Antiallergic and Vasoactive Drugs for Allergic Rhinitis

Part of the Allergy Frontiers book series (ALLERGY, volume 5)

Rhinitis is defined as the inflammation of the lining of the nose with one or more symptoms. The symptom profile of allergic rhinitis (AR) includes sneezing, itching of the eyes, nose, and throat, nasal obstruction, and rhinorrhoea. However, other problems and symptoms are also commonly associated with AR. For example, patients with seasonal AR commonly have conjunctivitis and may also have bronchial asthma. In central Europe, the association with bronchial asthma is greater with birch pollen allergy than grass pollen allergy. Headache and fatigue are other symptoms commonly associated with AR [1]. The most bothering symptom of AR is blocked nose, but loss of taste and smell are also associated symptoms.

AR is linked with asthma; more than 30% of patients with perennial AR have signs of asthma, and about 75% of patients with allergic asthma also have perennial AR [2].


Allergic Rhinitis Allergic Rhinitis Fluticasone Propionate Allergy Clin Immunol Seasonal Allergic Rhinitis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Temmel AFP, Schleinzer K, Marks B, et al (1998) Prospective epidemiological longitudinal study in allergic diseases. Otorhinolaryngol Nova 8:47Google Scholar
  2. 2.
    Corren J (1997) Allergic rhinitis and asthma: how important is the link? J Allergy Clin Immunol 99(2):781–786CrossRefGoogle Scholar
  3. 3.
    Juniper EF, Thompson AK, Ferrie PJ, et al (2000) Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionaire. Clin Exp Allergy 30:132–140CrossRefPubMedGoogle Scholar
  4. 4.
    Mygind N, Dahl R, Pedersen S, et al (1996) Pathogenesis of allergic rhinitis. In: Mygind N, Dahl R, Pedersen S, Thestrup-Pedersen K, eds. Essential allergy. Second edition. Berlin: Blackwell Science:201–206Google Scholar
  5. 5.
    International Rhinitis Management Working Group. International consensus report on the diagnosis and management of rhinitis (1994). Allergy 49 (suppl 19):1–34Google Scholar
  6. 6.
    Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization (2001) Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 108 (suppl 5):S147–334CrossRefPubMedGoogle Scholar
  7. 7.
    Bousquet J, Van Cauwenberge P, Aït Khaled N, et al (2006) Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy 61:1086–1096CrossRefPubMedGoogle Scholar
  8. 8.
    Bachert C, Vignola AM, Gevaert P, et al (2004) Allergic rhinitis, rhinosinusitis and asthma: one airway disease. Immunol Allergy Clin North Am 24:19–43CrossRefPubMedGoogle Scholar
  9. 9.
    Demoly P, Allaert FA, Lecasble M, et al (2003) Validation of the classification of ARIA. Allergy 58:672–675CrossRefPubMedGoogle Scholar
  10. 10.
    Simons FER (1994) H1-receptor antagonists: comparative tolerability and safety. Drug Saf 10:350–380CrossRefPubMedGoogle Scholar
  11. 11.
    Walsh GM, Annunziato L, Frossard N, et al (2001) New insights into the second-generation antihistamines. Drugs 61:207–236CrossRefPubMedGoogle Scholar
  12. 12.
    Hadley JA (1999) Evaluation and management of allergic rhinitis. Med Clin North Am 83:13–25CrossRefPubMedGoogle Scholar
  13. 13.
    Howarth PH, Salagean M, Dokic D (2000) Allergic rhinitis: not purely a histamine-related disease. Allergy 55:7–16CrossRefPubMedGoogle Scholar
  14. 14.
    Taborda-Barata L, Jacobson M, Walker S, et al (1996) Effect of cetirizine and prednisolone on cellular infiltration and cytokine mRNA expression during allergen-induced late cutaneous responses. Clin Exp Allergy 26:68–78CrossRefPubMedGoogle Scholar
  15. 15.
    Zweiman B, Atkins PC, Moskovitz A, et al (19997) Cellular inflammatory responses during immediate, developing, and established late-phase allergic cutaneous reactions: effects of ceti-rizine. J Allergy Clin Immunol 100:341–347CrossRefGoogle Scholar
  16. 16.
    Atkins PC, Zweiman B, Moskovitz A, et al (1997) Cellular inflammatory responses and mediator release during early developing late-phase allergic cutaneous inflammatory responses: effects of cetirizine. J Allergy Clin Immunol 99:806–811CrossRefPubMedGoogle Scholar
  17. 17.
    Horak F (2000) Clinical advantages of dual activity in allergic rhinitis. Allergy 55 (suppl 64):34–39CrossRefPubMedGoogle Scholar
  18. 18.
    Corey JP, Houser SM (2000) Nasal congestion: a review of its etiology, evaluation and treatment. Ear Nose Throat J 79:690–702PubMedGoogle Scholar
  19. 19.
    Horak F (2002) Impact and modulation of nasal obstruction. Allergy 57 (suppl 75):25–28CrossRefPubMedGoogle Scholar
  20. 20.
    Ciprandy G, Cirillo I, Vizzaccaro A, et al (2004) Nasal obstruction in patients with seasonal allergic rhinitis: Relationship between allergic inflammation and nasal airflow. Int Arch Allergy Immunol 134:34–40CrossRefGoogle Scholar
  21. 21.
    Ciprandi G, Cirillo I, Vizzaccaro A, et al (2005) Levocetirizine improves nasal symptoms and airflow in patients with perennial allergic rhinitis: A pilot study. Eur Ann Allergy Clin Immunol 37:25–29PubMedGoogle Scholar
  22. 22.
    Horak F, Stübner P, Zieglmayer R, et al (2003) Comparison of the effect of desloratadine 5-mg daily and placebo on nasal airflow and seasonal allergic rhinitis symptoms induced by grass pollen exposure. Allergy 58:481–485CrossRefPubMedGoogle Scholar
  23. 23.
    Horak F, Stübner UP (2002) Decongestant activity of desloratadine in controlled-allergen-exposure trials. Clin Drug Invest 22 (suppl 2):13–20CrossRefGoogle Scholar
  24. 24.
    Horak F, Stuebner UP, Zieglmayer R, et al (2002) Effect of desloratadine versus placebo on nasal airflow and subjective measures of nasal obstruction in subjects with grass pollen induced allergic rhinitis in an allergen exposure unit. J Allergy Clin Immunol 109:956–961CrossRefPubMedGoogle Scholar
  25. 25.
    Horak F, Stuebner UP (1999) Comparative tolerability of second generation antihistamines. Drug Saf 20:385–401CrossRefPubMedGoogle Scholar
  26. 26.
    Mann RD, Pearce GL, Dunn N, et al (2000) Sedation with “non-sedating” antihistamines: four prescription-event monitoring studies in general practice. Br Med J 320:1184–1186CrossRefGoogle Scholar
  27. 27.
    Gonzalez MA, Estes KS (1998) Pharmacokinetic overview of oral second-generation H 1 anti-histamines. Int J Clin Pharmacol Ther 36:292–300PubMedGoogle Scholar
  28. 28.
    Devillier P, Bousquet J (2007) Inhibition of the histamine-induced weal and flare response: a valid surrogate measure for antihistamine clinical efficacy? Clin Exp Allergy 37:400–414CrossRefPubMedGoogle Scholar
  29. 29.
    Plaut M, Valentine MD (2005) Clinical practice. Allergic rhinitis. N Engl J Med 353:1934–1944CrossRefPubMedGoogle Scholar
  30. 30.
    Horak F, Stübner P, Zieglmayer R, et al (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 22:151–157CrossRefPubMedGoogle Scholar
  31. 31.
    Drouin MA, Yang WH, Horak F (1995) Faster onset of action with topical levocabastine than with oral cetirizine. Mediators Inflamm 44:5–10CrossRefGoogle Scholar
  32. 32.
    Horak F, Jäger S, Toth J, et al (1994) Azelastine in pollen-induced allergic rhinitis. A pharma-codynamic study of action and efficacy. Drug Invest 7:34–40Google Scholar
  33. 33.
    Noble S, Mc Tavish D (1995) Levocabastine. An update of its pharmacology, clinical efficacy and tolerability in the topical treatment of allergic rhinitis and conjunctivitis. Drugs 50:1032–1049Google Scholar
  34. 34.
    Mc Neeley W, Wiseman LR (1998) Intranasal azelastine. A review of its efficacy in the management of allergic rhinitis. Drugs 56:91–114Google Scholar
  35. 35.
    Crampton HJ (2003) Comparison of ketotifen fumerate ophthalmic solution alone, deslorata-dine alone, and their combination for inhibition of the signs and symptoms of seasonal allergic rhinoconjunctivitis in the conjunctival allergen challenge model: A double-masked, placeboand active-controlled trial. Clin Ther 25:1975–1987CrossRefPubMedGoogle Scholar
  36. 36.
    Corren J, Storms W, Azelastine Cetirizine Trial No. 1 (ACT 1) Study Group (2005) Effevtiveness of azelastine nasal spray compared with oral cetirizine in patients with seasonal allergic rhinitis. Clin Ther 27(5):543–553CrossRefPubMedGoogle Scholar
  37. 37.
    Berger WE, White MV (2003) Efficacy of azelastine nasal spry in patients with an unsatisfactory response to loratadine. Ann Allergy Asthma Immunol 91:205–211PubMedGoogle Scholar
  38. 38.
    Laforce CF, Corren J, Wheeler WJ, et al (2004) Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients whose symptoms remain after treatment with fexofenadine. Ann Allergy Asthma Immunol 93:154–159PubMedGoogle Scholar
  39. 39.
    Yanez A, Rodrigo GJ (2002) Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: A systematic review with meta-analysis. Ann Allergy Asthma Immunol 89:479–484PubMedCrossRefGoogle Scholar
  40. 40.
    Fokkkens WJ, Godthelp T, Holm AF, et al (1998) Local corticosteroid treatment: The effect on cells and cytokines in nasal allergic inflammation. Am J Rhinol 12:21–26CrossRefGoogle Scholar
  41. 41.
    Weiner JM, Abramson MJ, puy RM (1998) Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: Systematic review of randomised controlled trials. BMJ 317:1624–1629PubMedGoogle Scholar
  42. 42.
    Jen A, Baroody F, De Tineo M, et al (2000) As-need use of fluticasone propionate nasal spray reduces symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol 105:732–738CrossRefPubMedGoogle Scholar
  43. 43.
    Graft D, Aaronson D, Chervinsky P, et al (1996) A placebo- and active-controlled randomized trial of prophylactic treatment of seasonal allergic rhinitis with mometasone fuorate aqueous nasal spray. J Allergy Clin Immunol 98:724–731CrossRefPubMedGoogle Scholar
  44. 44.
    Fokkens WJ, Cserhati E, Dos Santos JM, et al (2002) Budesonide queousus nasal spray is an effective treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours. Ann Allergy Asthma Immunol 89:279–284PubMedCrossRefGoogle Scholar
  45. 45.
    Lumry WR (1999) A review of the preclinical and clinical data of newer intranasal steroids used in the treatment of allergic rhinitis. J Allergy Clin Immunol 104:150–158CrossRefGoogle Scholar
  46. 46.
    Trangsrud AJ, Whitaker AL, Small RE (2002) Intranasal corticosteroids for allergic rhinitis. Pharmacotherapy 22:1458–1467CrossRefPubMedGoogle Scholar
  47. 47.
    Szelenyi I, Hochhaus G, Heer S, et al (2000) Loteprednol etabonate: A soft steroid for the treatment of allergic diseases of the airways. Drugs Today 36:313–320PubMedGoogle Scholar
  48. 48.
    Bodor N, Buchwald P (2000) Soft drug design: General principles and recent applications. Med Res Rev 20:58–101CrossRefPubMedGoogle Scholar
  49. 49.
    Nasser SM, Ewan PW (2001) Lesson of the week: Ddepot corticosteroid treatment for hay fever causing avascular necrosis of both hips. BMJ 322:1589–1591CrossRefPubMedGoogle Scholar
  50. 50.
    Busse W, Kraft M (2005) Cysteinyl leukotrienes in allergic inflammation. Strategic target for therapy. Chest 127:1312–1326Google Scholar
  51. 51.
    Haberal I, Corey JP (2003) The role of leukotrienes in nasal allergy. Otolaryngol Head Neck Surg 129:274–279CrossRefPubMedGoogle Scholar
  52. 52.
    Shahab R, Phillips DE, Johnes AS (2004) Prostaglandins, leukotrienes and perennial rhinitis. J Laryngol Otol 118:500–507CrossRefPubMedGoogle Scholar
  53. 53.
    Turner P, Dear J, Scadding G, et al (2001) Role of kinins in seasonal allergic rhinitis: Icatibant, a bradykinin B2 receptor antagonist, abolished the hyperresponsiveness and nasal eosino-philia induced by antigen. J Allergy Clin Immunol 107:105–113CrossRefPubMedGoogle Scholar
  54. 54.
    Lipworth BJ (1999) Leukotriene-receptor antagonists. Lancet 353:57–62CrossRefPubMedGoogle Scholar
  55. 55.
    Philip G, Malmstrom K, Hampel FC, et al (2002) Montelucast for treating seasonal allergic rhinitis: A randomized, double-blind, placebo-controlled trial performed in the spring. Clin Exp Allergy 32:1020–1028CrossRefPubMedGoogle Scholar
  56. 56.
    Currie GP, Srivastava P, Dempsey OJ, et al (2005) Therapeutic modulation of allergic airways disease with leukotrien receptor antagonists. Q J Med 98:171–182Google Scholar
  57. 57.
    Nayak AS, Philip G, Lu S, et al (2002) Efficacy and tolerability of montelukast alone or in combination with loratadine in seasonal allergic rhinitis: A multicenter, randomized, doubleblind, placebo controlled trial performed in fall. Ann Allergy Asthma Immunol 88:592–600PubMedCrossRefGoogle Scholar
  58. 58.
    Meltzer EO, Malmstrom K, Lu S, et al (2000) Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: Aa randomized, placebo-controlled clinical trial. J Allergy Clin Immunol 105:917–922CrossRefPubMedGoogle Scholar
  59. 59.
    Keskin O, Alyamac E, Tuncer A, et al (2006) Do the leukotriene receptor antagonists work in children with grass pollen-induced allergic rhinitis? Pediatr Allergy Immunol 17:259–268CrossRefPubMedGoogle Scholar
  60. 60.
    Pawankar R (2003) Exploring the role of leukotriene receptor antagonists in the management of allergic rhinitis and comorbid asthma. Clin Exp Allergy Rev 3:74–80CrossRefGoogle Scholar
  61. 61.
    Bousquet J, Chanal I, Alquie MC, et al (1993) Prevention of pollen rhinitis symptoms: Comparison of fluticasone propionate aqueous nasal spray and disodium cromoglycate aqueous nasal spray. A multicenter, double-blind, double-dummy, parallel-group study. Allergy 48:327–333CrossRefPubMedGoogle Scholar
  62. 62.
    Bousquet J, van Cauwenberge P, Khaltaev N (2004) ARIA in the pharmacy: Management of allergic rhinitis symptoms in the pharmacy. Allergy 59:373–387CrossRefGoogle Scholar
  63. 63.
    Hadley JA (2003) Cost-effective pharmacotherapy for inhalant allergic rhinitis. Otolaryngol Clin North Am 36:825–836CrossRefPubMedGoogle Scholar
  64. 64.
    Easthope S, Jarvis B (2001) Omalizumab. Drugs 61:253–260CrossRefPubMedGoogle Scholar
  65. 65.
    Jardieu PM, Fick RB (1999) IgE inhibition as a therapy for allergic disease. Int Arch Allergy Immunol 118:112–115CrossRefPubMedGoogle Scholar
  66. 66.
    Bez C, Schubert R, Kopp M, et al (2004) Effect of anti-immunoglobulinE on nasal inflammation in patients with seasonal allergic rhinoconjunctivitis. Clin Exp Allergy 34:1079–1085CrossRefPubMedGoogle Scholar
  67. 67.
    Holgate ST, Corne J, Jardieu P, et al (1998) Treatment of allergic disease with anti-IgE. Allergy 53(suppl 45):83–88CrossRefPubMedGoogle Scholar
  68. 68.
    Casale TB, Bernstein IL, Busse WW, et al (1997) Use of an anti-IgE humanized monoclonal antibody in ragweed-induced allergic rhinitis. J Allergy Clin Immunol 100:110–121CrossRefPubMedGoogle Scholar
  69. 69.
    Adelroth E, Rak S, Haahtela T, et al (2000) Recombinant humanized mAb-E25, and anti-IgE mAb, in birch pollen-induced seasonal allergic rhinitis. J Allergy Clin Immunol 106:253–259CrossRefPubMedGoogle Scholar
  70. 70.
    Van Cauwenberge P, Bachert C, Passalacqua G, et al (2000) Consensus statement on the treatment of allergic rhinitis. European Acad Allergol Clin Immunol Allergy 55:116–134CrossRefGoogle Scholar
  71. 71.
    Storms WW (2004) Pharmacologic approaches to daytime and night time symptoms of allergic rhinitis. J Allergy Clin Immunol 114:146–153CrossRefGoogle Scholar
  72. 72.
    Scadding GK (1995) Rhinitis medicamentosa. Clin Exp Allergy 25:391–394CrossRefPubMedGoogle Scholar
  73. 73.
    Beck RA, Mercado DL, Seguin SM, et al (1992) Cardiovascular effects of pseudoephedrine in medically controlled hypertensive patients. Arch Intern Med 152:1242–1245CrossRefPubMedGoogle Scholar
  74. 74.
    Bradley JG (1991) Nonprescription drugs and hypertension. Which ones affect blood pressure? Postgrad Med 89:195–202PubMedGoogle Scholar
  75. 75.
    Zieglmayer UP, Horak F, Toth J, et al (2005) Efficacy and safety of an oral formulation of cetirizine and prolonged-release pseudoephedrine versus budesonide nasal spray in the management of nasal congestion in allergic rhinitis. Treat Respir Med 4:283–287CrossRefPubMedGoogle Scholar
  76. 76.
    Horak F, Toth J, Marks B, et al (1998) Efficacy and safety relative to placebo of an oral formulation of cetirizine and sustained-release pseudoephedrine in the management of nasal congestion. Allergy 53:849–856CrossRefPubMedGoogle Scholar
  77. 77.
    Hendeles L, Hatton RC (2006) Oral phenylephrine: an ineffective replacement for pseu-doephedrine? J Allergy Clin Immunol. 118: 279–280CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  1. 1.Ear Nose and Throat DepartmentAllergy Centre Vienna West, Medical University ViennaViennaAustria

Personalised recommendations