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A treatment for allergic rhinitis: a view on the role of levocetirizine
Stephen Holgate1, Richard Powell, Maureen Jenkins
1Southampton General Hospital, and University of Southampton, Southampton, UK. cav@soton.ac.uk
Background:
Allergic rhinitis is a significant public health concern in many developed countries. However, despite evidence for a significant impact on patients' quality of life (QoL) including sleep disruption and reduced daytime performance, allergic rhinitis remains under-managed and hence poorly controlled. This is largely owing to lack of knowledge about, and poor adherence to, established treatment guidelines.
Scope:
The panel considered available evidence and focused on four published studies on the second-generation antihistamine, levocetirizine. Three of these studies explored the clinical impact of levocetirizine in a broad range of different clinical settings.
Findings:
Levocetirizine demonstrated an increased benefit over other antihistamines in terms of a more durable antihistamine response: levocetirizine provided improved symptom relief at 24 hours compared to desloratadine or fexofenadine, two frequently prescribed second-generation antihistamines. Levocetirizine also maintained relief of the key symptoms of allergic rhinitis and improved patients' QoL over a treatment period of 6 months, in a real-life setting. The variable efficacy and durability of response of different antihistamines arise from differing modulatory effects on the H(1)-receptor. The speed of relief of symptoms with levocetirizine is supported by the pharmacokinetic data, which shows that steady state plasma concentrations are achieved in a shorter period of time than other second-generation histamines (additionally levocetirizine T(max) is reached in 0.9 h).
Conclusion:
These findings support both the short-term and long-term use of levocetirizine in the clinical management of allergic rhinitis. The World Health Organization (WHO) ARIA Guidelines (Allergic Rhinitis and its Impact on Asthma), recommend using a combination of a non-sedating antihistamine with a decongestant, or glucocorticosteroids for treating allergic rhinitis - with the order and combination of treatment depending on severity and duration of symptoms.
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