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Pharmacotherapy of Perennial and Seasonal Allergic Rhinitis

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Summary

The options for pharmacotherapy of both perennial and seasonal allergic rhinitis continue to expand rapidly. The classic antihistamines will retain a place as effective drugs. They are without serious adverse effects, and are often available without a physician’s prescription. The newer antihistamines, such as terfenadine, astemizole, loratadine and cetirizine, have made a great impact because they are, for the most part, nonsedating and have little or no anticholinergic activity. They have few interactions with other drugs and, except for very specific limited interactions, have proven to be well tolerated by patients previously unable to use antihistamines. Some of the newer antihistamines are also antiallergic by mechanisms other than H1-receptor antagonism, which will expand their usefulness.

Corticosteroids may be used as oral or intranasal preparations. The most frequently used preparations are beclomethasone, triamcinolone, budesonide and fluticasone. Corticosteroids are anti-inflammatory agents, and primarily protect against the late allergic response.

Decongestants produce symptomatic relief but are not antiallergic, acting only on the target organ. Mast cell stabilisers were the first agents to improve both the immediate and late allergic responses. Intranasal sodium cromoglycate (cromolyn sodium) was the first available, being quite effective but requiring frequent administration. Intranasal nedocromil has several different mechanisms of action, including stabilising cell membranes and preventing mediator release. New oral preparations, such as ketotifen, may eventually be of benefit.

Other agents, such as mucolytics and anticholinergics, are still under development; all improve the symptoms of allergic rhinitis by a variety of mechanisms.

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  1. Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Helen F. Krause

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Krause, H.F. Pharmacotherapy of Perennial and Seasonal Allergic Rhinitis. Clin. Immunother. 3, 308–324 (1995). https://doi.org/10.1007/BF03259282

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