized clinical questionnaire survey, including the onset age, onset time, and symptoms as well as the severity of asthma, skin tests, and examination of serum IgE specific to autumnal pollens. RESULTS: The average onset age of the allergic rhinitis patients induced by autumnal pollens was 27.9 years, significantly younger than that of the allergic asthma patients (32.6 years, P < 0.001). Out of the 1120 patients 1096 (97.9%) had allergic rhinitis, 602 (53.8%) had asthma, 507 (45.3%) had allergic rhinitis only, and 10 (0.9%) had allergic asthma only. Among the 1096 patients with allergic rhinitis 585 (53.4%) suffered from seasonal asthma. Among the 602 patients with asthma 585 (97.2%) suffered from seasonal rhinitis, and 183 of the 602 patients (30.8%) needed emergency treatment. CONCLUSION: Autumnal pollens are very important causes which induce asthma during autumnal season in northern China.

Adolescent↗
PubMed2006

Intranasal application of Epstein-Barr virus/lipoplex to abrogate eosinophillia in murine model of allergic rhinitis.

BACKGROUND: Currently anti-inflammatory therapy with steroids for allergic rhinitis need long-term repeated administration, although it is effective. Gene therapy is being suggested to substitute it. The aim of this study was to investigate nonviral vector mediated exogenous gene expression in COS-7 cells in vitro and the effect of intranasal mouse interleukin (mIL)-12 transgene expression on allergen induced eosinophil infiltration of nasal mucosa in a murine model of allergic rhinitis. METHODS: In vitro COS-7 cells were infected with Epstein-Barr virus (EBV)/lipoplex. The expression of IL-12 p70 in cell culture supernatant was examined by enzyme-linked immunosorbent assay (ELISA). In mice with ovalbumin (OVA) induced allergic rhinitis, EBV/lipoplex was administered by nasal drops before OVA challenge once a day from day 1 to day 10. The expression of IL-12 mRNA and protein, the change of eosinophil count in nasal mucosa and serum total IgE were measured 24 hours after the last challenge. RESULTS: EBV/lipoplex could effectively transfect COS-7 cells. The expression of IL-12 p70 in cell culture supernatant was significantly more than in blank control. IL-12 via EBV plasmid vector transduction could be overexpressed in vivo. In pGEG.mIL-12 treated models, the nasal mucosa revealed a high level of widespread mIL-12 transduction by immunohistochemistry and in situ hybridization. Histological evaluation revealed marked suppression of eosinophil infiltration in nasal mucosa. The eosinophil count in allergic rhinitis group [(26.5 +/- 9.8)/high-power field (HPF)] was significantly increased over control group [(0.40 +/- 0.52)/HPF] (F = 56.94, P < 0.01), while the count in IL-12 gene therapy group [(4.60 +/- 2.63)/HPF] was significantly less than that of allergic group (F = 56.9, P < 0.01). Serum total IgE between in gene therapy mice [(88.83 +/- 6.71) ng/ml] and allergic rhinitis mice [(103.1 +/- 5.7) ng/ml] showed a significant difference (F = 1216, P < 0.05). CONCLUSIONS: Nonviral EBV plasmid vector, pGEG.mIL-12 was able to overexpress exogenous gene both in vitro and in murine nasal mucosa in vivo. IL-12 overexpression via EBV/lipoplex could stem allergen induced eosinophil infiltration in nasal mucosa in murine models of allergic rhinitis, which may suggest a new cytokine immunogenetic therapy for allergic rhinitis.

Administration, Intranasal↗
PubMed1989

The comparison of allergic responses to Dermatophagoides farinae between bronchial asthma and allergic rhinitis.

The allergic responses of 52 bronchial asthma patients who exhibited a positive bronchoprovocation test with house dust and 50 allergic rhinitis patients who had positive RAST results to Dermatophagoides farinae (D. farinae) were studied, including the measurement of D. farinae-specific IgE using D. farinae-RAST, total IgE and skin reactivity to D. farinae and house dust. A comparison between the allergic rhinitis group in which methacholine PC20 was more than 4.66 mg/mL and the allergic rhinitis group which presented negative results in the methacholine bronchial challenge test, indicated that there were significant differences in skin test reactivity and the ratio of specific IgE to total IgE (P less than .05). The allergic responses we observed were not different between the allergic rhinitis group in which methacholine PC20 was less than 4.66 mg/mL (asthmatic range of methacholine PC20) and the allergic rhinitis group in which methacholine PC20 was more than 4.66 mg/mL. When comparing the bronchial asthma group which showed positive results in D. farinae-RAST and the allergic rhinitis group in which methacholine PC20 was less than 4.66 mg/mL, significant differences were noted in total IgE level (P less than .05). These findings suggest that the development of bronchial asthma in patients with allergic rhinitis might be predicted by measuring the degree of bronchial hyperreactivity and their allergic responses.

Allergens↗
PubMed2006

Up-regulation of peroxisome proliferator-activated receptor gamma in perennial allergic rhinitis.

OBJECTIVES: To investigate the expression of peroxisome proliferator-activated receptor gamma (PPAR-gamma) messenger RNA and protein and to localize the PPAR-gamma protein in the nasal mucosa of patients with allergic rhinitis and control subjects. DESIGN: Prospective study. SETTING: Tertiary academic institution. Patients Twenty patients with perennial allergic rhinitis and 20 matched nonallergic patients. INTERVENTIONS: Inferior turbinate mucosa samples were obtained from 20 patients with perennial allergic rhinitis and 20 matched nonallegic patients. Peroxisome proliferator-activated receptor gamma messenger RNA was extracted from the inferior turbinate mucosae, and then reverse transcription-polymerase chain reaction was performed. Western blot testing was used to analyze differences in PPAR-gamma protein expression levels between patients with allergic rhinitis and normal controls, and the PPAR-gamma protein was localized immunohistochemically. RESULTS: The expression levels of PPAR-gamma messenger RNA and protein in the nasal mucosa was significantly increased in patients with perennial allergic rhinitis compared with controls. Peroxisome proliferator-activated receptor gamma protein was expressed in the epithelium, infiltrating inflammatory cells, and submucosal glands. CONCLUSIONS: Peroxisome proliferator-activated receptor gamma is expressed in the human nasal mucosa and is up-regulated in perennial allergic rhinitis. These results suggest a possible contribution for PPAR-gamma in chronic inflammation of the nasal mucosa in perennial allergic rhinitis.

Adult↗
PubMed2006

Capsaicin treatment of idiopathic rhinitis: the new panacea?

The management of patients with perennial nonallergic or idiopathic rhinitis is difficult. Diagnosis and treatment are hampered by several factors. First, the diagnosis is made by exclusion of other nasal diseases. As a consequence, idiopathic rhinitis is not defined according to clear-cut criteria. A commonly accepted phenotype of idiopathic rhinitis does not exist. Second, the pathophysiology of idiopathic rhinitis is not yet fully elucidated. In contrast with allergic rhinitis, inflammation does not appear to play an important role in idiopathic rhinitis. Recent studies indicate a neural dysregulation of the nasal mucosa. Additionally, the available therapeutic arsenal comprising both pharmacotherapy and surgery is at best partially efficacious in these patients. The efficacy of repeated capsaicin application has been established in several randomized controlled trials. This treatment modality may be the first step to more specific and better treatment options for patients with idiopathic rhinitis that is unresponsive to standard treatment.

Animals↗
PubMed1994

Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire.

BACKGROUND AND AIM: Perennial allergic rhinitis may impair social life. General scales of quality of life (QOL) are used to detect the importance of social life impairment, but the reliability and validity of QOL measures should be tested in patients with perennial allergic rhinitis. The extent to which QOL scores differ in patients with rhinitis and healthy subjects is unknown. METHODS: A cross-sectional study was carried out in 111 patients with moderate to severe perennial allergic rhinitis and 116 healthy subjects to assess the validity of a general QOL scale, the SF-36 Health Status Questionnaire. This scale is based on 36 items selected to represent nine health concepts (dimensions). The internal reliability of each dimension of the questionnaire was examined. The differences in QOL scores between patients with rhinitis and healthy subjects were studied. RESULTS: Most QOL scores were highly reliable. There was a significant impairment in eight of nine QOL dimensions in patients with perennial allergic rhinitis in comparison with healthy subjects. CONCLUSIONS: The SF-36 Health Status Questionnaire allows discrimination between patients with perennial allergic rhinitis and healthy subjects.

Adolescent↗
PubMed2006

The diagnosis and treatment of allergic rhinitis during pregnancy and lactation.

Rhinitis, including allergic rhinitis, in pregnancy represents a challenge to the physician in terms of its diagnosis and therapy. Although several unique in-fluences of pregnancy adversely affect nasal mucosa, there is growing recognition that most symptomatic nasal problems are expressions of diagnostic entities that have been or will be experienced by the patient in the nonpregnant state. In approaching gestational rhinitis, emphasis should be placed on making an early, accurate diagnosis so that limited, specific, and informed medicinal intervention can be used. Simultaneously, the physician should keep in mind that rhinosinusitis in pregnancy is not necessarily a benign clinical problem. It is important to remember that upper airway disease, if uncontrolled, has a significant adverse effect on quality of life and may exacerbate coexisting asthma, which could affect the pregnancy outcome adversely [82]. Specialty consultation with otolaryngology or allergy may be necessary in the symptomatic pregnant woman before an accurate diagnosis and successful therapeutic recommendations can be made. The medico-legal atmosphere in the United States poses problems in making clinical statements about the absolute safety of medicinal intervention during pregnancy. For physicians who choose to take up this therapeutic challenge,suitable pharmacologic agents are available to manage the pregnant patient who has rhinitis or rhinosinusitis to achieve the desired therapeutic outcome. Suggested guidelines for the treatment of allergic conjunctivitis and rhinitis are summarized in Box 2. In the individual clinical situation, management decisions must be made only after establishing an exact clinical diagnosis, giving full consideration to the therapeutic risks, benefits, and alternatives, and documenting this in the patient's record. Moreover, the physician's interpretation of the benefit-risk ratio and the therapeutic decisions based thereon must be fully explained to, and approved by, the pregnant patient before intervention is initiated.A significant number of women who suffer from rhinitis of pregnancy are allergic. Under these circumstances, the best first-line approach is avoidance of allergens, which can reduce symptoms significantly. Often, what is chosen first is either a medication or the decision to allow the pregnant patient to suffer the symptoms, which can affect the pregnancy outcome adversely. Limited allergy consultation can be useful under these circumstances to identify pertinent allergens and to direct avoidance effectively. If avoidance is unsuccessful, then,with the informed consent of the patient and documentation in the chart, medicinal intervention can begin as shown (see Box 2). Although many women and caregivers may choose not to intervene with medications based on fear of teratogenicity, such notions are contradicted by a significant amount of medical evidence. This is especially true of drug intervention for rhinitis and rhinosinusitis after the first trimester.

Diagnosis, Differential↗
PubMed2006

ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma.

Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (Key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementary-alternative medicine was frequently inadequate. Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.

Acupuncture↗