Clinical Immunotherapeutics

, Volume 3, Issue 4, pp 308–324 | Cite as

Pharmacotherapy of Perennial and Seasonal Allergic Rhinitis

  • Helen F. Krause
Review Article Treatment Review


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.


Allergic Rhinitis Budesonide Allergy Clin Immunol Nasal Spray Terfenadine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Krause HF. Antihistamines and decongestants. Otolaryngol Head Neck Surg 1992; 107: 835–40PubMedGoogle Scholar
  2. 2.
    Meltzer EO. Today’s approach to controlling allergic rhinitis. J Respir Dis 1992; 13 Suppl. 6A: S30–9Google Scholar
  3. 3.
    Reynolds JEF, editor. Martindale: the extra pharmacopoeia. London: The Pharmaceutical Press, 1993Google Scholar
  4. 4.
    Busse WW. Role of antihistamines in allergic disease. Ann Allergy 1994; 71: 371–5Google Scholar
  5. 5.
    Simons FER, Simons KJ. Second-generation Hi-receptor antagonists. Ann Allergy 1991; 66: 5–17PubMedGoogle Scholar
  6. 6.
    Woodward JK. Pharmacology of antihistamines. J Allergy Clin Immunol 1990; 86: 606–12PubMedCrossRefGoogle Scholar
  7. 7.
    Aaronson DW. Comparative efficacy of H1 antihistamines. Ann Allergy 1991; 67: 541–7PubMedGoogle Scholar
  8. 8.
    Massey WA, Lichtenstein LM. The effects of antihistamines beyond H1 antagonism in allergic inflammation. J Allergy Clin Immunol 1990; 86: 1019–24PubMedCrossRefGoogle Scholar
  9. 9.
    Richards DM, Brogden RN, Heel RC, et al. Astemizole: a review of its pharmacodynamic properties and therapeutic efficacy. Drugs 1984; 28(1): 38–61PubMedCrossRefGoogle Scholar
  10. 10.
    Rolf LN. Important drug warning [letter]. Marion Merrell Dow Inc., August 6, 1990Google Scholar
  11. 11.
    Monahan BP, Ferguson CL, Killeavy ES, et al. Torsades de pointes occurring in association with terfenadine use. JAMA 1990; 264: 2788–90PubMedCrossRefGoogle Scholar
  12. 12.
    Zipes DP. Q-T interval prolongation: etiology and relatives risks. In: Antihistamine consensus conference [monograph]. Little Falls (NJ): Health Learning Systems; Philadelphia: Temple University School of Medicine, 1993: 27Google Scholar
  13. 13.
    Woosley R, Darrow WR. Analysis of potential adverse drug reactions — a case of mistaken identity [letter]. Am J Cardiol 1994; 74: 208–9PubMedCrossRefGoogle Scholar
  14. 14.
    Bédard PM, Del Carpio J, Drouin MA, et al. Onset of action of loratadine and placebo and other efficacy variables in patients with seasonal allergic rhinitis. Clin Ther 1992; 14: 268–75PubMedGoogle Scholar
  15. 15.
    Haria M, Fitton A, Peters DH. Loratadine: a reappraisal of its pharmacological properties and therapeutic use in allergic disorders. Drugs 1994; 48(4): 617–37PubMedCrossRefGoogle Scholar
  16. 16.
    Brogden RN, McTavish D. Acrivastine: a review of its pharmacological properties and therapeutic efficacy in allergic rhinitis, urticaria, and related disorders. Drugs 1991; 41: 927–40PubMedCrossRefGoogle Scholar
  17. 17.
    Campoli-Richards DM, Buckley MMT, Fitton A. Cetirizine: a review of its pharmacological properties and clinical potential in allergic rhinitis, pollen-induced asthma, and chronic urticaria. Drugs 1990; 40: 762–81PubMedCrossRefGoogle Scholar
  18. 18.
    Pierson WE. Cetirizine: a unique second-generation antihistamine for treatment of rhinitis and chronic urticaria. Clin Ther 1991; 13: 92–9PubMedGoogle Scholar
  19. 19.
    Failliers CJ, Brandon ML, Buchman E. Double-blind comparison of cetirizine and placebo in the treatment of seasonal rhinitis. Ann Allergy 1991; 66: 257–62Google Scholar
  20. 20.
    Townley RG. Cetirizine: a new H1 antagonist with anti-eosinophilic activity in chronic urticaria. J Am Acad Dermatol 1991; 25: 668–74PubMedCrossRefGoogle Scholar
  21. 21.
    de Molina M, Cadahia A, Cano L, et al. Efficacy and tolerability of ebastine at two dose levels in the treatment of seasonal allergic rhinitis. Drug Invest 1989; 1(1): 40–6CrossRefGoogle Scholar
  22. 22.
    Horak FF, Jager S, Nimberger G, et al. Dose-related control of allergic rhinitis symptoms by a H1 receptor antagonist. Finding the proposer doses [sic] of dimethidene maleate in patients with allergic rhinitis. Int Arch Allergy Immunol 1994; 103(3): 298–302PubMedCrossRefGoogle Scholar
  23. 23.
    Rafferty P, Harrison PJ, Aurich R, et al. The in vivo potency and selectivity of azelastine as an H1 histamine-receptor antagonist in human airways and skin. J Allergy Clin Immunol 1988; 82: 1113–8PubMedCrossRefGoogle Scholar
  24. 24.
    Storms WW, Pearlman DS, Chervinski P, et al. Effectiveness of azelastine nasal solution in seasonal allergic rhinitis. Ear Nose Throat J 1994; 73(6): 382–94PubMedGoogle Scholar
  25. 25.
    Meltzer EO, Weiler JM, Dockhorn RJ, et al. Azelastine nasal spray in the management of seasonal allergic rhinitis. Ann Allergy 1994; 74(4): 354–9Google Scholar
  26. 26.
    Grossman J, Halverson PC, Meltzer EO. Double-blind assessment of azelastine in the treatment of perennial allergic rhinitis. Ann Allergy 1994; 73: 141–6PubMedGoogle Scholar
  27. 27.
    Dechant KL, Goa KL. Levocabastine: a review of its pharmacological properties and potential as a topical antihistamine in allergic rhinitis and conjunctivitis. Drugs 1991; 41(2): 202–22PubMedCrossRefGoogle Scholar
  28. 28.
    Mabry RL. Topical pharmacotherapy for allergic rhinitis: new agents. South Med J 1992; 85: 149–54PubMedCrossRefGoogle Scholar
  29. 29.
    Schata M, Jorde W, Richarz-Barthauer U. Levocabastine nasal spray better than sodium cromoglycolate and placebo in the topical treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 1991; 87: 873–8PubMedCrossRefGoogle Scholar
  30. 30.
    Palma-Carlos AG, Chieira C, Conde TA, et al. Double-blind comparison of levocabastine nasal spray with sodium cromoglycolate nasal spray in the treatment of seasonal allergic rhinitis. Ann Allergy 1991; 67: 394–8PubMedGoogle Scholar
  31. 31.
    Bahmer FA, Ruprecht KW. Safety and efficacy of topical levocabastine compared with oral terfenadine. Ann Allergy 1994; 72: 429–34PubMedGoogle Scholar
  32. 32.
    Naclerio RM. The effect of antihistamines on the immediate allergic response: a comparative review. Otolaryngol Head Neck Surg 1993; 108: 723–30PubMedGoogle Scholar
  33. 33.
    Meltzer EO, Weiler JM, Dockhorn RJ, et al. Azelastine nasal spray in the management of seasonal allergic rhinitis. Ann Allergy 1994; 72(4): 354–7PubMedGoogle Scholar
  34. 34.
    Gambardella R. A comparison of the efficacy of azelastine nasal spray and loratadine tablets in the treatment of seasonal allergic rhinitis. J Int Med Res 1993; 21(5): 268–75PubMedGoogle Scholar
  35. 35.
    Caiaffa MF, Iudice A, Macchia L, et al. Multicenter double-blind comparative study of terfenadine and cetirizine in hay fever. J Invest Allergol Clin Immunol 1992; 2(3): 162–6Google Scholar
  36. 36.
    Renton R, Fidler C, Rosenberg R. Multicenter, crossover study of the efficacy and tolerability of terfenadine 120mg versus cetirizine 10mg in perennial rhinitis. Ann Allergy 1991; 67: 416–20PubMedGoogle Scholar
  37. 37.
    Lockey RF, Findley S, Mitchell DQ, et al. Effects of cetirizine versus terfenadine in seasonal allergic rhinitis. Ann Allergy 1993; 70: 311–5PubMedGoogle Scholar
  38. 38.
    Simons FER, McMillan JL, Simons KJ. A double-blind, single-dose, cross over comparison of cetirizine, terfenadine, loratadine, astemizole and chlorpheniramine versus placebo: suppressive effects on histamine-induced wheals and flares during 24 hours in normal subjects. J Allergy Clin Immunol 1990; 86: 540–7PubMedCrossRefGoogle Scholar
  39. 39.
    Horak F, Jåger S, Berger U. Onset and duration of the effects of three antihistamines in current use — astemizole, loratadine and terfenadine forte — studied during prolonged, controlled allergen challenges in volunteers. J Int Med Res 1992; 20(5): 422–34PubMedGoogle Scholar
  40. 40.
    Carlsen KH, Kramer J, Fagertus HE, et al. Loratadine and terfenadine in perennial allergic rhinitis. Treatment of non-responders to the one drug with the other drug. Allergy 1993; 48(6): 431–6PubMedCrossRefGoogle Scholar
  41. 41.
    Søhoel P, Freng BA, Kramer J, et al. Topical levocabastine compared with orally administered terfenadine for the prophylaxis and treatment of seasonal rhinoconjunctivitis. J Allergy Clin Immunol 1993; 92 (1 part 1): 73–81PubMedCrossRefGoogle Scholar
  42. 42.
    United States Pharmacopeial Convention: Drug information for the health care professional. 13th ed. Rockville, MD: United States Pharmacopeial Convention, 1993: 297–351Google Scholar
  43. 43.
    Lutsky BN, Klose P, Melon J, et al. A comparative study of the efficacy and safety of loratadine syrup and terfenadine suspension in the treatment of 3 to 6 year old children with seasonal allergic rhinitis. Clin Ther 1993; 155(5): 855–65Google Scholar
  44. 44.
    Vuurman EF, van Veggel LM, Uiterwijk MM, et al. Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy 1993; 71(2): 121–6PubMedGoogle Scholar
  45. 45.
    Allegra L, Paupe J, Wiesman HG, et al. Ceterizine for seasonal allergic rhinitis in children aged 2–6: a double-blind comparison with placebo. Pediatr Allergy Immunol 1993; 4(3): 157–61PubMedCrossRefGoogle Scholar
  46. 46.
    Masi M, Candiani R, van de Venn H. A placebo controlled trial of ceterizine in seasonal allergic rhino-conjunctivitis in children aged 6 to 12 years. Pediatr Allergy Immunol 1993; 4 Suppl. 4: 47–52PubMedGoogle Scholar
  47. 47.
    Simons FE, Watson WT, Simons KJ. Pharmacokinetics and pharmacodynamics of ebastine in children. J Pediatr 1993; 122(4): 641–6PubMedCrossRefGoogle Scholar
  48. 48.
    Businco L, Monteleone A, Ruggeri L, et al. New strategies for the prevention and treatment of allergic rhinitis in children [review]. Rhinology 1992; 13 Suppl.: 27–37Google Scholar
  49. 49.
    Moller C, Andlin-Sobocki P, Blychart LO. Pharmacokinetics of astemizole in children. Rhinology 1992; 13 Suppl.: 21–5Google Scholar
  50. 50.
    Knight A. The role of decongestants in allergic rhinitis. J Respir Dis 1992; 13 Suppl.: S30–3Google Scholar
  51. 51.
    Krause HF. Pharmacotherapy for allergic nasal disease. Curr Opin Otolaryngol Head Neck Surg 1994; 2: 147–53CrossRefGoogle Scholar
  52. 52.
    Hendeles L. Selecting a decongestant [review]. Pharmacotherapy 1993; 13 (6 part 2): 129S–34S; [discussion] 143S-6SPubMedGoogle Scholar
  53. 53.
    Beck RA, Mercado DL, Seguin SM, et al. Cardiovascular effects of pseudoephedrine in medically controlled hypersensitive patients. Arch Int Med 1992; 152: 1242–5CrossRefGoogle Scholar
  54. 54.
    Krause HF. Surgery in the allergic patient. In: Krause HF, editor. Otolaryngic allergy and immunology. Philadelphia: WB Saunders, 1989Google Scholar
  55. 55.
    Mabry RL. Corticosteroids in rhinology. Otolaryngol Head Neck Surg 1993; 108: 768–70PubMedGoogle Scholar
  56. 56.
    Mabry RL. Corticosteroids in the management of upper respiratory allergy: the emerging role of steroid nasal sprays. Otolaryngol Head Neck Surg 1992; 107: 855–60PubMedGoogle Scholar
  57. 57.
    Storms WW. Clinical experiences with triamcinolone in rhinitis. J Respir Dis 1991; 12: 41–2Google Scholar
  58. 58.
    Naclario RM, Atkinson NF, Creticos PS, et al. Intranasal steroids inhibit seasonal increases in ragweed-specific immunoglobulin E antibodies. J Allergy Clin Immunol 1993; 92(5): 717–21CrossRefGoogle Scholar
  59. 59.
    al-Mohaimeid H. A parallel group comparison of budesonide and beclomethasone diproprionate for treatment of perennial allergic rhinitis in adults. J Int Med Res 1993; 21(2): 67–73PubMedGoogle Scholar
  60. 60.
    Agertoft L, Wolthers OD, Fuglsang G, et al. Nasal powder administration of budesonide for seasonal rhinitis in children and adolescents. Pediatr Allergy Immunol 1993; 4(3): 152–6PubMedCrossRefGoogle Scholar
  61. 61.
    Wright RG, Jones AS, Beckingham E, et al. A double blind comparison of intranasal budesonide 400 micrograms and 800 micrograms in perennial rhinitis. Clin Otolaryngol 1992; 17(4): 354–8CrossRefGoogle Scholar
  62. 62.
    Haye R, Gomez EG. A multicenter study to assess long-term use of fluticasone proprionate aqueous nasal spray in comparison with beclomethasone diproprionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology 1993; 13(4): 169–74Google Scholar
  63. 63.
    van As A, Bronsky EA, Dockhorn RJ, et al. Once daily fluticasone proprionate is as effective for perennial rhinitis as twice daily beclomethasone diproprionate. J Allergy Clin Immunol 1993; 91(6): 1146–54PubMedCrossRefGoogle Scholar
  64. 64.
    Colovick MD, O’Connor M, Stepner N, et al. Double-blind comparison of intranasal fluticasone proprionate 200µg daily with 200µg twice daily in the treatment of patients with severe seasonal allergic rhinitis to ragweed. Ann Allergy 1994; 72: 435–40Google Scholar
  65. 65.
    Bryson HM, Faulds D. Intranasal fluticasone proprionate: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in allergic rhinitis [review]. Drugs 1992; 43(5): 760–75PubMedCrossRefGoogle Scholar
  66. 66.
    LaForce LF, Dockhorn RT, Findlay SR, et al. Fluticasone proprionate: an effective alternative treatment for seasonal rhinitis in adults and adolescents. J Fam Pract 1994; 38(2): 145–52PubMedGoogle Scholar
  67. 67.
    Conley SF. Comparative trial of acceptability of beclomethasone diproprionate and a new formulation of flunisolide. Ann Allergy 1994; 72: 529–32PubMedGoogle Scholar
  68. 68.
    King HC. Mast cell stabilizers. Otolaryngol Head Neck Surg 1992; 107: 841–4PubMedGoogle Scholar
  69. 69.
    Mabry RL. Topical pharmacotherapy for allergic rhinitis: nedocromil [review]. Am J Otolaryngol 1993; 14(6): 379–81PubMedCrossRefGoogle Scholar
  70. 70.
    Parish RC, Miller LJ. Nedocromil sodium [review]. Ann Pharmacother 1993; 27(5): 599–606PubMedGoogle Scholar
  71. 71.
    Donnelly A, Casale TB. Nedocromil is rapidly effective in the therapy of seasonal allergic rhinitis. J Allergy Clin Immunol 1993; 91(5): 997–1004PubMedCrossRefGoogle Scholar
  72. 72.
    Grant SM, Goa KL, Fitton A, et al. Ketotifen: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in asthma and allergic disorders. Drugs 1990; 40(3): 412–48PubMedCrossRefGoogle Scholar
  73. 73.
    Magyar P, Gyori Z, Mark Z, et al. The protective effect of N-acetyl-aspartyl-glutamate (NAAGA) against nasal obstruction provoked by antigen in allergic rhinitis. Allergy 1993; 48(8): 631–3PubMedCrossRefGoogle Scholar
  74. 74.
    Johnston SL, Price JN, Lau LCK, et al. The effect of local hyperthermia on allergen-induced nasal congestion and mediator release. J Allergy Clin Immunol 1993; 92(6): 850–6PubMedCrossRefGoogle Scholar
  75. 75.
    Georgitis JW. Local hyperthermia and nasal irrigation for perennial allergic rhinitis: effect on symptoms and nasal airflow. Ann Allergy 1993; 71: 385–9PubMedGoogle Scholar
  76. 76.
    Georgitis JW. The anticholinergic treatment of allergic perennial rhinitis. J Allergy Clin Immunol 1992; 90 (6 Part 2): 1071–6PubMedCrossRefGoogle Scholar
  77. 77.
    Meltzer EO. Intranasal anticholinergic therapy of rhinorrhea [review]. J Allergy Clin Immunol 1992; 90 (6 part 2): 1055–64PubMedCrossRefGoogle Scholar
  78. 78.
    Meltzer EO, Orgel HA, Bronsky EA, et al. Ipratropium bromide aqueous nasal spray for patients with perennial allergic rhinitis: a study on its effect on their symptoms, quality of life and nasal cytology. J Allergy Clin Immunol 1992; 90(2): 242–9PubMedCrossRefGoogle Scholar
  79. 79.
    Mansmann HC, Rosen J, Ziering R. et al. Pentigetide nasal solution: a multi center study evaluating efficacy and safety in patients with seasonal allergic rhinitis. Ann Allergy 1991; 62: 409–15Google Scholar
  80. 80.
    Rajakulasingam K, Howarth PH. Topical capsaicin therapy in chronic rhinitis: a way forward? Clin Exp Allergy 1991; 21: 531–2PubMedCrossRefGoogle Scholar
  81. 81.
    Samolinska Zawisza U, Zawisza E. Nifedipine in hay fever. Allergy 1992; 47 Suppl.: 115CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Helen F. Krause
    • 1
  1. 1.Department of OtolaryngologyUniversity of Pittsburgh School of MedicinePittsburghUSA

Personalised recommendations