Current Treatment Approaches for Allergic Rhinitis

Allergic rhinitis (AR) is an intermitting or persisting infl ammation of upper airway mucosa that
accompanied with following typical symptoms: nasal congestion and rhinorrhea, pruritus,
sneezing. Sometimes symptoms are combined. More than 70% of patients report the AR impact on
professional activity and decrease of learning ability and about 90% of patients report the impact
on quality of life.
AR is based on Ig-E-dependent reaction of mucosa to direct contact stimulation by allergens. The
fi rst phase of the disease is characterized by immediate Ig-E-mediated response of mast cells that
manifests in histamine-mediated eff ects. The second, late phase is characterized by persistent
allergic infl ammation.
The understanding of main AR pathophysiological mechanisms is key to the eff ectiveness of therapy.
Avoidance of exposure to allergen is an etiotropic therapy and recommended for all patients without
exceptions. Complex interactions of above mentioned mechanisms defi ne multilevel algorithm of
pathogenetic AR therapy and targeting the key points of infl ammatory pathway accordingly to
phase of immune response.
The fi rst line therapy of the early phase of disease are drugs that mitigate excessive histamine
release and consequent damaging eff ects on targeted organs. These drugs fi rst of all include
antihistamines that bind to histamine receptors on concurrent basis. The late phase needs complex
therapies aff ecting multiply pathogenetic points involved in activation of allergic infl ammation.
At this stage intranasal corticosteroids are the drugs of choice. In case of poor clinical response
to combination therapy antagonists of leukotriene receptors should be administered and other
additional therapies should be considered. Specifi c immunotherapy possesses a distinct position in
AR treatment. Surgical intervention is indicated for only specifi c group of patients with AR and the
main purpose is restoration of nasal breathing.
The article reviews key principles of diff erent drug therapies application in AR treatment algorithm
according to international guidelines.