Targeting congestion in allergic rhinitis: The importance of intranasal corticosteroids

Abstract

The cardinal nasal symptoms of allergic rhinitis (AR) are sustained by an underlying inflammatory process. Congestion is one of the most prominent and distressing symptoms for patients and is strongly associated with a broadly deteriorated quality of life and significant losses in productivity. The purpose of this study was to explore the role of intranasal corticosteroids (INSs) in down-regulating the inflammatory response to allergen and their clinical efficacy on AR symptoms, particularly congestion. AR is characterized by an influx of inflammatory cells and mediators into the nasal mucosa after antigen exposure. The response is biphasic, encompassing an early and a late phase. Antigen exposure has a priming effect, decreasing the threshold for subsequent allergic reaction on rechallenge and increasing the responsiveness of the nasal mucosa. INSs are a mainstay of therapy for AR and the most effective intervention for nasal congestion and other nasal symptoms, with established superiority to antihistamines, decongestants, and leukotriene antagonists. In addition to symptom relief, INSs suppress numerous stages of the inflammatory cascade, inhibiting the influx of inflammatory cells and mediators. Topical nasal corticosteroids have a low incidence of local adverse effects, negligible systemic absorption, and excellent safety. Congestion is one of the most bothersome symptoms of AR. INS therapy improves AR symptoms, with particular efficacy in relieving congestion, by attenuating nasal hyperresponsiveness. Pretreatment with INSs has been shown to relieve early and late-phase clinical symptoms of AR. Modification of the disease process results in significant relief of symptoms and leads to fewer disease exacerbations.

Allergic Rhinitis and Inflammatory Airway Disease: Interactions within the Unified Airspace

“…The therapeutic advantages of INSs arise through modulating the activation and repression of genes regulating components of the inflammatory cascade, mitigating TH2 expression and transformation, inhibiting the influx of immune cell populations and a range of cytokines, chemokines, adhesion molecules, histamine, leukotrienes, and allergen-specific IgE. 4,[71][72][73][74] Long-term use of newer-generation INSs lacks the safety concerns associated with prolonged exposure to systemic glucocorticoids. 4,71,72 Control of comorbid asthma and AR with INS treatment and associated beneficial effects on lower airway disease control has been documented.…”

Sequential Engagement of FcεRI on Mast Cells and Basophil Histamine H4 Receptor and FcεRI in Allergic Rhinitis

“…The recurrent and chronic symptoms of allergic rhinitis, sneezing, itching, rhinorrhea, and nasal congestion, impair the quality of life in these patients and contribute to a major socio-economic burden. Similar to other allergic diseases, corticosteroids (topical) remain the most effective therapy in AR, despite major limitations (2). Only half of the patients gain adequate relief, while a large proportion suffers from persistent symptoms (Allergies in America: A landmark survey of nasal allergy sufferers (2006): Available online at www.mmcpub.com/scsaia/AdultSummary.pdf).…”

Alleviation of murine allergic rhinitis by C19, a C-terminal peptide of chemokine-like factor 1 (CKLF1)

“…It is also tends to remain in the nasal area rather than diffusing throughout the body and is considered very safe. [14,21]. Intranasal therapy with C19 can ameliorate allergic symptoms, suppress the Th2 response, and inhibit eosinophil accumulation as efficiently as treatment with Budesonide.…”