Rhinitis medical therapy: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Treatment of Allergic Rhinitis=== | |||
The treatment of allergic rhinitis includes the following key components:<ref name="pmid25182359">{{cite journal| author=Lee S| title=Practical clinical approaches to the allergic rhinitis patient. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S66-9 | pmid=25182359 | doi=10.1002/alr.21389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182359 }} </ref><ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> | The treatment of allergic rhinitis includes the following key components:<ref name="pmid25182359">{{cite journal| author=Lee S| title=Practical clinical approaches to the allergic rhinitis patient. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S66-9 | pmid=25182359 | doi=10.1002/alr.21389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182359 }} </ref><ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> | ||
* Patient education on allergen avoidance and non-pharmacologic treatments such as saline douching of the nose | * Patient education on allergen avoidance and non-pharmacologic treatments such as saline douching of the nose | ||
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* Surgery in selected cases | * Surgery in selected cases | ||
===Pharmacotherapy<ref name="pmid25182359">{{cite journal| author=Lee S| title=Practical clinical approaches to the allergic rhinitis patient. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S66-9 | pmid=25182359 | doi=10.1002/alr.21389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182359 }} </ref><ref name="pmid25644617">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: Allergic rhinitis. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 1 Suppl | pages= S1-43 | pmid=25644617 | doi=10.1177/0194599814561600 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25644617 }} </ref>=== | ====Pharmacotherapy<ref name="pmid25182359">{{cite journal| author=Lee S| title=Practical clinical approaches to the allergic rhinitis patient. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S66-9 | pmid=25182359 | doi=10.1002/alr.21389 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182359 }} </ref><ref name="pmid25644617">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: Allergic rhinitis. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 1 Suppl | pages= S1-43 | pmid=25644617 | doi=10.1177/0194599814561600 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25644617 }} </ref>==== | ||
The choice of pharmacotherapy in allergic rhinitis is based on the severity and persistence of the disease, as depicted in the table below. | The choice of pharmacotherapy in allergic rhinitis is based on the severity and persistence of the disease, as depicted in the table below. | ||
{| class="wikitable" | {| class="wikitable" | ||
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* Unacceptable adverse effect of medication | * Unacceptable adverse effect of medication | ||
* Patient's desire to reduce the long-term use of medications | * Patient's desire to reduce the long-term use of medications | ||
===Treatment of Nonallergic Rhinitis=== | |||
Nonallergic rhinitis comprises a heterogeneous group of disorders that are not completely understood. There are no specific guidelines for most forms of nonallergic rhinitis. | |||
==References== | ==References== | ||
Revision as of 03:44, 25 January 2017
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Rhinitis Microchapters |
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Rhinitis medical therapy On the Web |
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Risk calculators and risk factors for Rhinitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Rhinitis is a heterogegeous disorder that is often undertreated or overlooked( PMID 11449200)
Treatment
Treatment of Allergic Rhinitis
The treatment of allergic rhinitis includes the following key components:[1][2][3]
- Patient education on allergen avoidance and non-pharmacologic treatments such as saline douching of the nose
- Pharmacotherapy
- Allergen-specific immunotherapy in patients uncontrolled with pharmacotherapy
- Surgery in selected cases
Pharmacotherapy[1][4]
The choice of pharmacotherapy in allergic rhinitis is based on the severity and persistence of the disease, as depicted in the table below.
| Medical Treatment of Allergic Rhinitis | |||
|---|---|---|---|
| Severity of Rhinitis | Medication
(Use in conjunction with allergen avoidance and saline douching) |
Treatment Failure
(Ensure patient adherence to treatment before making changes to the treatment plan) |
Evaluation and treatment of associated conditions |
| Mild | Nonsedating oral/intranasal antihistamine | Consider intranasal steroids |
|
| Moderate | Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine) | Persistent/uncontrolled symptoms after 2-4weeks of treatment:
Failure of medical therapy:
| |
| Severe | Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine) | ||
Other Medications
- Leukotriene receptor antagonists- These can be prescribed for children with allergic rhinitis and concomitant asthma. It can also be of benefit in children with seasonal allergic rhinitis. They are not recommended for use in adults with persistent allergic rhinitis, and they should not be offered as primary therapy for the treatment of allergic rhinitis.[4][1][2]
Allergen-Specific Immunotherapy[5]
This entails the repeated administration of specific allergens to patients with IgE-mediated conditions in order to provide protection against the allergic symptoms and inflammatory reactions that are associated with the natural exposure to the allergens. Allergen immunotherapy is effective in the management of allergic disorders such as allergic rhinitis, allergic conjunctivitis, asthma, and stinging insect hypersensitivity. It can be administered via the subcutaneous or the sublingual routes. For immunotherapy to be considered, positive skin/RAST test results for specific IgE antibodies should correlate with the suspected allergen and patient exposure. Some of the indications for immunotherapy are:
- Poor control of symptoms with medications and allergen avoidance
- Unacceptable adverse effect of medication
- Patient's desire to reduce the long-term use of medications
Treatment of Nonallergic Rhinitis
Nonallergic rhinitis comprises a heterogeneous group of disorders that are not completely understood. There are no specific guidelines for most forms of nonallergic rhinitis.
References
- ↑ 1.0 1.1 1.2 Lee S (2014). "Practical clinical approaches to the allergic rhinitis patient". Int Forum Allergy Rhinol. 4 Suppl 2: S66–9. doi:10.1002/alr.21389. PMID 25182359.
- ↑ 2.0 2.1 Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
- ↑ Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
- ↑ 4.0 4.1 Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: Allergic rhinitis". Otolaryngol Head Neck Surg. 152 (1 Suppl): S1–43. doi:10.1177/0194599814561600. PMID 25644617.
- ↑ Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I; et al. (2011). "Allergen immunotherapy: a practice parameter third update". J Allergy Clin Immunol. 127 (1 Suppl): S1–55. doi:10.1016/j.jaci.2010.09.034. PMID 21122901.