Current trends in treatment of allergic rhinitis

Allergic rhinitis is an IgE-mediated disease, leading to inflammation of the nasal mucosa. Typical symptoms of allergic rhinitis are nasal congestion, rhinorrhea, sneezing, and/or nasal itching. Allergic rhinitis is a major health problem worldwide that causes illness and disability in daily life, affecting social life, sleep, school, and work. The economic cost of allergic rhinitis is substantial. Management of allergic rhinitis can be categorized largely into allergen avoidance, pharmacotherapy, immunotherapy, and surgical treatment. Although the general consensus is that allergen avoidance should lead to an improvement of symptoms, it is nearly impossible to completely avoid all allergens in real life. The importance of allergen avoidance is that minimizing allergen exposure can decrease medication dosage. Pharmacotherapy of allergic rhinitis may include any of histamine antagonist, topical/oral corticosteroid, leukotriene antagonist, decongestant, mast cell stabilizer, and cholinergic antagonist alone or in combination. Oral and intranasal spray of these medications are the main routes of administration. Immunotherapy is the medical procedure that uses controlled exposure to known allergens to reduce the severity of allergic disease. There are two ways of administering this treatment: subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Surgical treatment of the allergic rhinitis patient aims to resolve nasal obstruction by performing septoplasty or turbinoplasty.

The Importance of Allergen Avoidance in High Risk Infants and Sensitized Patients: A Meta-analysis Study

PURPOSE: At this time, there is uncertainty regarding whether allergen avoidance is the most appropriate strategy for managing or preventing allergies. The purpose of this study was to evaluate the effectiveness of allergen avoidance in the prevention of allergic symptoms in previously sensitized patients and newborns that have the potential to develop allergies. METHODS: We performed online searches of articles published from January 1980 to December 2012 in PubMed and The Cochrane Central Register of Controlled Trials, and selected articles involving randomized controlled trials (RCTs) and allergen avoidance. The parameters used to determine allergenic potential in newborns included the risk ratio (RR) of eczema, asthma, rhinitis, wheeze, and cough. The methods employed to evaluate previously sensitized patients were the standardized mean difference (SMD) of forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR). Data quality was assessed using the Jadad scale. RESULTS: A total of 14 RCTs were identified. Meta-analysis demonstrated that allergen avoidance for newborns did not reduce the subsequent incidence of allergic diseases (eczema, P=0.21; rhinitis, P=0.3; cough, P=0.1) but significantly reduced the incidence of asthma and wheezing in high-risk infants (asthma, P=0.03; wheeze, P=0.0004). However, previously sensitized patients who reduced their exposure to known allergens did not show improvement in their lung functions (FEV1, P=0.3; PEFR morning, P=0.53; PEFR evening, P=0.2; PEFR, P=0.29). CONCLUSIONS: Allergen avoidance may not always be successful in preventing allergic symptoms. However, rigorous methodological studies are required to confirm this hypothesis.

Discrepancies in Guidelines for Allergy Management in Asia-Pacific.

Objectives: We have conducted this study to assess (1) the existence of prevention programmes for AR as developed by professional and health care organizations in Asia- Pacific countries; (2) any discrepancies in local guidelines in comparison to ARIA, or within and across these countries. Study design: Web search study. Methodology: We have conducted a study using Web search in accordance with the perspective of physicians or patients for the relevant prevention and pharmacotherapy guidelines in the management of AR as developed by professional and health care organizations in Asia-Pacific countries/regions. Results: National allergy (AR and/or asthma) preventive programs are found in only 6 out of 17 (22.2%) countries (excluding Japan and South Korea). There exist several aspects of discrepancies in existing educational programs such as in (1) allergic disease (asthma or AR) that the guidelines focus on; (2) targeted age groups (children or adults); and (3) breadth and depth of coverage, such as for particular inhalant allergens or food allergies only. Based on the information provided by MIMS website (updated in 2011 by UBM Medica, London, United Kingdom) and the MIMS proven by the country’s local health authority, controversies exist in recommended minimum age, doses and potential side-effects of many commonly used 2nd-generation antihistamines and intranasal corticosteroids. Conclusion: This is the first study that demonstrates discrepancies and a lack of public education programmes for AR prevention and management in Asia-Pacific countries/regions.