Treatment of allergic rhinitis

An increased understanding of the pathophysiology of allergic rhinitis can provide a logical basis for improved therapeutic strategies tailored individually to each patient. The first recommendation is the avoidance of possible or verified allergens. If this does not provide significant relief or is impractical, then immunotherapy plays a preventative role in some patients and it has been shown to be effective in certain cases. Initially, most patients try new nonsedating antihistamines, sometimes combined with a short course of topical vasoconstrictors. When nasal obstruction is a problem, a steroid spray is preferred. It is often necessary to add topical treatment for eye symptoms, e.g. antihistamine or cromoglycate eyedrops. In severe cases simultaneous administration of nasal corticosteroids and nonsedating antihistamines may achieve optimal control of symptoms. Cromolyn derivates are also effective in mild or moderate rhinoconjunctivitis and are especially recommended in the treatment of children. Systemic corticosteroid therapy should be reserved for the rare patient with extreme symptoms, and limited to short courses. Recent studies have shown that if patients are provided with appropriate medication, education and instruction, symptoms of allergic rhinitis can be well controlled with minimum impairment of quality of life.