In addition to the introduction of several new pharmacologic agents, two of the most significant recent developments in the management of allergic rhinitis have been the renewed emphasis on preventive measures, such as allergen avoidance and immunotherapy, and the importance of performing an accurate differential diagnosis of the disease. Recently, these evolving management trends were delineated in an algorithm proposed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, which suggests that an initial evaluation be performed by a primary care physician. Based on findings at the initial evaluation, the patient should be treated either empirically in the primary care setting or referred to an allergist-immunologist for consultation. The allergist uses an evidence-based therapeutic approach based on a differential diagnosis of the type of rhinitis, which uses information derived from a detailed medical history, physical examination of the airway, and ancillary tests, particularly skin tests. Rhinitis management by an allergist emphasizes a three-pronged approach that incorporates avoidance, immunotherapy, and pharmacologic therapy. However, because both avoidance and immunotherapy have their limitations, pharmacologic therapy remains the mainstay of rhinitis management, and allergists usually recommend that optimal first-line therapy be broad based and capable of safely alleviating the symptoms of both allergic and nonallergic disease. First generation oral antihistamines, topical corticosteroids and the topical antihistamine azelastine are the most broad-based treatments available. Second-generation oral antihistamines and leukotriene antagonists also are useful in treating allergic rhinitis.
Document Type: Regular Paper
Publication date: July 1, 2001
More about this publication?
Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.
The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.
Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.
Articles marked "F" offer free full text for personal noncommercial use only.