Immunotherapy with targeted allergens is the only treatment that changes natural history of allergic rhinitis

Here are a few key excerpts from the 2011 Lancet review of allergic rhinitis:

Allergic rhinitis is a very common disorder that affects 20-40% of people of all ages, peaking in the teenage years.

It is frequently ignored, underdiagnosed, misdiagnosed, and mistreated, which not only is detrimental to health but also has societal costs.

Significance of allergic rhinitis

Although allergic rhinitis is very clinically relevant because it underlies many complications, is a major risk factor for poor asthma control, and affects quality of life and productivity at work or school. Allergic rhinitis also plays a role in chronic sinusitis.

Management of allergic rhinitis

Management of allergic rhinitis is best when directed by guidelines.

A diagnostic and therapeutic trial of could be started in people with clinically identified allergic rhinitis. This typically consists of a second generation, non-sedating oral H2-antihistamine.

However, to confirm the diagnosis, specific IgE reactivity needs to be recorded.

Documented IgE reactivity has the added benefit of guiding implementation of environmental controls, which could substantially ameliorate symptoms of allergic rhinitis. It might prevent development of asthma, especially in an occupational setting.

Patients' education is a vital component of treatment.

Medications for allergic rhinitis

Many classes of drug are available, effective, and safe.

Intranasal corticosteroids are superior to other treatments, have a good safety profile, and treat all symptoms of allergic rhinitis effectively. They have a NNT of 4, similar to immunotherapy.

Intranasal antihistamines have the advantage of quick onset of action, within 15 minutes for azelastine.

First-generation antihistamines are associated with sedation, psychomotor retardation, and reduced academic performance.

Only immunotherapy with individually targeted allergens has the potential to alter the natural history of allergic rhinitis.

Even with the best pharmacotherapy, one in five affected individuals remains highly symptomatic, and further research is needed in this area.



Treatment Options for Allergic Rhinitis and Non-Allergic Rhinitis (click to enlarge the image).

References

Allergic rhinitis. Alexander N Greiner MD, Peter W Hellings MD, Guiseppina Rotiroti MD, Dr Glenis K Scadding MD. The Lancet, Volume 378, Issue 9809, Pages 2112 - 2122, 17 December 2011.
Image source: Wikipedia, Creative Commons license.