The Journal of Allergy and Clinical Immunology
Volume 118, Issue 5 , Pages 985-996, November 2006

Pharmacologic rationale for treating allergic and nonallergic rhinitis

  • Alexander N. Greiner, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Alexander N. Greiner, MD, Allergy and Asthma Medical Group and Research Center, 9610 Granite Ridge Dr, Suite B, San Diego, CA 92123.
    • ,
  • Eli O. Meltzer, MD

From Allergy and Asthma Medical Group and Research Center and the University of California San Diego School of Medicine

Received 22 May 2006; received in revised form 8 June 2006; accepted 13 June 2006. published online 19 September 2006.

San Diego, Calif

This activity is available for CME credit. See page 34A for important information.

Allergic rhinitis (AR) and perennial nonallergic rhinitis (PNAR) represent conditions affecting millions of individuals across the world. Although the diagnosis of AR might be presumptively based on the types of symptoms and the history of allergen triggers, confirmation requires documentation of specific IgE reactivity. In contrast, PNAR is a condition with similar symptomatology but in which the patient has no identifiable specific allergic sensitivities. This review presents the diverse options of currently available pharmacologic agents for the treatment of AR and PNAR, including intranasal corticosteroids, H1-antihistamines, decongestants, cromolyn sodium, antileukotrienes, anticholinergics, capsaicin, anti-IgE, and intranasal saline. Furthermore, appropriate stepped-up, stepped-down pharmacotherapeutic algorithms are described for the various forms of rhinitis.

Key words: Allergic rhinitis, nonallergic rhinitis, nonallergic rhinitis with eosinophilia syndrome, perennial nonallergic rhinitis, pharmacotherapy, H1-antihistamines, intranasal corticosteroids, antileukotrienes, capsaicin, cromolyn sodium

Abbreviations used: AR, Allergic rhinitis, INS, Intranasal corticosteroid, NARES, Nonallergic rhinitis with eosinophilia syndrome, OTC, Over the counter, PNAR, Perennial nonallergic rhinitis, VMR, Vasomotor rhinitis

 

 (Supported by an unrestricted educational grant from Genentech, Inc. and Novartis Pharmaceuticals Corporation)Series editor: Harold S. Nelson, MDDisclosure of potential conflict of interest: A. N. Greiner has received grant support from Alcon, Allux, Altana, AstraZeneca, Clay-Park Labs, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffman-La Roche, Medicinova, MedPointe, Merck, Novartis, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, and Wyeth and is on the speakers' bureau for AstraZeneca KOS, Pfizer, and Sanofi-Aventis. E. O. Meltzer has received grant support from Alcon, Allux, AstraZeneca, Clay-Park Labs, Critical Therapeutics, Genentech, GlaxoSmithKline, Hoffmann-La Roche, Medicinova, MedPointe, Merck, Novartis, Pharmaxis, Rigel, Sanofi-Aventis, Schering-Plough, and Wyeth; has consultant arrangements with Abbott, Adelphi, Alcon, Allux, Altana, Amgen, AstraZeneca, Capnia, Critical Therapeutics, Dey, Evolutec, Genentech, GlaxoSmithKline, Greer, Inspire, KOD, MedPointe, Merck, Novartis, Pfizer, Rigel, Sanofi-Aventis, Schering-Plough, Shionogi, Verus, and Wyeth; and is on the speakers' bureau for AstraZeneca, Alcon, Altana, Genentech, Genesis, GlaxoSmithKline, MedPointe, Merck, Novartis, Pfizer, Sanofi-Aventis, Schering-Plough, and Verus.

PII: S0091-6749(06)01380-7

doi:10.1016/j.jaci.2006.06.029

The Journal of Allergy and Clinical Immunology
Volume 118, Issue 5 , Pages 985-996, November 2006

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