Managing Allergic Rhinitis: The Role of Pharmacotherapy

Since approximately 50 million Americans have allergic rhinitis (AR), almost all primary care physicians will encounter this disease.¹ The prevalence of AR has increased dramatically in the past 30 years and may still be rising.² The financial impact is significant, with the direct costs estimated to be $7.3 billion and indirect costs estimated at $4.28 billion, including loss of productivity. This amounts to a total cost of $11.58 billion in the United States for 2002.³

Patients with AR may experience a variety of symptoms, including sneezing, rhinorrhea, nasal itching, congestion, and/or postnasal drainage. Although it may be easy to dismiss this disease as innocuous, patients often experience headaches, fatigue, impaired concentration, reduced productivity, loss of sleep, increased occupational risks, and decreased emotional well-being and social functioning.

In treating patients with AR, the most important first step in achieving symptomatic improvement is avoidance of the offending allergen(s). If a patient has seasonal AR and is mainly sensitive to outdoor pollens, recognizing pollen seasons and remaining indoors during that time is most helpful. For dust mite allergy, allergen-proof covers for mattresses and pillows, frequent washing of linens in hot water, and eliminating carpeting are the first steps to successful management. For pet allergy, removal of the pet from the home is obviously important; however, this recommendation is rarely followed.

Avoidance measures are the mainstay of treatment. However, if such measures fail or are unrealistic, there are several pharmacological therapies that can successfully control the symptoms of AR. In this article, we review the benefits and limitations of the available pharmacological therapies.

Understanding AR
In 2008, the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology defined rhinitis as “characterized by one or more of the following nasal symptoms: congestion, rhinorrhea (anterior and posterior), sneezing, and itching.”⁴ AR, in particular, is a hypersensitivity reaction to specific allergens that occurs in sensitized patients, which is mediated by IgE antibodies that result in the inflammation.⁵ AR has been traditionally described as seasonal or perennial depending on the specific allergens to which the person is sensitized. The Joint Task Force also defines episodic allergic rhinitis as “allergic nasal symptoms elicited by sporadic exposures to inhalant aeroallergens that are not usually encountered in the patient’s indoor or outdoor environment, such as while visiting a home with pets when a patient has no usual exposure to pets.”⁴

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