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Review Article

Treatment Options for the Management of Perennial Allergic Rhinitis, with a Focus on Intranasal Corticosteroids

Stephen A. Brunton, MD, Leonard M. Fromer, MD
Volume: 100 Issue: 7 July, 2007

Abstract:

Perennial allergic rhinitis (PAR) can have a significant impact on a patient's quality of life. While allergen avoidance is the first line of management for PAR, complete avoidance is difficult. Therapeutic options available for PAR include intranasal corticosteroids (INS), H1-antihistamines, decongestants and local chromones, as well as immunotherapy. For mild symptoms, INS and antihistamines are the standard of care, whereas for moderate-to-severe PAR, INS are the preferred therapy due to their proven efficacy. Patient quality of life and therapy preference play a role in maintaining adherence to treatment.


Key Points


* Several classes of pharmacologic agents are available for the treatment of perennial allergic rhinitis (PAR), including intranasal corticosteroids (INS), H1- antihistamines, local chromones and decongestants.


* Intranasal corticosteroids are the first-line option in moderate-to-severe PAR and can also be used in mild PAR, due to their proven efficacy.


* Second-generation oral antihistamines are effective at controlling mild-to-moderate PAR, have a fast onset of action and good safety profiles.


* Oral decongestants, usually in combination with oral antihistamines, are recommended for mild nasal congestion and as add-on therapy to INS for moderate-to-severe nasal congestion. Intranasal decongestants can also be used in severe cases of blockage.


* Local chromones are available as intranasal formulations for reducing the nasal symptoms of PAR, particularly in children.


* Successful treatment of PAR requires long-term treatment and patient adherence. Therefore, patient quality of life and patient preference for an agent should be considered when choosing a therapeutic option.

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