Abstract
Allergic rhinitis affects 20 to 30% of adults in both the United States and Europe and perhaps a somewhat higher percentage of children. In addition to nasal and ocular symptoms directly related to the allergic process, interference of these symptoms with sleep leads to daytime sleepiness and impaired quality of life. Patients miss work because of symptoms but an even greater problem is interference with work productivity, or presenteeism, which has been reported to be the biggest contributor to the total economic cost of allergic rhinitis. There has been increasing awareness that many patients with either seasonal or perennial symptoms but negative skin and in vitro tests for allergen sensitivity have local nasal allergy, diagnosable by the presence of allergen-specific IgE in their nasal secretions or a positive nasal allergen challenge or both. The pharmaceutical management of allergic rhinitis rests on symptomatic treatment with antihistamines that perhaps are more effectively administered intranasally than orally and intranasal corticosteroids. Allergen immunotherapy is very effective, even for local allergic rhinitis, and the shortcomings of subcutaneous immunotherapy of inconvenience and safety are reduced by the introduction of sublingual immunotherapy (SLIT). Use of the latter is currently somewhat limited by the lack of appropriate dosing information for SLIT liquids and the limited number of allergens for which SLIT tablets are available.
Highlights
Allergic rhinitis (AR) is a common condition
This study found similar nasal leukocyte-lymphocyte profiles in both sets of rhinitis patients, which were different from that of controls
The patients with local AR (LAR) in this study demonstrated a significant worsening of their rhinitis over time and this was clinically relevant and associated with development of asthma[34]
Summary
Allergic rhinitis (AR) is a common condition. Estimates of its prevalence vary widely but good epidemiologic studies suggest that 20 to 30% of adults and up to 40% of children are affected[1]. Both of these forms of AIT involve several years of treatment to produce lasting results and in many patients this leads to poor adherence with the treatment program[81]. Abbreviations AIT, allergy immunotherapy; AR, allergic rhinitis; ARC, allergic rhinoconjunctivitis; ARIA, Allergic Rhinitis and its Impact on Asthma; CAM, complementary and alternative medicine; D. pt., Dermatophagoides pteronyssinus; FDA, US Food and Drug Administration; HDM, house dust mite; INSS, individual nasal symptom score; IR, idiopathic rhinitis; LAR, local allergic rhinitis; NAPT, nasal allergen provocation test; NAR, non-allergic rhinitis; PAR, perennial allergic rhinitis; PNAR, perennial non-allergic rhinitis; SAR, seasonal allergic rhinitis; SCIT, subcutaneous immunotherapy; sIgE, specific IgE; SLIT, sublingual immunotherapy; SR, systematic review; TRAE, treatment-related adverse event. Grant information The author(s) declared that no grants were involved in supporting this work
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