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Abstract

We are grateful for the opportunity to address the interesting comments made by Dr Lipworth and colleagues1Lipworth BJ Lee DKC Jackson CM Decongestant effects of antihistamines: a class effect?.J Allergy Clin Immunol. 2003; 111: 653Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar regarding our study of the effects of desloratadine and placebo on nasal airflow, nasal congestion symptoms, and other seasonal allergic rhinitis symptoms induced by grass pollen in an allergen exposure unit.2Horak F Stubner UP Zieglmayer R Harris AG 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. 2002; 109: 956-961Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar It was not our intention to infer uniqueness regarding the properties of desloratadine in terms of nasal congestion. Rather, we simply restated the classical view that although antihistamines have universal efficacy in controlling sneezing, nasal itching, and rhinorrhea, many have poor efficacy against nasal congestion.3Gentile DA Friday GA Skoner DP Management of allergic rhinitis: antihistamines and decongestants.Immunol Allergy Clin North Am. 2000; 20: 355-368Abstract Full Text Full Text PDF Scopus (21) Google Scholar Our study was performed to assess whether the effect of desloratadine on improving patient-reported nasal congestion in placebo-controlled clinical trials was accompanied by objectively measured improvements in nasal airflow. We used active anterior rhinomanometry to assess nasal airflow dynamics because it is a reliable and validated measure for which normal ranges are published4Schumacher MJ Nasal congestion and airway obstruction: the validity of available objective and subjective measures.Curr Allergy Asthma Rep. 2002; 2: 245-251Crossref PubMed Scopus (38) Google Scholar and that is recognized as an appropriate objective standard.5Malm L Gerth van Wijk R Bachert C Guidelines for nasal provocations with aspects on nasal patency, airflow, and airflow resistance. International Committee on Objective Assessment of the Nasal Airways, International Rhinologic Society.Rhinology. 2000; 38: 1-6PubMed Google Scholar Using anterior active rhinomanometry, we have demonstrated effects on nasal airflow with desloratadine (reproducibly),6Horak F Stübner P Zieglmayer R Harris AG Desloratadine reduces nasal congestion and maintains nasal airflow in patients with seasonal allergic rhinitis exposed to allergen in the Vienna challenge chamber.Allergy. 2001; 56: 281Google Scholar azelastine,7Horak F Jäger S Toth J Berger U Nirnberger G Azelastine in pollen-induced allergic rhinitis.Drug Invest. 1994; 7: 34-40Crossref Scopus (11) Google Scholar and astemizole,8Horak F Toth J Jager S Berger U Effects of H1-receptor antagonists on nasal obstruction in atopic patients.Allergy. 1993; 48: 226-229Crossref PubMed Scopus (25) Google Scholar but not with other antihistamines, including cetirizine and fexofenadine.9Horak F Stubner P Zieglmayer R Kavina A De Vos C Burtin B et al.Controlled comparison of the efficacy and safety of cetirizine 10 mg o.d. and fexofenadine 120 mg o.d. in reducing symptoms of seasonal allergic rhinitis.Int Arch Allergy Immunol. 2001; 125: 73-79Crossref PubMed Scopus (66) Google Scholar We acknowledge the recent study by Dr Lipworth's group that demonstrated that 5 mg of desloratadine and 180 mg of fexofenadine significantly improved nasal airflow measured on the basis of domiciliary nasal peak inspiratory flow and nasal congestion symptom severity compared with placebo.10Wilson AM Haggart K Sims EJ Lipworth BJ Effects of fexofenadine and desloratadine on subjective and objective measures of nasal congestion in seasonal allergic rhinitis.Clin Exp Allergy. 2002; 32: 1504-1509Crossref PubMed Scopus (69) Google Scholar We agree that the subjective relief of nasal congestion reported by patients should be complemented by objective measurements of nasal airflow.