Rhinitis medical therapy
Rhinitis medical therapy On the Web
American Roentgen Ray Society Images of Rhinitis medical therapy
Rhinitis is a heterogegeous disorder that is frequently undertreated or ignored. It is a highly prevalent disease that can significantly affect the quality of life of individuals affected. Chronic rhinitis is also one of the most common diseases seen by physicians. A thorough understanding of the pathophysiologic mechanisms involved and the various treatment modalities, would ultimately result in both patient and physician satisfaction.
Treatment of Allergic Rhinitis
- Patient education on allergen avoidance and non-pharmacologic treatments such as saline douching of the nose
- Allergen-specific immunotherapy in patients uncontrolled with pharmacotherapy
- Surgery in selected cases
The choice of pharmacotherapy in allergic rhinitis is based on the severity and persistence of the disease, as depicted in the table below.
|Medical Treatment of Allergic Rhinitis|
|Severity of Rhinitis||Medication
(Use in conjunction with allergen avoidance and saline douching)
(Ensure patient adherence to treatment before making changes to the treatment plan)
|Evaluation and treatment of associated conditions|
|Mild||Nonsedating oral/intranasal antihistamine||Consider intranasal steroids|
|Moderate||Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine)||Persistent/uncontrolled symptoms after 2-4weeks of treatment:
Failure of medical therapy:
|Severe||Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine)|
- Leukotriene receptor antagonists: These can be prescribed for children with allergic rhinitis and concomitant asthma. It can also be of benefit in children with seasonal allergic rhinitis. They are not recommended for use in adults with persistent allergic rhinitis, and they should not be offered as primary therapy for the treatment of allergic rhinitis.
This entails the repeated administration of specific allergens to patients with IgE-mediated conditions in order to provide protection against the allergic symptoms and inflammatory reactions that are associated with the natural exposure to the allergens. Allergen immunotherapy is effective in the management of allergic disorders such as allergic rhinitis, allergic conjunctivitis, asthma, and stinging insect hypersensitivity. It can be administered via the subcutaneous or the sublingual routes. For immunotherapy to be considered, positive skin/RAST test results for specific IgE antibodies should correlate with the suspected allergen and patient exposure. Some of the indications for immunotherapy are:
- Poor control of symptoms with medications and allergen avoidance
- Unacceptable adverse effect of medication
- Patient's desire to reduce the long-term use of medications
Treatment of Nonallergic Rhinitis
Nonallergic rhinitis comprises a heterogeneous group of disorders that are not completely understood. There are no specific guidelines for most forms of nonallergic rhinitis. Known triggers of rhinitis should be avoided when possible. Nasal irrigation with saline also helps alleviate the symptoms and patients should be properly educated on how to perform saline douching. Each form of nonallergic rhinitis should be treated individually.
Gustatory rhinitis can be treated effectively with intranasal anticholinergic medications when necessary. However, the avoidance of the implicated food is the first line treatment modality. Vidian nerve neurectomy is sometimes used as a last resort in the management of patients, this approach is however not recommended because it is usually short-lasting and has frequent unpleasant side effects.
Nonallergic Rhinitis with Eosinophilic Syndrome (NARES)
Patients with NARES show good response to topical intranasal steroids. However, NARES is now an uncommon diagnosis as physicians seldom do nasal cytologic examinations.
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