Immunotherapy in Mixed Rhinitis: Is it Effective Compared to Use in Allergic Rhinitis?

Abstract

RationaleImmunotherapy (IT) is an effective therapeutic option for patients with allergic rhinitis (AR). However, approximately 50% of AR patients report significant non-allergic triggers, termed mixed rhinitis (MR). Mixed rhinitis is often more difficult to treat. The purpose of this study was to compare the efficacy of IT between AR and MR patients.MethodsA historical prospective cohort study design was employed. Medical records were reviewed from an academic allergy practice to identify AR patients who started IT in 2001. One reviewer compiled data through chart review using a standardized form, including allergic and non-allergic triggers, symptoms, and medications at the onset and after completion of ≥3 years of IT. The relationship between rhinitis subtype and outcomes including changes in symptoms and medication use was analyzed.ResultsAmong 98 patients enrolled, 65 (66%) were classified as MR based on having at least one non-allergic trigger. Patients were predominantly Caucasian (n = 83, 85%) and male (n = 55, 56%). No significant differences in symptom status were found. After a full course of IT, all patients had decreased use of antihistamines, decongestants, and nasal corticosteroids (p < 0.02); AR patients had a greater reduction in nasal corticosteroid use compared to MR patients (p = 0.049, OR 0.25, 95% CI 0.065-0.99). Furthermore, 20.4% of MR patients required 3 or more medications after completing IT compared to 4% of AR patients (p = 0.025).ConclusionsImmunotherapy is effective in decreasing medication use in both AR and MR patients. Despite this overall efficacy, MR patients require more medication after completing IT to maintain symptom control. RationaleImmunotherapy (IT) is an effective therapeutic option for patients with allergic rhinitis (AR). However, approximately 50% of AR patients report significant non-allergic triggers, termed mixed rhinitis (MR). Mixed rhinitis is often more difficult to treat. The purpose of this study was to compare the efficacy of IT between AR and MR patients. Immunotherapy (IT) is an effective therapeutic option for patients with allergic rhinitis (AR). However, approximately 50% of AR patients report significant non-allergic triggers, termed mixed rhinitis (MR). Mixed rhinitis is often more difficult to treat. The purpose of this study was to compare the efficacy of IT between AR and MR patients. MethodsA historical prospective cohort study design was employed. Medical records were reviewed from an academic allergy practice to identify AR patients who started IT in 2001. One reviewer compiled data through chart review using a standardized form, including allergic and non-allergic triggers, symptoms, and medications at the onset and after completion of ≥3 years of IT. The relationship between rhinitis subtype and outcomes including changes in symptoms and medication use was analyzed. A historical prospective cohort study design was employed. Medical records were reviewed from an academic allergy practice to identify AR patients who started IT in 2001. One reviewer compiled data through chart review using a standardized form, including allergic and non-allergic triggers, symptoms, and medications at the onset and after completion of ≥3 years of IT. The relationship between rhinitis subtype and outcomes including changes in symptoms and medication use was analyzed. ResultsAmong 98 patients enrolled, 65 (66%) were classified as MR based on having at least one non-allergic trigger. Patients were predominantly Caucasian (n = 83, 85%) and male (n = 55, 56%). No significant differences in symptom status were found. After a full course of IT, all patients had decreased use of antihistamines, decongestants, and nasal corticosteroids (p < 0.02); AR patients had a greater reduction in nasal corticosteroid use compared to MR patients (p = 0.049, OR 0.25, 95% CI 0.065-0.99). Furthermore, 20.4% of MR patients required 3 or more medications after completing IT compared to 4% of AR patients (p = 0.025). Among 98 patients enrolled, 65 (66%) were classified as MR based on having at least one non-allergic trigger. Patients were predominantly Caucasian (n = 83, 85%) and male (n = 55, 56%). No significant differences in symptom status were found. After a full course of IT, all patients had decreased use of antihistamines, decongestants, and nasal corticosteroids (p < 0.02); AR patients had a greater reduction in nasal corticosteroid use compared to MR patients (p = 0.049, OR 0.25, 95% CI 0.065-0.99). Furthermore, 20.4% of MR patients required 3 or more medications after completing IT compared to 4% of AR patients (p = 0.025). ConclusionsImmunotherapy is effective in decreasing medication use in both AR and MR patients. Despite this overall efficacy, MR patients require more medication after completing IT to maintain symptom control. Immunotherapy is effective in decreasing medication use in both AR and MR patients. Despite this overall efficacy, MR patients require more medication after completing IT to maintain symptom control.