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Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies
1Allergy and Respiratory Diseases, Clinic Dipartmento di Medicina Interna e Specialita Mediche (DIMI), University of Genova, Genova, Italy. canonica@unige.it
Clinical and Experimental Immunology
|September 22, 2009
Summary
Allergic rhinitis patients often have subclinical inflammation, termed minimal persistent inflammation, which can worsen symptoms and lead to asthma. Intranasal corticosteroids are recommended for continuous treatment of this underlying inflammation.
Area of Science:
- Immunology
- Allergology
- Pharmacology
Background:
- Traditional allergic rhinitis classification (seasonal/perennial) overlooks subclinical inflammation.
- Minimal persistent inflammation, characterized by nasal mucosal inflammatory cell infiltration, occurs even with subthreshold allergen exposure.
- This subclinical state may increase susceptibility to overt symptoms and comorbidities like asthma.
Purpose of the Study:
- To evaluate therapeutic options for managing both overt allergic rhinitis symptoms and underlying minimal persistent inflammation.
- To identify medications suitable for long-term, continuous administration to inhibit persistent inflammation.
Main Methods:
- Review of existing literature on allergic rhinitis pathophysiology and treatment options.
- Comparative analysis of intranasal corticosteroids, antihistamines, and antileukotrienes based on efficacy, safety, and administration convenience.
- Assessment of anti-inflammatory properties and suitability for continuous use.
Main Results:
- Subthreshold allergen exposure induces inflammatory markers in the nasal mucosa, indicative of minimal persistent inflammation.
- Intranasal corticosteroids, antihistamines, and antileukotrienes are common treatments for allergic rhinitis.
- Intranasal corticosteroids demonstrate potent anti-inflammatory effects and favorable long-term safety profiles.
Conclusions:
- Minimal persistent inflammation is a significant factor in allergic rhinitis, contributing to hyperreactivity and comorbidities.
- Effective management requires addressing both overt symptoms and the underlying inflammatory state.
- Intranasal corticosteroids are the most suitable therapeutic option for continuous management of persistent inflammation in allergic rhinitis.
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