Allergic rhinitis: a comprehensive view of the problem

Abstract

Currently, allergic sensitization is considered as one of the key causes of the development of chronic inflammatory processes in the nasal cavity and paranasal sinuses. The choice of optimal drugs for the treatment of allergic rhinitis still remains a relevant, socially significant and interdisciplinary problem. The article analyzes the modern strategy for the treatment of allergic rhinitis and assesses the incidence of comorbid pathology associated with allergic sensitization in patients with this pathology. In accordance with the latest clinical guidelines, a discussion of a stepwise approach to the treatment of allergic rhinitis was carried out. Based on data from a number of studies, the advantages of prescribing intranasal corticosteroids (InGCS) and leukotriene receptor antagonists (ALR) in the treatment of allergic rhinitis, including when combined with bronchial asthma and chronic rhinosinusitis with nasal polyps, have been identified. Among the officially registered drugs for the basic treatment of allergic rhinitis, the characteristics of the original intranasal spray mometasone furoate and the leukotriene receptor blocker montelukast are described in detail. The discussion describes the possibilities of potentiating the effects of topical corticosteroids through combination with leukotriene receptor antagonists. A clinical example demonstrates the feasibility of using a combination of the intranasal corticosteroid Nasonex with the leukotriene receptor blocker Singulair to control the course of allergic rhinitis and chronic rhinosinusitis with nasal polyps and, as a consequence, prevent the development of remodeling of the respiratory tract mucosa in such patients. During a follow-up examination after 3 months of therapy, the patient noted a subjective improvement in general well-being, nasal breathing, sense of smell, normalization of sleep, and a significant decrease in nasal discharge. There is no need for decongestants, sneezing is not a concern, and there is no respiratory discomfort. The combined use of ALR and InGCS enhances the anti-inflammatory effect of therapy.