Antihistamine selection in patients with allergic rhinitis

Area of Science:

• Allergy and Immunology
• Pharmacology

Background:

• Allergic rhinitis, encompassing seasonal and perennial forms, affects a significant patient population.
• Antihistamines are a cornerstone treatment for allergic rhinitis symptoms.

Purpose of the Study:

• To evaluate and compare the efficacy and side effect profiles of five distinct antihistamine classes in patients with allergic rhinitis.
• To determine patient preference and long-term adherence to specific antihistamine classes.

Main Methods:

• A cohort of 782 patients with allergic rhinitis received five different antihistamine products, each representing a major class, for two-week periods.
• Patient-reported symptoms and side effects were graded on a 0-4 scale, with particular attention to troublesome side effects (grades 3-4).
• Patient preference and long-term adherence (1, 3, and 5 years) to the initially selected antihistamine class were tracked.

Main Results:

• Antihistamine products were ranked by increasing frequency of significant side effects: trimeprazine, chlorpheniramine, hydroxyzine, diphenhydramine, and tripelennamine.
• Patient preference order was chlorpheniramine (27%), diphenhydramine (22%), tripelennamine (20%), hydroxyzine (16%), and trimeprazine (14%).
• Less than 1% of patients could not find an acceptable antihistamine class, and long-term adherence to the first choice remained substantial over five years.

Conclusions:

• The study suggests a rational approach to selecting antihistamines for allergic rhinitis based on efficacy and side effect profiles.
• Chlorpheniramine and diphenhydramine emerged as preferred options with a favorable balance of efficacy and tolerability.
• The findings support the use of an antihistamine class-based selection strategy for managing allergic rhinitis.