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Managing allergic and nonallergic rhinitis with an intranasal antihistamine

Managing allergic and nonallergic rhinitis with an intranasal antihistamine

Many physicians consider oral antihistamines to be the first-line therapy for allergic rhinitis. While these agents effectively reduce the symptoms of itching, sneezing, and rhinorrhea, they do not have much of an effect on nasal congestion. Intranasal antihistamines appear to have an edge over the oral agents in that they do reduce nasal congestion and they have a rapid onset of action. A recent review of the literature provides additional evidence of the efficacy of intranasal antihistamines in the treatment of both allergic rhinitis and vasomotor rhinitis, which is the most common form of nonallergic rhinitis.

Kaliner reviewed articles published between 1995 and 2007 that addressed the use of the intranasal antihistamine azelastine in patients with rhinitis. The results of several randomized, placebo-controlled trials support the efficacy and safety of this agent in the treatment of allergic rhinitis and vasomotor rhinitis. Treatment with azelastine resulted in sustained improvement in rhinitis, nasal congestion, and other symptoms. Studies also showed that the combination of azelastine and an intranasal corticosteroid improved the efficacy of treatment of allergic rhinitis by more than 40%, compared with use of either therapy alone.

Kaliner concluded that the use of intranasal azelastine is effective in managing both allergic rhinitis and nonallergic vasomotor rhinitis. Intranasal antihistamines may be especially useful if nasal congestion is a major symptom or if rapid symptom relief is needed.

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