Abstract
Background: The pathogenesis of vasomotor rhinitis is not understood. It is unlikely that antihistamines, based on their H1 antagonist activity alone, would be effective in this disorder.Methods: Nonetheless, at least one double-blind, placebo-controlled multicenter trial has found that intranasal azelastine relieves symptoms of this disorder better than placebo. The mechanism responsible for its beneficial effect in nonallergic rhinitis is unclear but probably relates to "anti-inflammatory/antiallergic" activities.Results: Such mechanisms have been demonstrated for a number of different oral antihistamines, but often the concentrations required in vitro are higher than those that are normally achieved in vivo using recommended dosing. It has been postulated that intranasal administration, which can achieve high local levels, might be a factor responsible for enhancing the "anti-inflammatory/antiallergic" properties.Conclusions: Interpreting this information allows one to conclude that antihistamines may be potentially effective agents in vasomotor rhinitis, and are more likely to be so when administered intranasally, despite the fact that data documenting this beneficial effect are sparse.
Highlights
BackgroundIt is unlikely that antihistamines, based on their H1 antagonist activity alone, would be effective in this disorder
Perhaps the best way to introduce the topic of the role of antihistamines in the management of vasomotor rhinitis is to quote a statement from the ARIA Workshop Reports.[1]
Improvements were noted in sneezing and rhinorrhea, prompting the authors to conclude that loratadine “improves the effectiveness of flunisolide in treatment of nonallergic rhinitis with eosinophilia (NARES).”
Summary
It is unlikely that antihistamines, based on their H1 antagonist activity alone, would be effective in this disorder. The mechanism responsible for its beneficial effect in nonallergic rhinitis is unclear but probably relates to “anti-inflammatory/antiallergic” activities. It has been postulated that intranasal administration, which can achieve high local levels, might be a factor responsible for enhancing the “anti-inflammatory/antiallergic” properties. Conclusions: Interpreting this information allows one to conclude that antihistamines may be potentially effective agents in vasomotor rhinitis, and are more likely to be so when administered intranasally, despite the fact that data documenting this beneficial effect are sparse. Presented at a roundtable conference held in December 2008 in Washington, DC. The meeting was sponsored by the TREAT Foundation (Washington, DC) and supported through an unrestricted educational grant from Meda Pharmaceuticals. Correspondence to: Phil Liberman, MD, Clinical Professor of Medicine and Pediatrics, Division of Allergy and Immunology, Departments of Medicine and Pediatrics, University of Tennessee, Memphis, 7205 Wolf River Boulevard, Suite 200, Germantown, TN 38138
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