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PubMed2002

Allergic rhinitis and its impact on asthma: an evidence-based treatment strategy for allergic rhinitis.

The overall pathogenic view of respiratory allergy has deeply changed and evolved during the last ten years. Much emphasis has been laid to the relationship between rhinitis and asthma, which is between the upper and the lower respiratory airways. This strict link has been evidenced through clinical observations and epidemiological studies and also on the basis of immunological observations and outcomes of therapy. Furthermore, the frequent co-existence of rhinitis and asthma (up to 80 percent of asthmatic patients have co-existing allergic rhinitis, while up to 40 percent of allergic rhinitis patients have asthma, the coexistence of sinusitis and asthma, the presence of rhinitis as a risk factor for developing asthma, further emphasize this link and together lead to the operative definition of Allergic Rhinobronchitis or, United Airways Disease (UAD). The strict link existing between upper and lower respiratory tract can be also regarded from the viewpoint of therapeutical outcomes. The more detailed knowledge of the intricate mechanisms sustaining allergic inflammation in the respiratory tract (i.e. antigen presentation, cytokines, chemokines and adhesion molecules) has clarified the functional relationships between nose and lung. Thus allergic rhinitis or asthma is not a disease confined to a specific target organ, but rather a disorder of the whole respiratory tract, with a range of clinical manifestations, leading to relevant diagnostic and therapeutic implications as indicated in the WHO Initiative ARIA, the first evidence-based guideline emphasizing the impact of allergic rhinitis on asthma and where a step-wise treatment strategy targeting both the upper and lower airway effectively has been proposed. Moreover, the use of novel potential therapies that target both rhinitis and asthma like antileukotrienes or anti-IgE are indeed a future strategy.

Asthma↗

PubMed2004

Occupational allergy to wheat flour. Nasal response to specific inhalative challenge in asthma and rhinitis vs. isolated rhinitis: a comparative study.

OBJECTIVES: The purpose of the study was to compare cytological and biochemical changes in nasal lavage fluid induced by wheat flour inhalatory challenge in bakers with allergic rhinitis and with asthma accompanied by rhinitis. MATERIALS AND METHODS: A single-blind, placebo controlled study was conducted in 64 bakers with allergic rhinitis (n = 17), bronchial asthma and rhinitis (n = 24) and without occupational allergy (n = 23). Nasal washings were examined before, 30 min, 4 and 24 h after the specific provocation, wheras non-specific bronchial hyperreactivity (PC20) before and after 24 h. RESULTS: A significant decrease in PC20 after the challenge test was observed only in patients with asthma and rhinitis. Eosinophil count and percentage, basophil count and the permeability index induced by specific provocation were significantly increased in both rhinitis patients and asthmatics. Moreover, the increase especially in total count and proportion of eosinophils as well as in the permeability index was more pronounced in subjects suffering from asthma and rhinitis than in those with rhinitis alone, although the changes were not statistically significant. CONCLUSIONS: The results indicate the applicability of the "nasal pool" technique as a simple diagnostic procedure in flour-induced airway allergy. However, the evaluation of nasal lavage fluid, although a very sensitive and specific method of diagnosing respiratory allergic disease, cannot be used to distinguish patients with upper and lower airway allergy.

Adult↗

PubMedDate not supplied

Bronchial hyperresponsiveness in adults with seasonal and perennial rhinitis: is there a link for asthma and rhinitis?

Epidemiological studies have shown that asthma and rhinitis often coexist in the same patients and the prevalence of asthma is greater in patients with rhinitis. The aim of this study was to evaluate the differences in bronchial reactivity in subjects with seasonal and perennial rhinitis. We enrolled 128 subjects with seasonal or perennial allergic rhinitis divided into three groups: A with perennial rhinitis and allergy to Dermatophagoides Pteronissynus; B with seasonal rhinitis and allergy to Graminae and Parietaria, who underwent methacholine challenge test (MCHt) during the exposure period (fron March until May); C with seasonal rhinitis and allergy to Graminae and Parietaria, who underwent MCHt during the non exposure period (from June until February). The PC20 mean values of group A (1774.8 ± 20.7) and group B (1740.7 ± 38.8) were not significantly different, but significantly lower than those of group C (3010.0 ± 56.9) (p=0.001). The subjects with group A were positive to the MCHt in 54.54%, against 29.28% of group B and 11.62% of group C (p=0.007). The results show differences in the degree of bronchial responsiveness. The dose-response curves documented a lower value of PC20 in the group with perennial rhinitis and a statistically significant difference of bronchial hyperresponsiveness prevalence between the three groups (p=0.007).

Journal Article↗

PubMed1996

Motivation for participation in clinical trials of drugs for the treatment of asthma, seasonal allergic rhinitis, and perennial nonallergic rhinitis.

BACKGROUND: While previous studies of enrollment motivation have been conducted with either healthy subjects or subjects with certain other diseases, little is known about the motives of subjects with asthma or rhinitis symptoms who seek to enter clinical trials. OBJECTIVE: This study was conducted to assess the self-reported role that altruism, healthcare receipt, and financial gain play in the motivation of subjects with symptoms of bronchial asthma, seasonal allergic rhinitis, and perennial nonallergic rhinitis who attempted to enroll in clinical trials. METHODS: Subjects with symptoms of asthma, allergic rhinitis, and perennial nonallergic rhinitis who sought to enroll in phase III clinical trials completed surveys from December 1991 to August 1992 (n = 295). The importance of altruistic and nonaltruistic motives was rated on numerical scales. RESULTS: Improved control of symptoms and learning more about the illness and medications for treatment were the most important nonaltruistic motives (P less than .05). Financial motives and second opinion were moderately important but less important than healthcare motives (P less than .05). This population as a whole agreed that the altruistic motives listed in the survey were reasons to enroll. CONCLUSION: Subjects with symptoms of asthma, allergic rhinitis, and perennial nonallergic rhinitis entered clinical trials for altruistic reasons and to receive healthcare treatment for their chronic illness including related health education. For the entire group, self-reported financial motives were less important than illness-related healthcare.

Adolescent↗

PubMed2004

Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting: the Quality of Sleep in Allergic Rhinitis study.

BACKGROUND: Sleep disturbances due to allergic rhinitis can contribute to daytime fatigue, impair mood, and decrease daytime functioning. OBJECTIVE: To measure allergic rhinitis patients' nocturnal rhinitis-related quality of life using a new, validated disease-specific instrument, the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ). METHODS: This open-label study was conducted in a primary care setting. Adult patients with seasonal or perennial allergic rhinitis rated nocturnal rhinitis-related quality of life using the NRQLQ and sleep disturbances using the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 3 weeks of treatment with triamcinolone acetonide aqueous nasal spray (TAA AQ), 220 microg/d. Changes from baseline in overall and individual domain scores for both the NRQLQ and PSQI were evaluated using t tests for paired differences. RESULTS: The majority of the patients (N = 651) were female (58%), were white (85%), and shared a bed with a partner (63%). Mean +/- SD patient age was 45.7 +/- 15.5 years. TAA AQ treatment was associated with significant improvements in overall NRQLQ score (mean +/- SD change, -1.5 +/- 1.3; P < .001) and in individual domain scores (P < .001 for sleep problems, symptoms during sleep, symptoms upon waking in morning, and practical problems). Similarly, overall and individual PSQI domain scores were statistically significantly improved (P < .001). There were strong correlations between NRQLQ and PSQI scores (all comparisons P < .001). CONCLUSIONS: Treatment with TAA AQ for 3 weeks resulted in statistically significant improvements in nocturnal rhinitis-related quality of life and sleep quality in allergic rhinitis patients treated in a primary care setting.

Administration, Intranasal↗

PubMedDate not supplied

Nasal eosinophilia in allergic and nonallergic rhinitis: usefulness of the nasal smear in the diagnosis of allergic rhinitis.

Diagnostic nasal cytology has been advocated for use in distinguishing allergic from nonallergic rhinitis. We sought to determine prospectively the frequency of nasal eosinophilia (NE) in 100 patients in whom having allergic rhinitis (AR), nonallergic rhinitis, and other atopic conditions not involving the respiratory tract have been diagnosed. A nasal smear was obtained from consenting adults using the Rhino-Probe curette. Patients taking local or systemic corticosteroids, those with chronic rhinitis associated with aspirin sensitivity, and those with sinusitis were excluded. All cytograms were coded and read by a single "blinded" investigator. NE was considered significant if greater than 20% of sampled cells were eosinophils. Twenty-six of 61 (43%) patients with AR had NE. No NE was detected in the control population or in the skin test negative group of patients in whom having nonallergic rhinitis was diagnosed. One of 16 patients with allergic disease not involving the respiratory tract exhibited NE; this patient had atopic dermatitis with peripheral eosinophilia. No cases of eosinophilic nonallergic rhinitis were detected. There was no significant correlation of symptoms or the number of positive skin tests with NE. These data suggest that the nasal smear for eosinophils is an insensitive but specific test for the diagnosis of allergic rhinitis, when patients with nasal polyposis and aspirin sensitivity and/or negative skin tests are excluded.

Adult↗

PubMed2004

[Computed tomography stage in patients with allergic rhinitis and nonallergic rhinitis with eosinophilia syndrome].

OBJECTIVES: To compare computed tomography (CT) scores and nasal eosinophilia between patients with allergic rhinitis and nonallergic rhinitis with eosinophilia syndrome (NARES) and to evaluate the effect of the number of responsible allergens on the CT scores. PATIENTS AND METHODS: Sixty-three patients with a positive skin prick test, 11 patients with NARES and 15 healthy volunteers were included in this study. Allergic rhinitis patients were divided into three groups according to sensitivity to one allergen, two allergens, and more than two allergens. All the patients were examined by paranasal CT scans. The mean CT scores were determined by using the Lund-Mackay grading system and the results were compared. RESULTS: The mean CT scores were 5.4+/-5.8, 15.6+/-6.2, and 1.0+/-0.6 in patients with allergic rhinitis and NARES and in the control group, respectively. The mean CT score and eosinophilia in nasal smears were significantly higher in NARES patients compared to those with allergic rhinitis (p<0.05). No significant differences were found between the three groups of allergic rhinitis in this respect (p>0.05). CONCLUSION: Although the paranasal sinuses are affected by both allergic rhinitis and NARES, this effect is greater in NARES. The number of allergens causing sensitivity does not influence the CT score.

Adolescent↗

PubMed1997

A comparison of cytokine release from epithelial cells cultured from nasal biopsy specimens of atopic patients with and without rhinitis and nonatopic subjects without rhinitis.

BACKGROUND: Recent studies have suggested that airway epithelial cells of atopic and nonatopic individuals may differ in their ability to produce proinflammatory cytokines. METHODS: We have cultured human nasal epithelial cells (NECs) as confluent explant cultures from nasal biopsy specimens of well-characterized nonatopic normal volunteers without rhinitis (n = 8), atopic volunteers without rhinitis (n = 9), and atopic patient volunteers with rhinitis (n = 10) and measured the amounts of IL-1 beta, IL-8, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor-alpha, and RANTES released spontaneously into the culture medium by these cells in vitro. NECs from patients with allergic rhinitis were cultured from biopsy specimens obtained on two different occasions, during and after the pollen season. RESULTS: In general, NECs from atopic individuals released significantly greater amounts of IL-1 beta, IL-8, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor-alpha, and RANTES than NECs from nonatopic individuals. IL-8 was released in greatest quantity and IL-1 beta in lowest quantity, regardless of whether the NECs were derived from atopic or nonatopic volunteers. Of the atopic individuals, NECs of atopic patients with rhinitis naturally exposed to pollen released greater quantities of all these cytokines, compared with NECs of atopic patients with rhinitis and atopic patients without rhinitis who were not exposed to allergen. CONCLUSIONS: These results suggest that NECs of atopic individuals, who are genetically predisposed to upper airway disease, release increased amounts of proinflammatory cytokines and that natural exposure to allergen enhances the release of these cytokines, exacerbating the symptoms of allergic disease.

Adolescent↗

PubMed1999

Double-blind trials of azelastine nasal spray monotherapy versus combination therapy with loratadine tablets and beclomethasone nasal spray in patients with seasonal allergic rhinitis. Rhinitis Study Groups.

BACKGROUND: Azelastine hydrochloride is an H1-receptor antagonist with antiinflammatory properties that is available in the US as Astelin Nasal Spray for the treatment of seasonal allergic rhinitis. The symptoms of seasonal allergic rhinitis can initially be treated with monotherapy using either an antihistamine or an intranasal corticosteroid. Patients whose symptoms do not respond adequately are often prescribed a combination of both an antihistamine and an intranasal corticosteroid. OBJECTIVE: Three multicenter, randomized, double-blind studies were conducted to determine whether patients with moderate-to-severe symptoms of seasonal allergic rhinitis who had responded inadequately to monotherapy with either an oral antihistamine or an intranasal corticosteroid, and who were candidates for combination therapy with both an oral antihistamine and an intranasal corticosteroid, could be effectively treated with azelastine nasal spray monotherapy. METHODS: Following a 1- to 2-week washout period, patients were randomized to 7 days of double-blind treatment with either azelastine nasal spray (2 sprays per nostril bid, 1.1 mg/day) monotherapy or combination therapy with oral loratadine (Claritin, one 10-mg tablet/day) plus intranasal beclomethasone dipropionate monohydrate (Beconase AQ, 2 sprays per nostril bid, 336 microg/day). Efficacy was determined at the end of the study by both a physician assessment of the need for additional anti-rhinitis medication and a patient global evaluation of therapeutic effectiveness. The three studies were conducted at 71 investigational sites during the 1998 spring allergy season. Three separate studies were conducted to verify the reproducibility of the new study design. RESULTS: In all three studies a total of 1,070 patients were randomized to double-blind treatment. There were no statistically significant differences in the percentage of patients treated with azelastine nasal spray versus patients treated with a combination of loratadine tablets and beclomethasone nasal spray who did not require additional anti-rhinitis medication (32% to 45% and 39% to 46%, respectively). The patient global evaluation indicated that 77% to 84% of the patients treated with azelastine nasal spray had symptomatic improvement and 85% to 90% of the patients treated with loratadine tablets and beclomethasone nasal spray had symptomatic improvement. The most commonly reported adverse experience with azelastine nasal spray was a transient aftertaste (8%), while the most commonly reported adverse experience with loratadine tablets and beclomethasone nasal spray in combination was headache (6%). CONCLUSIONS: Based on the percentage of patients not requiring additional antirhinitis medication and the patient assessment of efficacy, azelastine nasal spray monotherapy was as effective as the combination of oral loratadine plus intranasal beclomethasone in treating moderate-to-severe symptoms of seasonal allergic rhinitis.

Administration, Intranasal↗

PubMed1991

Nasal hyper-responsiveness to histamine, methacholine and phentolamine in patients with perennial non-allergic rhinitis and in patients with infectious rhinitis.

Recently it has been shown that patients with atopic rhinitis and with an allergy to house dust mites have a stronger nasal response to insufflation of histamine, methacholine and phentolamine than a control group. This hyper-responsiveness could not be demonstrated in patients with perennial non-allergic rhinitis, unless the patients were selected according to the predominant symptoms in the history. Patients with rhinorrhoea ('runners') proved to be hyper-responsive to methacholine compared with normal controls. The existence of two subpopulations was emphasized by hyper-responsiveness to both histamine and methacholine in the runners group compared with the patients with a stuffy nose ('blockers'). Patients with chronic nasal infections (characterized by recurrent episodes of purulent discharge) showed no hyper-responsiveness at all, indicating that either hyper-reactivity does not play an important part in this patient population or methods to detect hyper-reactivity in this group are inadequate. In contrast to our earlier observations in patients with atopic rhinitis, increased responsiveness to phentolamine could not be detected either in the patients with perennial rhinitis or in the patients with infectious rhinitis, indicating that the possible alpha-adrenergic dysfunction found in patients with atopic rhinitis is restricted to this group.

Adolescent↗

PubMed2004

Perennial rhinitis in the under 4s: a difficult problem to treat safely and effectively? A comparison of intranasal fluticasone propionate and ketotifen in the treatment of 2-4-year-old children with perennial rhinitis.

To compare the safety and efficacy of fluticasone propionate aqueous nasal spray (FPANS) and oral ketotifen in children aged 2-4 years with perennial rhinitis. A randomized, multicentre, double-blind, double dummy, placebo-controlled study. Paediatric patients between the ages of 2-4 years with perennial rhinitis. Rhinitis symptoms score (parent-rated), clinical evaluation of symptoms (investigator-rated) and adverse event profiles during the treatment period. Patients treated with FPANS had a significant reduction in both the total night-time rhinitis symptom assessment for weeks 4-6 (p-value 0.036), and the total daytime rhinitis symptom score over the same period (p-value 0.049). Generally, except for nasal itching/rubbing over weeks 1-3, the patients taking FPANS had lower recorded symptom scores for all individual symptoms measured. Nasal blockage, in particular, was significantly reduced over the 4-6 week period (p-value 0.027). The overall investigator-rated clinical evaluation showed substantial improvement or improvement in nine of 12 of the children taking FPANS compared with four of 14 taking ketotifen. Finally, there were no reports of serious adverse events, the incidence of drug-related adverse events was low and there was no statistical difference between the groups. FPANS may be an appropriate treatment to control the symptoms of rhinitis in children between 2 and 4 years old.

Administration, Intranasal↗

PubMed1993

Comparison of powder and aerosolized budesonide in perennial rhinitis: validation of rhinitis quality of life questionnaire.

The aims of the study were to compare the efficacy and side effects of intranasal budesonide as a dry powder and as a freon propelled pressurized aerosol in the treatment of perennial rhinitis and to validate a perennial rhinitis quality of life questionnaire. The design was a single-blind, randomized, parallel group comparison of two active treatments over a 6-week period. Sixty adults with symptomatic perennial rhinitis, stratified for atopy, received 400 micrograms intranasal budesonide administered daily either as one inhalation/nostril/day of pure drug powder or two puffs/nostril/day of drug delivered by a freon propelled aerosol. Subjects kept daily symptom diaries and, at each clinic visit, rhinitis quality of life and adverse experiences were recorded. Fifty-eight subjects completed the study. During the 6 weeks, there were significant improvements in symptoms and quality of life in both treatment groups. The improvements tended to be slightly greater in the aerosol group but the differences did not reach significance. Most frequently reported adverse experiences were headache and nosebleed, which were equally distributed in the two groups. We conclude that budesonide taken 400 micrograms daily for 6 weeks was associated with improvements in perennial rhinitis with little evidence of any difference in efficacy or side effects between the powder and aerosol. The questionnaire is a valid instrument for assessing quality of life in perennial rhinitis clinical trials.

Adult↗

PubMed1991

[Differentiation between allergic rhinitis and vasomotor rhinitis. Light and electron microscopic studies].

The pathological changes of nasal mucosa from allergic rhinitis and vasomotor rhinitis were observed. The results showed that the general characteristic was vascular dilatation with increased permeability and glandular proliferation with increased secretory activity. The pathological difference between mucous membranes of allergic and vasomotor rhinitis were mainly cellular infiltration and degree of damage on vascular wall. In allergic rhinitis there were more eosinophils, basophils, neutrophils and some mast cells and plasma cells in nasal mucosa. Gap formation in capillary wall was found in allergic nasal mucosa, there were less cellular infiltration and no gap formation in vasomotor rhinitis.

Diagnosis, Differential↗

PubMed1995

A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial rhinitis: efficacy in allergic and non-allergic perennial rhinitis.

BACKGROUND: Fluticasone propionate is a new potent, topically active corticosteroid with negligable oral bioavailability. Data on its comparative efficacy in perennial allergic and non-allergic rhinitis are limited. OBJECTIVE: To compare the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 micrograms once or twice daily with beclomethasone dipropionate aqueous nasal spray (BPD) 200 micrograms twice daily and placebo in patients with allergic and non-allergic perennial rhinitis. METHODS: The 12-week study had a multicentre, double-blind, randomized, parallel group design. Efficacy was assessed from symptom scores recorded on daily diary cards. RESULTS: FPANS 200 micrograms once or twice daily was significantly better than placebo but not better than BDP in relieving the nasal symptoms of rhinitis. FPANS at either dose was equally effective in the treatment of allergic and non-allergic perennial rhinitis. There were few adverse events and no treatment-related abnormalities in laboratory measurements in either FPANS-treated group. Comparison between treatment groups indicated that FPANS was as well tolerated as placebo and BDP at the doses studied. CONCLUSIONS: In the majority of patients FPANS 200 micrograms once daily in as effective as BDP 200 micrograms twice daily in the relief of perennial allergic rhinitis.

Administration, Intranasal↗

PubMed1992

Rhinitis during pregnancy and rhinitis medicamentosa.

Vasomotor rhinitis is a nonspecific disorder that is caused neither by infection nor allergy but rather by an imbalance of the autonomic nervous system with a preponderant action of parasympathetic fibers on nasal blood vessels. Rhinitis during pregnancy appears to result from the increased production of estrogen; increased estrogen levels caused by treatment, puberty, or liver disease may also cause rhinitis. Nasal saline mist, antihistamines, and topical corticosteroids are recommended; intranasal corticosteroid injections are also useful but must be administered under expert care. Rhinitis medicamentosa results from overuse of topical vasoconstrictors, which produce a rebound phenomenon. Rebound can also result from numerous medications, including antihypertensive preparations that reduce catecholamine levels, antidepressants, antipsychotics, and tranquilizers. Management of rhinitis medicamentosa consists in limiting the use of vasoconstrictors to no more than 3 days and giving the patient saline nasal sprays, daytime oral vasoconstrictors, and nocturnal antihistamines. Corticosteroids, preferably topical nasal steroids rather than even a short-term course of systemic administration, should also be used.

Adrenal Cortex Hormones↗

PubMed2005

[Investigation of the effect of oxymetazoline on the duration of rhinitis. results of a placebo-controlled double-blind study in patients with acute rhinitis].

AIMS AND METHOD: A prospective placebo-controlled double-blind study investigated the question whether oxymetazoline has a clinically relevant impact on the duration of acute rhinitis. The study included 247 patients with acute rhinitis who, over a maximum of 10 days, received either oxymetazoline hydrochloride (test substance group) or physiological saline solution applied in the form of a spray (control group). The main target measure was the duration of rhinitis, with time to onset of effect and symptoms as secondary measures. The safety of the treatment was determined on the basis of patient satisfaction, heart rate measurement, and undesired side effects recorded. RESULTS: The duration of the rhinitis decreased significantly under oxymetazoline in comparison with the control group (4 vs. 6 days). On average, the effect of oxymetazoline set in after 25 seconds, as compared with 90 seconds for physiological saline (difference significant, P < 0.001). From the second day of treatment, the symptoms improved significantly more markedly in the oxymetazoline group, and were identical again in both arms of the study from the 9th day onward. The physicians assessed the efficacy of oxymetazoline to be good orvery good in 85% of the cases as compared with 38% for the physiological saline solution (P <0.001). 84% of the patients in the oxymetazoline group assessed the effect to be good or very good, as compared with 44% in the patients in the physiological saline group (P < 0.001). CONCLUSION: All the parameters investigated revealed oxymetazoline to be significantly superior to physiological saline solution. Treatment with the former significantly shortened the duration of the rhinitis by one-third (2 days).

Acute Disease↗

PubMed1999

Adverse effects of benzalkonium chloride on the nasal mucosa: allergic rhinitis and rhinitis medicamentosa.

Prolonged, repeated use of nasal decongestants for symptomatic relief of allergic rhinitis often results in rhinitis medicamentosa (RM), a condition involving "rebound swelling" and additional congestion. Most decongestant sprays contain the preservative benzalkonium chloride (BKC), which causes toxic reactions in the nose, eyes, ears, and lungs, and may exacerbate the symptoms of allergic rhinitis. Recent studies demonstrate the effects of nasal sprays containing BKC or the decongestant oxymetazoline (OXY) in the development of RM. Using rhinostereometry, a technique that measures nasal mucosal swelling and nasal reactivity (with histamine challenge tests), prolonged use of OXY has been shown to induce nasal mucosal swelling and hyperreactivity. Sustained use of BKC alone induces nasal mucosal swelling and, in combination with OXY, BKC appears to have a long-term adverse effect on nasal mucosa. Its presence may also contribute to the RM resulting from overuse of decongestant sprays. Additional research is needed to confirm the deleterious effects of BKC in nasal products. However, these potential effects may be points of clinical differentiation in the treatment of allergic rhinitis and prevention of RM.

Benzalkonium Compounds↗

PubMed1987

Nasal disorders in children. Allergic rhinitis, vasomotor rhinitis, and nasal polyps.

Although the symptoms of allergic rhinitis, vasomotor rhinitis, and nasal polyps are similar, these conditions usually require different treatment. Allergic rhinitis responds best to environmental control, avoidance of allergens and irritants, and intermittent use of medication. Hyposensitization therapy is useful in some patients. Vasomotor rhinitis is usually helped by avoidance of environmental factors, but medical or surgical management is sometimes appropriate. Nasal polyps can be removed surgically.

Child↗