Current treatment strategies for seasonal allergic rhinitis: where are we heading?

Abstract

Introduction Allergic rhinitis (AR) is very commonly caused by pollens. The symptoms of AR consist of sneezing, nasal congestion, rhinorrhea, nasal itching and airflow obstruction. The diagnosis has long been based on clinical history, skin prick tests and in vitro measurement of specific IgE, but the innovative approach of precision medicine has made diagnostic tools of much greater accuracy available. Areas covered This review covers the advances in the treatment of seasonal AR concerning the drugs to be used according to the grade of disease and the characteristics of the patients, and the role of allergen immunotherapy (AIT), which is the only treatment capable of acting, in addition to the symptoms, on the cause of AR and therefore to modify its natural history. Expert opinion Drug treatment of AR include a large number of agents, the choice of which depends on the severity of the disease. AIT has high evidence of efficacy demonstrated by meta-analyses, and further improvement is currently apparent, as for diagnosis, applying the means of precision medicine. However, when AIT is performed in current practice, without the strict rules of controlled trials, long-term low adherence is a major problem to be solved.

Pearls and pitfalls of OTC medications for seasonal allergies

“…3,4,9 Studies have demonstrated better efficacy of intranasal corticosteroids compared with oral antihistamines for treating AR symptoms. 4,9 Additionally, intranasal corticosteroids improve nasal congestion, unlike antihistamines. 5 Intranasal corticosteroids can be used as monotherapy or in addition to antihistamines.…”

“…3,6 Older adults are particularly susceptible to the CNS and anticholinergic effects of antihistamines. 4 Additionally, these agents should be avoided in children less than 2 years because they can cause paradoxical agitation. 9 Neonates and infants are susceptible to CNS depressant effects.…”

Mechanism and clinical evidence of immunotherapy in allergic rhinitis

“…The treatment of choice for AR should be the elimination of the environmental allergen responsible for the symptoms. However, despite this recommendation, complete allergen control is extremely difficult to achieve and scientific evidence to support allergen prevention measures is limited while an effective management of the disease can be achieved through a comprehensive approach combining prevention, allergen control and pharmacological treatment ( 1 , 8 ).…”

“…Allergic rhinitis (AR) is an inflammation of the nasal mucosa characterized by sneezing, itchiness, rhinorrhea and nasal obstruction, caused by hypersensitivity to inhaled allergens. The symptoms of AR may be variegated and arise after inhalation and primary sensitization to few or numerous allergens such as pollen of various plants, house dust mite, hair, and organic material from certain animals ( 1 , 2 ).…”

Clinical outcomes of AIT in the elderly population

“…Allergen immunotherapy (AIT) remains one of the most important treatment methodologies in contemporary allergology [1 & ,2,3]. Its efficacy in treating allergic rhinitis, some forms of asthma, and allergies to Hymenoptera venoms and selected foods has been confirmed in many clinical randomized and nonrandomized trials, reports, and meta-analyses, [4][5][6][7][8][9][10][11]. Qualification criteria, contraindications, routes of administration, and the assessment of safety and efficacy depending on the desensitized allergens are included in many international consensuses, most importantly, in the European Academy of Allergy and Clinical Immunology (EAACI) recommendations [6,10,12,13].…”