Medical Treatment of Allergic Rhinitis

Abstract

Most individuals with allergic rhinitis experience symptom improvement with pharmacologic management. Individuals with intermittent symptoms are usually handled effectively with oral decongestants, antihistamines, or a combination when necessary. Continuous use of a topical nasal steroid can be more appropriate for individuals with persistent symptoms. Nasal steroids may be used with, or instead of, regular consumption of a decongestant and/or an antihistamine. The more recent, second-generation non-sedating antihistamines avoid the drowsy side effects of the older, first-generation antihistamines. Eye drops and topical nasal sprays with antihistamine, anticholinergic medications, or cromolyn, as well as brief use of oral corticosteroids (for severe, acute attacks) can also alleviate allergic rhinitis symptoms. Steroids in general have a proven high level of efficacy. For the symptoms of allergic rhinitis, corticosteroids given intranasally are also highly efficacious. There is sometimes, however, a delay in the onset of the clinical effect. Regular usage is advisable. Every form of nonallergic rhinitis is amenable to treatment delivered intranasally. Leukotriene receptor antagonists are an alternative for treating allergic rhinitis. Pseudoephedrine given by mouth is a potent decongestant, which can be prescribed for prolonged periods. Nonetheless, the following side effects are reported: neurogenic symptoms, effects on the heart resulting in palpitations and sleep problems. Intranasal cromoglycate reportedly stabilises mast cell function and exerts an antiallergic effect by inhibiting mast cell degranulation. Cromoglycate does not in itself have an anti-inflammatory effect or cause blockade of histamine receptors. Cromoglycate is recommended as a prophylactic treatment. In this chapter, the medical treatment of allergic rhinitis is reviewed. © Springer Nature Switzerland AG 2020.