In this paper, we review the current management of
allergic rhinitis and new directions for future treatment. Currently, management includes
pharmacotherapy,
allergen avoidance and possibly
immunotherapy. The simple washing of nasal cavities using isotonic saline provides a significant improvement and is useful, particularly in children. The most effective medication in persistent
rhinitis used singly is topical
corticosteroid, which decreases all symptoms, including ocular ones.
Antihistamines reduce nasal itch, sneeze and
rhinorrhea and can be used orally or topically. When intranasal
antihistamine is used together with topical
corticosteroid, the combination is more effective and acts more rapidly than either
drug used alone.
Alternative therapies, such as
homeopathy, acupuncture and intranasal
carbon dioxide, or devices such nasal air filters or intranasal
cellulose, have produced some positive results in small trials but are not recommended by
Allergic Rhinitis and its Impact on
Asthma (ARIA). In the field of allergic
immunotherapy, subcutaneous and sublingual routes are currently used, the former being perhaps more efficient and the latter safer. Sublingual
tablets are now available. Their efficacy compared to standard routes needs to be evaluated. Efforts have been made to develop more effective and simpler
immunotherapy by modifying
allergens and developing alternative routes. Standard
allergen avoidance procedures used alone do not provide positive results. A comprehensive, multi-trigger, multi-component approach is needed, including avoidance of
pollutants such as cigarette
smoke.