Recommendations for the pharmacologic management of allergic rhinitis

Abstract

Allergic rhinitis (AR) affects at least 60 million people in the United States each year, resulting in a major impact on patient quality of life, productivity, and direct and indirect costs. As new therapies, data, and literature emerge in the management of AR, there is a need to communicate and disseminate important information to health care professionals to advance the practice of medicine and lessen the disease burden from AR. Treatment recommendations for AR have not been updated since the 2012 Food and Drug Administration approval of nonaqueous intranasal aerosol agents using hydrofluoroalkane propellants and the first aqueous intranasal combination product. Here, we present an updated algorithm for the pharmacologic treatment of AR that includes these new treatment options. Treatment recommendations are categorized by disease severity (mild versus moderate/severe) and duration of symptoms (episodic versus nonepisodic, with episodic defined as <3 days/wk or for <3 weeks). Preferred treatments are suggested, as well as alternative options for consideration by clinicians in the context of individual patient needs. This recommendation article also outlines the importance of treatment monitoring, which can be conducted using the recently developed Rhinitis Control Assessment Test. Successful therapeutic outcomes depend on multiple factors, including use of the most effective pharmacologic agents as well as patient adherence to therapy. Therefore, it is imperative that rhinitis patients not only receive the most effective therapeutic options, but that they also understand and are able to adhere to the comprehensive treatment regimen. Successful treatment, with all of these considerations in mind, results in better disease outcomes, improved quality of life for patients, and greater economic productivity in the home and workplace.

Recent advances in allergic rhinitis

“…The onset of action was 30 minutes, and clinical improvement was observed during the first day of assessment and there was sustained benefit for the entire two-week study period 45 . An updated consensus treatment algorithm proposes an approach to treatment that is in keeping with the ARIA guidelines and highlights a more prominent role for nasal antihistamines 46 .…”

Allergic Rhinitis Control Test questionnaire-driven stepwise strategy to improve allergic rhinitis control: a prospective study

“…However, this classification cannot meet the whole needs of AR management. Generally, very few mild AR patients will visit a doctor, which is not beneficial to the prevention of AR progression and might lead to the worsening of disease process . Moreover, this classification does not take the patients’ previous medication into consideration and most patients already receive medications before they see a doctor or go to hospital, which makes the standard treatment recommended by ARIA not applicable.…”

Intranasal Spray Medications for Maintenance Therapy of Allergic Rhinitis

“…There also needs to be an assessment of how to best adjust therapy, step-up or step-down, according to disease control and using current treatment strategies, which are based on symptom frequency and disease severity. 2,8,19,22,23 The goal remains that all patients should receive the best medication regimen available, tailored according to their diagnosis and disease severity.…”

“…7 The burden of disease for AR is substantial. A recent article called the burden “massive.” 8 The negative impact of AR, in terms of symptoms, comorbid conditions, impact on function and daily activities, and costs, has been well described; for greater insight, the reader is directed to references cited here. 3–6,8–16…”