Pharmacotherapy in Common Allergic Diseases

  • Erina M. Lin
Part of the Advanced Topics in Science and Technology in China book series (ATSTC)


Allergic diseases are immunologically mediated hypersensitivity reactions that are increasing in prevalence throughout the world. Symptoms associated with allergic diseases can significantly affect one’s sense of well-being. Management of allergic diseases involves diagnostic testing to identify suspected allergens accompanied by subsequent avoidance measures and pharmacotherapy. Pharmacotherapy plays an important role in the control and alleviation of allergic symptoms, but does not cure the underlying allergy. Nevertheless, the use of medications in allergy treatment is an essential component of effective management of allergic disease and can greatly enhance one’s quality of life (WHO et al., 2002). A wide array of medications is available for the treatment of common allergic diseases such as allergic rhinitis, allergic conjunctivitis, and asthma. Classes of medications recom- mended for use in allergic diseases are reviewed, and include antihistamines, leukotriene antagonists, mast cell stabilizers, corticosteroids, anticholinergics, and beta-agonists. Specific indications, mechanism of action, and potential side effects of these medications are discussed.


Common Allergic Disease 
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  1. Adkinson, N.F., Busse, W., Bochner, B., et al. (2008). Middleton’s Allergy: Principles and Practice (7th ed.). Mosby: Elsevier, pp. 1575–1583.Google Scholar
  2. Bachert, C., van Cauwenberge, P. (2003). The WHO ARIA (allergic rhinitis and its impact on asthma) initiative. Chem Immunol Allergy, 82, 119–126.PubMedCrossRefGoogle Scholar
  3. Barnes, P.J. (1998). Efficacy of inhaled corticosteroids in asthma. J Allergy Clin Immunol, 102, 531–538.PubMedCrossRefGoogle Scholar
  4. Barnes, P.J. (2000). Anti-IgE therapy in asthma: Rationale and therapeutic potential. Int Arch Allergy Immunol, 123, 196–204.PubMedCrossRefGoogle Scholar
  5. Barnes, P.J. (2009). Anti-IgE therapy. Up to date. Scholar
  6. Barney, N.P., Graziano, F.M., Cook, E.B., et al. (2008). Treatment of allergic conjunctivitis. In: Adkinson: Middleton’s Allergy: Principles and Practice (7th ed.). Mosby: Elsevier, p.64.Google Scholar
  7. Berger, W., Hampel Jr., F., Bernstein, J., et al. (2006). Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol, 97(3), 375–381.PubMedCrossRefGoogle Scholar
  8. Berger, W., De Chandt, M.T., Cairns, C.B. (2007). Zileuton: Clinical implications of 5-Lipoxygenase inhibition in severe airway disease. Int J Clin Pract, 61(4), 663–676.PubMedCrossRefGoogle Scholar
  9. Bergeron, C., Boulet, L.P. (2006). Structural changes in airway diseases: Characteristics, mechanisms, consequences, and pharmacologic modulation. Chest, 129, 1068–1087.PubMedCrossRefGoogle Scholar
  10. Berkowitz, R.B., McCafferty, F., Lutz, C., et al. (2006). Onset of action of fexofenadine hydrochloride 60 mg/pseudoephedrine hydrochloride 120 mg in subjects aged 12 years with moderate to severe seasonal allergic rhinitis: A pooled analysis of two single-dose, randomized, double-blind, placeboControlled allergen exposure unit studies. Clin Therapy, 28(10), 1658–1669.CrossRefGoogle Scholar
  11. Bielory, L., Friedlaender, M.H. (2008). Allergic conjunctivitis. Immunology and Allergy Clinics of North America, 28(1), 43–58.PubMedCrossRefGoogle Scholar
  12. Blaiss, M.S. (2007). Safety considerations of intranasal corticosteroids for the treatment of allergic rhinitis. Allergy Asthma Proc, 28(2), 145–152.PubMedCrossRefGoogle Scholar
  13. Borish, L.J. (2003). Allergic rhinitis: Systemic inflammation and implications for management. J Allergy Clin Immunol, 112(6), 1021–1031.PubMedCrossRefGoogle Scholar
  14. Boulet, L.P. (2008). Approach to adults with asthma. In: Adkinson: Middleton’s Allergy: Principles and Practice (7th ed.). Mosby: Elsevier, p. 76.Google Scholar
  15. Boushey Jr., H.A., Corry, D.B., Fahy, J.V., et al. (2005). In: Mason: Murray & Nadel’s Textbook of Respiratory Medicine (4th ed.). Philadelphia: Elsevier, p. 37.Google Scholar
  16. Bousquet, J., Khaltaev, N. (2001). ARIA Workshop Group, World Health Organization: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol, 108(Suppl 5), S147–S334.PubMedCrossRefGoogle Scholar
  17. Bousquet, J., Clark, T. J. H., Hurd, S. et al. (2007). GINA guidelines on asthma and beyond. Allergy, 62, 102–112.PubMedGoogle Scholar
  18. Bronsky, E., Boggs, P., Findlay, S., et al. (1995). Comparative efficacy and safety of a once-daily loratadine-pseudoephedrine combination versus its components alone and placebo in the management of seasonal allergic rhinitis. J Allergy Clin Immunol, 96(2), 139–147.PubMedCrossRefGoogle Scholar
  19. Childhood Asthma Management Program (CAMP) Research Group (2000). Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med., 343(15), 1054–1063.CrossRefGoogle Scholar
  20. Corren, J., Casale, T., Deniz, Y., et al. (2003). Omalizumab, a recombinant humanized anti-IgE antibody, reduces asthma-related emergency room visits and hospitalizations in patients with allergic asthma. J Allergy Clin Immunol, 111, 87–90.PubMedCrossRefGoogle Scholar
  21. Dana, M.R. (2009). Allergic conjunctivitis. Scholar
  22. Deschenes, J., Discepola, M., Abelson, M.B. (1999). Comparative evaluation of olopatadine ophthalmic solution (0.1%) using the provocative antigen challenge model. Acta Ophthalmol Scand, 77, 47–52.Google Scholar
  23. deShazo, R.D., Kemp, S.F., Corren, J., Feldweg, A.M. (2010). Pharmacotherapy of allergic rhinitis. Up to Date. 2010 (18.1) February (cited 2010 February 10). Scholar
  24. Devillier, P., Baccard, N., Advenier, C. (1999). Leukotrienes, leukotriene receptor antagonists and leukotriene synthesis inhibitors in asthma: an update. Part I. Synthesis, receptors and role of leukotrienes in asthma. Pharmacol Res, 40, 3–13.PubMedCrossRefGoogle Scholar
  25. Doshnik, P.C., Ehlers, W.H. (1994). Clinical immunologic diseases: Ocular allergy. In: The cornea: Scientific foundation and clinical practice (3rd ed.). Boston: Little Brown.Google Scholar
  26. Ducharme, F.M. (2003). Inhaled glucocorticoids versus leukotriene receptor antagonists as single agent asthma treatment: Systematic review of current evidence. BMJ, 326, 621.PubMedCrossRefGoogle Scholar
  27. Dykewicz, M.S., Fineman, S., Skoner, D.P., et al. (1998). Diagnosis and management of rhinitis: Complete guidelines of the joint task force on practice parameters in allergy, asthma and immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol, 81(5 Pt 2), 478–518.PubMedCrossRefGoogle Scholar
  28. Eickelberg, O., Pansky, A., Mussmann, R., et al. (1999). Transforming growth factor-beta1 induces interleukin-6 expression via activating protein-1 consisting of JunD homodimers in primary human lung fibroblasts. J Biol Chem, 274, 12933–12938.PubMedCrossRefGoogle Scholar
  29. Evans, D.J., Taylor, D.A., Zetterstrom, O., et al. (1997). A comparison of low-dose inhaled budesonide plus theophylline and high-dose inhaled budesonide for moderate asthma. N Engl J Med, 337(20), 1412–1418.PubMedCrossRefGoogle Scholar
  30. Guevara, J., Ducharme, F., Keren, R., et al. (2006). Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 3 Scholar
  31. Guilbert, T.W., Martinez, F.D., Zeiger R.S., et al. (2006). Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med, 354(19), 1985–1997.PubMedCrossRefGoogle Scholar
  32. Hendeles, L., Weinberger, M. (2009). Theophylline use in asthma. http:// contents/theophylline-use-in-asthma.Google Scholar
  33. Juniper, E.F., Stahl, E., Doty, R.L., et al. (2005). Clinical outcomes and adverse effect monitoring in allergic rhinitis. J Allergy Clin Immunol, 115(3 Pt 2), S390–413.PubMedCrossRefGoogle Scholar
  34. Kemp, J.P. (2009). The use of chromones (cromoglycates) in the treatment of asthma. Scholar
  35. Kidney, J., Dominguez, M., Taylor, P.M., et al. (1995). Immunomodulation by theophylline in asthma. Demonstration by withdrawal of therapy. Am J Respir Crit Care Med, 151(6), 1907–1914.PubMedCrossRefGoogle Scholar
  36. LaForce, C. (1999). Use of nasal steroids in managing allergic rhinitis. J Allergy Clin Immunol, 103(3 Pt 2), S388–S394.PubMedCrossRefGoogle Scholar
  37. Leone, F.T., Fish, J.E., Szefler, S.J., West, S.L. (2003). Systematic review of the evidence regarding potential complications of inhaled corticosteroid use in asthma: collaboration of American College of Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and American College of Allergy, Asthma, and Immunology. Chest, 124(6), 2329–2340.PubMedCrossRefGoogle Scholar
  38. Manzouri, B., Flynn, T.H., Larkin, F., et al. (2006). Pharma-cotherapy allergic eye disease. Expert Opinion on Pharmacotherapy, 7, 1191–1200.PubMedCrossRefGoogle Scholar
  39. Milgrom, H., Fick Jr., R.B., Su, J.Q., et al. (1999). Treatment of allergic asthma with monoclonal anti-IgE antibody. N Engl J Med, 341, 1966–1973.PubMedCrossRefGoogle Scholar
  40. National Asthma Education and Prevention Program Science Base Committee and Expert Panel on the Management of Asthma (2002). Appendix A-2. Usual dosages for asthma medications. J Allergy Clin Immunol, 110(5, Suppl 1), S212–S219, doi: 10.1016/S0091-6749(02)80013-6.Google Scholar
  41. National Heart, Lung, and Blood Institute (NHLBI)/World Health Organizatiom (WHO) (1995). Global Initiative for Asthma Management and Prevention. Workshop Report, US Department of Health and Human Services. National Institutes of Health, Bethesda, MD. Pub #95-3659.Google Scholar
  42. National Heart, Lung, and Blood Institute (NHLBI) (2007). National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD., 74, 305.Google Scholar
  43. Nayak, A., Langdon, R.B. (2007). Montelukast in the treatment of allergic rhinitis: An evidence-based review. Drugs, 67(6), 887–901.PubMedCrossRefGoogle Scholar
  44. Ousler, G.W., Workman, D.A., Torkildsen, G.L. (2007). An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther, 29(4), 611–616.PubMedCrossRefGoogle Scholar
  45. Peters, S., McCallister, J.W., Pascual, R. (2009). Treatment of moderate persistent asthma in adolescents and adults. Scholar
  46. Philip, G., Nayak, A.S., Berger, W.E., et al. (2004). The effect of montelukast on rhinitis symptoms in patients with asthma and seasonal allergic rhinitis. Curr Med Res Opin, 20, 1549–1558.PubMedCrossRefGoogle Scholar
  47. Pullerits, T., Praks, L., Ristioja, V., et al. (2002). Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol, 109(6), 949–955.PubMedCrossRefGoogle Scholar
  48. Ratner, P.H., Howland, W.C., Arastu, R., et al. (2003). Fluticasone propionate aqueous nasal spray provided significantly greater improvement in daytime and nighttime nasal symptoms of seasonal allergic rhinitis compared with montelukast. Ann Allergy Asthma Immunol, 90(5), 536–542.PubMedCrossRefGoogle Scholar
  49. Rivington, R.N., Boulet, L.P., Cote, J., et al. (1995). Efficacy of Uniphyl, salbutamol, and their combination in asthmatic patients on high-dose inhaled steroids. Am J Respir Crit Care Med, 151(2 Pt 1), 325–332.PubMedCrossRefGoogle Scholar
  50. Schultz, B.L. (2006). Pharmacology of ocular allergy. Cur Opinion Allergy Clin Immunol, 6(5), 383–389.CrossRefGoogle Scholar
  51. Soler, M., Matz, J., Townley, R., et al. (2001). The anti-IgE antibody omalizumab reduces exacerbations and steroid requirement in allergic asthmatics. Eur Respir J, 18, 254–261.PubMedCrossRefGoogle Scholar
  52. van Bavel, J., Findlay, S.R., Hampel F.C., Jr., et al. (1994). Intranasal fluticasone propionate is more effective than terfenadine tablets for seasonal allergic rhinitis. Arch Intern Med, 154(23), 2699–2704.PubMedCrossRefGoogle Scholar
  53. Vaquerizo, M.J., Casan, P., Castillo, J., et al. (2003). Effect of montelukast added to inhaled budesonide on control of mild to moderate asthma. Thorax, 58(3), 204–210.PubMedCrossRefGoogle Scholar
  54. Verster, J.C., Volkerts, E.R. (2004). Antihistamines and driving ability: Evidence from on-the-road driving studies during normal traffic. Ann Allergy Asthma Immunol, 92(3), 294–303; quiz 303-305, 355.PubMedCrossRefGoogle Scholar
  55. Welsh, P.W., Stricker, W.E., Chu, C.P., et al. (1987). Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc, 62(2), 125–134.PubMedCrossRefGoogle Scholar
  56. Wenzel, S. (2009). Treatment of severe asthma in adolescents and adults. Scholar
  57. Wilson, A.M., O’Byrne, P.M. (2004). Parameswaran KLeukotriene receptor antagonists for allergic rhinitis: A systematic review and meta-analysis. Am J Med, 116 (5), 338–344.PubMedCrossRefGoogle Scholar

Copyright information

© Zhejiang University Press, Hangzhou and Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Erina M. Lin
    • 1
  1. 1.University of CaliforniaLos AngelesUSA

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