Pharmacotherapy of Allergic Rhinitis

  • Jeffrey M. Lehman
  • Michael S. Blaiss
Part of the Allergy Frontiers book series (ALLERGY, volume 5)

The primary goal of allergic rhinitis (AR) treatment is to alleviate symptoms, improve quality of life and prevent comorbidities. In addition to allergen avoidance there are several pharmacologic agents available: oral and topical H1-antihistamines, intranasal glucocorticosteroids, leukotriene receptor antagonists, mast cell stabilizers, anticholinergic agents and decongestants.

Medications used for AR are typically administered orally or intranasally. The intranasal route allows for higher concentrations of the drug to be delivered thus minimizing the systemic side effects. However, many patients with AR have an aversion to using nasal spray, and oral medications are typically used in these patients.


Allergic Rhinitis Allergic Rhinitis Fluticasone Propionate Allergy Clin Immunol Nasal Spray 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Simons FER (2003) H1M-antihistamines: more relevant than ever in the treatment of allergic disorders. J Allergy Clin Immunol 112:S42–52PubMedCrossRefGoogle Scholar
  2. 2.
    Lehman JM, Blaiss MS (2006) Selecting the optimal oral H1 antihistamine for patients with allergic rhinitis. Drugs 66:2309–19PubMedCrossRefGoogle Scholar
  3. 3.
    Simons FER (2004) Advances in H1-anthistamines. N Engl J Med 351:2203–17PubMedCrossRefGoogle Scholar
  4. 4.
    Rimmer SJ, Church MK (1990) The pharmacology and mechanisms of action of histamine H1 -antagonists. Clin Exp Allergy 20:3–17PubMedCrossRefGoogle Scholar
  5. 5.
    Leurs R, Church MK, Taglialatela M (2002) H1 -antihistamines: inverse agonism, anti-inflammatory actions and cardiac effects. Clin Exp Allergy 32:489–98PubMedCrossRefGoogle Scholar
  6. 6.
    Naclerio RM (1993) The effect of antihistamines on the immediate allergic response: a comparative review. Otolaryngol Head Neck Surg 108:723–30PubMedGoogle Scholar
  7. 7.
    Ciprandi G, Passalacqua G, Canonica GW (1999) Effects of H1 antihistamines on adhesion molecules: a possible rationale for long-term treatment. Clin Exp Allergy 29:49–53PubMedCrossRefGoogle Scholar
  8. 8.
    Schroeder JT, Schleimer RP, Lichtenstein LM, Kreutner W (2001) Inhibition of cytokine generation and mediator release by human basophils treated with desloratadine. Clin Exp Allergy 31:1369–77PubMedCrossRefGoogle Scholar
  9. 9.
    Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, Li JT, Bernstein IL, Berger W, Spector S, Schuller D (1998) Diagnosis and management of rhinitis: complete guIDelines of the joint task force on practice parameters in allergy, asthma and immunology. Ann Allergy Asthma Immunol 81:478–518PubMedCrossRefGoogle Scholar
  10. 10.
    Kay GG (2000) The effects of antihistamines on cognition and performance. J Allergy Clin Immunol 105:S622–27PubMedCrossRefGoogle Scholar
  11. 11.
    Bousquet J, Van Cauwenberge P, Khaltaev N (2001) Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 108:147–334CrossRefGoogle Scholar
  12. 12.
    Meltzer EO (2005) Evaluation of the optimal oral antihistamine for patients with allergic rhinitis. Mayo Clin Proc 80:1170–76PubMedCrossRefGoogle Scholar
  13. 13.
    Simons FER, Simons KJ (1999) Clinical pharmacology of new histamine H 1 receptor antagonists. Clin Pharmacokinet 36:329–52PubMedCrossRefGoogle Scholar
  14. 14.
    Golightly LK, Greos LS (2005) Second-generation antihistamines. Actions and efficacy in the management of allergic disorders. Drugs 65:341–84Google Scholar
  15. 15.
    Slater JW, Zechnich AD, Haxby DG (1999) Second-generation antihistamines: a comparative review. Drugs 57:31–47PubMedCrossRefGoogle Scholar
  16. 16.
    Thomson L, Blaylock MG, Sexton DW, Campbell A, Walsh GM (2002) Cetirizine and levo-cetirizine inhibit eotaxin-induced eosinophil transendothelial migration through human dermal or lung microvascular endothelial cells. Clin Exp Allergy 32:1187PubMedCrossRefGoogle Scholar
  17. 17.
    Zyrtec® (cetirizine hydrochlorIDe) tablets and syrup: package insert. 2002 Pfizer Inc., New YorkGoogle Scholar
  18. 18.
    Meltzer EO, Weiler JM, WIDlitz MD (1996) Comparative outdoor study of the efficacy, onset and duration of action, and safety of cetirizine, loratadine, and placebo for seasonal allergic rhinitis. J Allergy Clin Immunol 97:617–6PubMedCrossRefGoogle Scholar
  19. 19.
    Ciprandi G, Passalacqua G, Mincarini M, Ricca V, Canonica GW (1997) Continuous versus on demand treatment with cetirizine for allergic rhinitis. Ann Allergy Asthma Immunol 79:507–11PubMedCrossRefGoogle Scholar
  20. 20.
    Ciprandi G, Tosca M, Ricca V, Passalacqua G, Riccio AM, Bagnasco M, Canonica GW (1997) Cetirizine treatment of rhinitis in children with pollen allergy: evIDence of its antiallergic activity. Clin Exp Allergy 27:1160–6PubMedCrossRefGoogle Scholar
  21. 21.
    Pearlman DS, Lumry WR, Winder JA, Noonan MJ (1997) Once-daily cetirizine effective in the treatment of seasonal allergic rhinitis in children aged 6 to 11 years: a randomized, doubleblind, placebo-controlled study. Clin Pediatr 36:209–15CrossRefGoogle Scholar
  22. 22.
    Sabbah A, Daele J, Wade AG, Ben-Soussen P, Attali P (1999) Comparison of the efficacy, safety, and onset of action of mizolastine, cetirizine, and placebo in the management of seasonal allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol 83:319–25PubMedGoogle Scholar
  23. 23.
    Murray JJ, Nathan RA, Bronsky EA, Olufade AO, Chapman D, Kramer B (2002) Comprehensive evaluation of cetirizine in the management of seasonal allergic rhinitis: impact on symptoms, quality of life, productivity, and activity impairment. Allergy Asthma Proc 23:391–8PubMedGoogle Scholar
  24. 24.
    Burtin B, Duchateau J, Pignat JC, Donnelly F, Bousquet J (2000) Further improvement of quality of life by cetirizine in perennial allergic rhinitis as a function of treatment duration. Invest Allergol Clin Immunol 10:66–70Google Scholar
  25. 25.
    De Vos, Mitchev K, Pinnelli, et al. (2008) Non-interventional study comparing treatment satisfaction in patients treated with antihistamines. Clin Drug Invest 28 (4): 221–230CrossRefGoogle Scholar
  26. 26.
    Mohler, SR, Nicholson A, Harvey RP, Miura Y, Meeves SG (2002) The use of antihistamines in safety-critical jobs: a meeting report. Curr Med Res Opin 18:332–7PubMedCrossRefGoogle Scholar
  27. 27.
    de Blic J, Wahn U, Potter P (2004) Levocetirizine for SAR and PAR in children. Eur Respir J 24:s164Google Scholar
  28. 28.
    Kay GG, Berman B, Mockoviak SH, Morris CE, Reeves D, Starbuck V, Sukenik E, Harris AG (1997) Initial and steady-state effects of diphenhydramine and loratadine on sedation, cognition, mood, and psychomotor performance. Arch Intern Med 157:2350–6PubMedCrossRefGoogle Scholar
  29. 29.
    Hindmarch I, Shamsi Z (1999) Antihistamines: models to assess sedative properties, assessment of sedation, safety and other sIDe-effects. Clin Exp Allergy 29:133–142PubMedCrossRefGoogle Scholar
  30. 30.
    Serra HA, Alves O, Rizzo LF, Devoto FM, Ascierto H (1998) Loratadine-pseudoephedrine in children with allergic rhinitis, a controlled double-blind trial. Br J Clin Pharmacol 45:147–50PubMedCrossRefGoogle Scholar
  31. 31.
    Druce HM, Thoden WR, Mure P, Furey SA, Lockhart EA, Xie T, Galant S, Prenner BM, Weinstein S, Ziering R, Brandon ML (1998) Brompheniramine, loratadine, and placebo in allergic rhinitis: a placebo-controlled comparative trial. J Clin Pharmacol 38:382–9PubMedGoogle Scholar
  32. 32.
    Schroeder JT, Schleimer RP, Lichtenstein LM, Kreutner W (2001) Inhibition of cytokine generation and mediator release by human basophils treated with desloratadine. Clin Exp Allergy 31:1369–77PubMedCrossRefGoogle Scholar
  33. 33.
    Meltzer EO, Prenner BM, Nayak A (2001) Efficacy and tolerability of once-daily 5 mg deslo-ratadine, an H1-receptor antagonist, in patients with seasonal allergic rhinitis: assessment during the spring and fall allergy seasons. Clin Drug Invest 21:25–32CrossRefGoogle Scholar
  34. 34.
    Berger WE, Schenkel EJ, Mansfield LE; Desloratadine Study Group (2002) Safety and efficacy of desloratadine 5 mg in asthma patients with seasonal allergic rhinitis and nasal congestion. Ann Allergy Asthma Immunol 89:485–91PubMedCrossRefGoogle Scholar
  35. 35.
    Simons FER, Prenner BM, Finn A (2003) Efficacy and safety of desloratadine in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 111:617–22PubMedCrossRefGoogle Scholar
  36. 36.
    Bielory L, Lien KW, Bigelsen S (2005) Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis. Drugs 65:215–28PubMedCrossRefGoogle Scholar
  37. 37.
    Paolieri F, Battifora M, Riccio A, Bertolini C, Cutolo M, Bloom M, Ciprandi G, Canonica GW, Bagnasco M (1998) Terfenadine and fexofenadine reduce in vitro ICAM-1 expression on human continuous cell lines. Ann Allergy Asthma Immunol 81:601–7PubMedCrossRefGoogle Scholar
  38. 38.
    Day JH, Briscoe MP, Welsh A, Smith JN, Clark A, Ellis AK, Mason J (1997) Onset of action, efficacy, and safety of a single dose of fexofenadine hydrochlorIDe for ragweed allergy using an environmental exposure unit. Ann Allergy Asthma Immunol 79:533–40PubMedCrossRefGoogle Scholar
  39. 39.
    Wahn U, Meltzer EO, Finn AF, Kowalski ML, Decosta P, Hedlin G, Scheinmann P, Bachert C, Rosado Pinto JE, Baena-Cagnani C, Potter P, Simons FE, Ruuth E (2003) Fexofenadine is efficacious and safe in children (aged 6–11 years) with seasonal allergic rhinitis. J Allergy Clin Immunol 111:763–9PubMedCrossRefGoogle Scholar
  40. 40.
    Sussman GL, Mason J, Compton D, Stewart J, Ricard N (1999) The efficacy and safety of fexofenadine HCl and pseudoephedrine, alone and in combination, in seasonal allergic rhinitis. J Allergy Clin Immunol 104:100–6PubMedCrossRefGoogle Scholar
  41. 41.
    Casale TB, Andrade C, Qu R (1999) Safety and efficacy of once-daily fexofenadine HCl in the treatment of autumn seasonal allergy rhinitis. Allergy Asthma Proc 20:193–8PubMedCrossRefGoogle Scholar
  42. 42.
    Bronsky EA, Falliers CJ, Kaiser HB, Ahlbrandt R, Mason JM (1998) Effectiveness and safety of fexofenadine, a new nonsedating H1-receptor antagonist, in the treatment of fall allergies. Allergy Asthma Proc 19:135–41PubMedCrossRefGoogle Scholar
  43. 43.
    Meltzer EO, Casale TB, Nathan RA, Thompson AK (1999) Once-daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 83:311–7PubMedCrossRefGoogle Scholar
  44. 44.
    Bernstein DI, Schoenwetter WF, Nathan RA, Storms W, Ahlbrandt R, Mason J (1997) Efficacy and safety of fexofenadine hydrochlorIDe for treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 79:443–8PubMedCrossRefGoogle Scholar
  45. 45.
    van Cauwenberge P, Juniper EF (2000) Comparison of the efficacy, safety and quality of life provIDed by fexofenadine hydrochlorIDe 120 mg, loratadine 10 mg and placebo administered once daily for the treatment of seasonal allergic rhinitis. Clin Exp Allergy 30:891–9PubMedCrossRefGoogle Scholar
  46. 46.
    Ambudkar SV, Dey S, Hrycyna CA, Ramachandra M, Pastan I, Gottesman MM (1999) Biochemical, cellular, and pharmacological aspects of the multIDrug transporter. Annu Rev Pharmacol Toxicol 39:361–98PubMedCrossRefGoogle Scholar
  47. 47.
    Dresser GK, Bailey DG, Leake BF, Schwarz UI, Dawson PA, Freeman DJ, Kim RB (2002) Fruit juices inhibit organic anion transporting polypeptIDe-mediated drug uptake to decrease the oral availability of fexofenadine. Clin Pharmacol Ther 71:11–20PubMedCrossRefGoogle Scholar
  48. 48.
    Milne RW, Larson LA, Jorgensen KL, Bastlund J, Stretch GR, Evans AM (2000) Hepatic disposition of fexofenadine: influence of the inhibitors erythromycin and dibromosulphotha-lein. Pharm Res 17:1511–5PubMedCrossRefGoogle Scholar
  49. 49.
    LaForce CF, Corren J, Wheeler WJ, Berger WE (2004) Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients who remain symptomatic after treatment with fexofenadine. Ann Allergy Asthma Immunol 93:154–9PubMedCrossRefGoogle Scholar
  50. 50.
    Astelin® (Azelastine HCL) nasal spray: package insert. MedPointe Pharmaceuticals, Somerset, NJ. 2006Google Scholar
  51. 51.
    Lieberman PL, Settipane RA (2003) Azelastine nasal spray: a review of pharmacology and clinical efficacy in allergic and nonallergic rhinitis. Allergy Asthma Proc 24:95–105PubMedGoogle Scholar
  52. 52.
    Storms WW, Pearlman DS, Chervinsky P, Grossman J, Halverson PC, Freitag JJ, WIDlitz MD (1994) Effectiveness of azelastine nasal solution in seasonal allergic rhinitis. Ear Nose Throat J 73(382–6):390–4Google Scholar
  53. 53.
    Ratner PH, Findlay SR, Hampel F Jr, van Bavel J, WIDlitz MD, Freitag JJ (1994) A doubleblind, controlled trial to assess the safety and efficacy of azelastine nasal spray in seasonal allergic rhinitis. J Allergy Clin Immunol 94:818–25PubMedCrossRefGoogle Scholar
  54. 54.
    Meltzer EO, Weiler JM, Dockhorn RJ, WIDlitz MD, Freitag JJ (1994) Azelastine nasal spray in the management of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 72:354–9Google Scholar
  55. 55.
    Corren J, Storms W, Bernstein J, Berger W, Nayak A, Sacks H (2005) Effectiveness of azelastine nasal spray compared with oral cetirizine in patients with seasonal allergic rhinitis. Clin Ther 27:543–53PubMedCrossRefGoogle Scholar
  56. 56.
    Horak F, Zieglmayer UP, Zieglmayer R, Kavina A, Marschall K, Munzel U, Petzold U (2006) Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy. Curr Med Res Opin 22:151–7PubMedCrossRefGoogle Scholar
  57. 57.
    Charpin D, Godard P, Garay RP, Baehre M, Herman D, Michel FB (1995) A multicenter clinical study of the efficacy and tolerability of azelastine nasal spray in the treatment of seasonal allergic rhinitis: a comparison with oral cetirizine. Eur Arch Otorhinolaryngol 252:455–8PubMedCrossRefGoogle Scholar
  58. 58.
    Patel P, Roland PS, Marple BF, Benninger PJ, Margalias H, Brubaker M, Beezley SF, Drake M, Potts SL, Wall GM (2007) An assessment of the onset and duration of action of olopata-dine nasal spray. Otolaryngol Head Neck Surg 137:918–24PubMedCrossRefGoogle Scholar
  59. 59.
    Hampel FC Jr, Ratner PH, Amar NJ, van Bavel JH, Mohar D, Fairchild CJ, Wall GM, Brubaker MJ, Drake M, Crenshaw KM (2006) Improved quality of life among seasonal allergic rhinitis patients treated with olopatadine HCl nasal spray 0.4% and olopatadine HCl nasal spray 0.6% compared with vehicle placebo. Allergy Asthma Proc 27:202–7PubMedCrossRefGoogle Scholar
  60. 60.
    Meltzer EO, Hampel FC, Ratner PH, Bernstein DI, Larsen LV, Berger WE, Finn AF Jr, Marple BF, Roland PS, Wall GM, Brubaker MJ, Dimas C, Potts SL, Silver LH, Barnes JR (2005) Safety and efficacy of olopatadine hydrochlorIDe nasal spray for the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 95:600–6PubMedCrossRefGoogle Scholar
  61. 61.
    Patel D, Garadi R, Brubaker M, Conroy JP, Kaji Y, Crenshaw K, Whitling A, Wall GM (2007) Onset and duration of action of nasal sprays in seasonal allergic rhinitis patients: olopatadine hydrochlorIDe versus mometasone furoate monohydrate. Allergy Asthma Proc 28:592–9PubMedCrossRefGoogle Scholar
  62. 62.
    Gandhi RK, Blaiss MS (2005) Current concepts and therapeutic strategies for allergic rhinitis. Otorinolaringologia 55:187–201Google Scholar
  63. 63.
    Settipane G, Korenblat PE, Winder J, Lumry W, Murphree J, Alderfer VB, Simpson B, Smith JA (1995) Triamcinolone acetonIDe aqueous nasal spray in patients with seasonal ragweed allergic rhinitis: a placebo-controlled, double-blind study. Clin Ther 17:252–63PubMedCrossRefGoogle Scholar
  64. 64.
    Wiseman LR, Benfield P (1997) Intranasal fluticasone propionate. A reappraisal of its pharmacology and clinical efficacy in the treatment of rhinitis. Drugs 53:885–907Google Scholar
  65. 65.
    Meltzer EO, Jalowayski AA, Orgel HA, Harris AG (1998) Subjective and objective assessments in patients with seasonal allergic rhinitis: effects of therapy with mometasone furoate nasal spray. J Allergy Clin Immunol 102:39–49PubMedCrossRefGoogle Scholar
  66. 66.
    Kaiser HB, Naclerio RM, Given J, Toler TN, Ellsworth A, Philpot EE (2007) Fluticasone furoate nasal spray: A single treatment option for the symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 119:1430–7PubMedCrossRefGoogle Scholar
  67. 67.
    Wingertzahn MA, Sato H, Nave R, Nonaka T, Mochizuki T, Takahama S,Kondo S (2005) Comparison of nasal tissue concentrations in rabbits following administration of hypotonic and isotonic ciclesonIDe suspensions. J Allergy Clin Immunol 115:S126CrossRefGoogle Scholar
  68. 68.
    Graf P (1999) Adverse effects of benzalkonium chlorIDe on the nasal mucosa: allergic rhinitis and rhinitis medicamentosa. Clin Ther 21:1749–55PubMedCrossRefGoogle Scholar
  69. 69.
    Bernstein IL (2000) Is the use of benzalkonium chlorIDe as a preservative for nasal formulations a safety concern? A cautionary note based on compromised mucociliary transport. J Allergy Clin Immunol 105:39–44PubMedCrossRefGoogle Scholar
  70. 70.
    Ratner PH, Wingertzahn MA, van Bavel JH, Hampel F, Darken PF, Shah T (2006) Efficacy and safety of ciclesonIDe nasal spray for the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol 118:1142–8PubMedCrossRefGoogle Scholar
  71. 71.
    Welsh PW, Stricker WE, Chu CP, Naessens JM, Reese ME, Reed CE, Marcoux JP (1987) Efficacy of beclomethasone nasal solution, flunisolIDe, and cromolyn in relieving symptoms of ragweed allergy. Mayo Clin Proc 62:125–34PubMedGoogle Scholar
  72. 72.
    Corren J (1999) Intranasal corticosteroIDs for allergic rhinitis: how do different agents compare? J Allergy Clin Immunol 104:S144–9PubMedCrossRefGoogle Scholar
  73. 73.
    Scadding GK, Lund VJ, Jacques LA, Richards DH (1995) A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial rhinitis: efficacy in allergic and non-allergic perennial rhinitis. Clin Exp Allergy 25:737–43PubMedCrossRefGoogle Scholar
  74. 74.
    van As A, Bronsky EA, Dockhorn RJ, Grossman J, Lumry W, Meltzer EO, Seltzer JM, Rogenes PR (1993) Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate. J Allergy Clin Immunol 91:1146–54PubMedCrossRefGoogle Scholar
  75. 75.
    Haye R, Gomez EG (1993) A multicentre study to assess long-term use of fluticasone propi-onate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis. Rhinology 31:169–74PubMedGoogle Scholar
  76. 76.
    Jen A, Baroody F, de Tineo M, Haney L, Blair C, Naclerio R (2000) As-needed use of fluticasone propionate nasal spray reduces symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 105:732–8PubMedCrossRefGoogle Scholar
  77. 77.
    Berkowitz RB, Nolop RB, Mesarina-Wicki BE, C93-184 Study Group (1997) Onset of action of mometasone furoate (Nasonex) nasal spray in seasonal allergic rhinitis. J Allergy Clin Immunol 99:S441Google Scholar
  78. 78.
    Nielsen LP, Dahl R (2003) Comparison of intranasal corticosteroIDs and antihistamines in allergic rhinitis: a review of randomized, controlled trials. Am J Respir Med 2:55–65PubMedGoogle Scholar
  79. 79.
    Weiner JM, Abramson MJ, Puy RM (1998) Intranasal corticosteroIDs versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomized controlled trials. BMJ 317:1624–9PubMedGoogle Scholar
  80. 80.
    Blaiss MS (2007) Safety consIDerations of intranasal corticosteroIDs for the treatment of allergic rhinitis. Allergy Asthma Proc 28:145–52PubMedCrossRefGoogle Scholar
  81. 81.
    Szefler SJ (2001) Pharmacokinetics of intranasal corticosteroIDs. J Allergy Clin Immunol 108:S26–31PubMedCrossRefGoogle Scholar
  82. 82.
    Lipworth BJ, Seckl JR (1997) Measures for detecting systemic bioactivity with inhaled and intranasal corticosteroIDs. Thorax 52:476–82PubMedCrossRefGoogle Scholar
  83. 83.
    Trangsrud AJ, Whitaker AL, Small RE (2002) Intranasal corticosteroIDs for allergic rhinitis. Pharmacotherapy 22:1458–67PubMedCrossRefGoogle Scholar
  84. 84.
    Cervin A, Hansson C, Greiff L, Andersson M (2003) Nasal septal perforations during treatment with topical nasal glucocorticosteroIDs are generally not associated with contact allergy to steroIDs. ORL J Otorhinolaryngol Relat Spec 65:103–05PubMedGoogle Scholar
  85. 85.
    Waddell AN, Patel SK, Toma AG, Maw AR (2003) Intranasal steroID sprays in the treatment of rhinitis: is one better than another? J Laryngol Otol 117:843–45PubMedCrossRefGoogle Scholar
  86. 86.
    Galant SP, Melamed IR, Nayak AS, Blake KV, Prillaman BA, Reed KD, Cook CK, Philpot EE, Rickard KA (2003) Lack of effect of fluticasone propionate aqueous nasal spray on the hypothalamic-pituitary-adrenal axis in 2- and 3-year-old patients. Pediatrics 112:96–100PubMedCrossRefGoogle Scholar
  87. 87.
    Skoner D, Gentile D, Angelini B, Kane R, Birdsall D, Banerji D (2003) The effects of intranasal triamcinolone acetonIDe and intranasal fluticasone propionate on short-term bone growth and HPA axis in children with allergic rhinitis. Ann Allergy Asthma Immunol 90:56–62PubMedCrossRefGoogle Scholar
  88. 88.
    Wilson AM, McFarlane LC, Lipworth BJ (1998) Effects of repeated once daily dosing of three intranasal corticosteroIDs on basal and dynamic measures of hypothalamic-pituitary-adrenal-axis activity. J Allergy Clin Immunol 101:470–74PubMedCrossRefGoogle Scholar
  89. 89.
    Wilson AM, Sims EJ, McFarlane LC, Lipworth BJ (1998) Effects of intranasal corticoster-oIDs on adrenal, bone, and blood markers of systemic activity in allergic rhinitis. J Allergy Clin Immunol 102:598–604PubMedCrossRefGoogle Scholar
  90. 90.
    Moller C, Ahlstrom H, Henricson KA, Malmqvist LA, Akerlund A, Hildebrand H (2003) Safety of nasal budesonIDe in the long-term treatment of children with perennial rhinitis. Clin Exp Allergy 33:816–22PubMedCrossRefGoogle Scholar
  91. 91.
    Juniper EF, Stahl E, Doty RL, Simons FE, Allen DB, Howarth PH (2005) Clinical outcomes and adverse effect monitoring in allergic rhinitis. J Allergy Clin Immunol 115:S390–413PubMedCrossRefGoogle Scholar
  92. 92.
    Wolthers OD, Pedersen S (1993) Short-term growth in children with allergic rhinitis treated with oral antihistamine, depot and intranasal glucocorticosteroIDs. Acta Paediatr 82:635–40PubMedGoogle Scholar
  93. 93.
    Wolthers OD, Pedersen S (1994) Knemometric assessment of systemic activity of once daily intranasal dry-powder budesonIDe in children. Allergy 49:96–9PubMedCrossRefGoogle Scholar
  94. 94.
    Bielory L, Blaiss M, Fineman SM, Ledford DK, Lieberman P, Simons FE, Skoner DP, Storms WW (2006) Concerns about intranasal corticosteroIDs for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 96:514–25PubMedGoogle Scholar
  95. 95.
    Bui CM, Chen H, Shyr Y, Joos KM (2005) Discontinuing nasal steroIDs might lower intraocular pressure in glaucoma. J Allergy Clin Immunol 116:1042–47PubMedCrossRefGoogle Scholar
  96. 96.
    Opatowsky I, Feldman RM, Gross R, Feldman ST (1995) Intraocular pressure elevation associated with inhalation and nasal corticosteroIDs. Ophthalmology 102:177–79PubMedGoogle Scholar
  97. 97.
    Plautt M, Valentine MD (2005) Allergic rhinitis. N Engl J Med 353:1934–44CrossRefGoogle Scholar
  98. 98.
    Wilson AM, O'Byrne PM, Parameswaran K (2004) Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis. Am J Med 116:338–44PubMedCrossRefGoogle Scholar
  99. 99.
    van Adelsberg J, Philip G, Pedinoff AJ, Meltzer EO, Ratner PH, Menten J, Reiss TF; Montelukast Fall Rhinitis Study Group (2003) Montelukast improves symptoms of seasonal allergic rhinitis over a 4-week treatment period. Allergy 58:1268–76PubMedCrossRefGoogle Scholar
  100. 100.
    Chervinsky P, Philip G, Malice MP, Bardelas J, Nayak A, Marchal JL, van Adelsberg J, Bousquet J, Tozzi CA, Reiss TF (2004) Montelukast for treating fall allergic rhinitis: effect of pollen exposure in 3 studies. Ann Allergy Asthma Immunol 92:367–73PubMedCrossRefGoogle Scholar
  101. 101.
    Rodrigo GJ, Yanez A (2006) The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials. Ann Allergy Asthma Immunol 96:779–86PubMedCrossRefGoogle Scholar
  102. 102.
    Meltzer EO, Malmstrom K, Lu S, Prenner BM, Wei LX, Weinstein SF, Wolfe JD, Reiss TF (2000) Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 105:917–22PubMedCrossRefGoogle Scholar
  103. 103.
    Borum P, Mygind N, Schultz Larsen F (1979) Intranasal ipratropium: a new treatment for perennial rhinitis. Clin Otolaryngol 4:407–11PubMedCrossRefGoogle Scholar
  104. 104.
    Wagenmann M, Naclerio RM (1992) Complications of sinusitis. J Allergy Clin Immunol 90:552–4PubMedCrossRefGoogle Scholar
  105. 105.
    Bonini S, Bonini M, Bousquet J, Brusasco V, Canonica GW, Carlsen KH, Corbetta L, Cummiskey J, Delgado L, Del Giacco SR, Haahtela T, Jaeger S, Moretti C, Palange P, Passalacqua G, Passali D, Pedersen BK, Popov T, Rasi G, Ventura MT, Vignola AM (2006) Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN. Allergy 61:681–92PubMedCrossRefGoogle Scholar
  106. 106.
    Pleskow W, Grubbe R, Weiss S, Lutsky B (2005) Efficacy and safety of an extended-release formulation of desloratadine and pseudoephedrine vs the indivIDual components in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 94:348–54PubMedCrossRefGoogle Scholar
  107. 107.
    Lockey RF (2006) Rhinitis medicamentosa and the stuffy nose. J Allergy Clin Immunol 118:1017–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Jeffrey M. Lehman
    • 1
  • Michael S. Blaiss
    • 2
  1. 1.Department of Medicine and Pediatrics, Division of Allergy and ImmunologyUniversity of Tennessee Health Science CenterMemphisUSA
  2. 2.Department of Medicine and Pediatrics, Division of Clinical Allergy and ImmunologyUniversity of Tennessee Health Science CenterGermantownUSA

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