Treatment Of Nonallergic Rhinitis Research Articles

Effectiveness of Kinetic Oscillation Stimulation Treatment in Persistent Moderate-severe Allergic Rhinitis Compared to Medical Therapy

Introduction: KOS represent an innovative non-surgical solution developed at the Karolinska University Hospital in Stockholm (Sweden) which consists of a intranasal stimulation via an air inflated catheter indicated to treat non allergic rhinitis and migraine. The KOS method for rhinitis has proved to be so effective as it simultaneously stimulates the nasal mucosa and the local autonomic nervous system, which represents the predisposing ultrastructural factor and is able to maintain the neurogenic inflammation responsible for the nasal symptoms of chronic rhinitis, very disabling for the quality of life of rhinitic patients. We wanted to verify whether the positive results obtained in the treatment of non-allergic rhinitis that we observed in our previous study could also be obtained in patients with allergic rhinitis, who similarly share many of the nasal symptoms. Materials and Methods: A total of 110 patients (63 males), aged >18 years, consecutively enrolled, all undergoing complete ENT evaluation with physical clinical examination, endoscopy, nasal symptoms VAS and SNOT-22 questionnaire, affected by allergic rhinitis (AR) persistent moderate-to-severe grade. All patients were alternately assigned to 2 homogeneous groups (Group A: Control Subjects, Group B: KOS Treated Patients), each group included 55 individuals. Simple randomization was achieved with a sequence of random numbers from a computer-generated sequence. During the study, both groups received standard medications (Ebastine tablet 10 mg and Mometasone furoate nasal spray 50 mcg/actuation per nostril per day) for 90 days. At the beginning of medical treatment, group B patients underwent first KOS treatment (repeated after 20 days). Both groups were asked to report any side effects during the study. Results: The treated patients already benefited immediately after the extraction of the balloon reporting a sensation of a more patent nose and reduction of nasal secretions which progressively improves in the following days. For the subjective complaints (nasal obstruction, sneezing, rhinorrhea, and itching), the improvement was significant within each group, with the most significant improvements in treatment group B. When the KOS treatment group was compared with medical treatment alone (Group A), greater efficacy was observed in Group B with regards to the reduction of nasal symptoms and nasal endoscopic findings. Regarding the objective results (rhinomanometric assessments), similar trends, such as subjective ones, were observed within each group. The improvements within each treatment group were significant without side effects. Comparison between Groups A and B, before and after treatment, with the SNOT-22 questionnaire relating to the 5 most important questions (5 most important items) showed an improvement in both study groups but with better results, however regards efficacy, in Group B. Discussion: Our results reveal a greater efficacy achieved using a combined approach, with the association between medical treatment and KOS, compared to medical treatment alone, in the control of the sympotms of AR associated with hypertrophy of the inferior turbinates. The symptoms evaluated by VAS showed greater efficacy in their control in those patients in treatment group B, in particular those patients who had undergone treatment with KOS presented objective parameters (AAR, endoscopic score) and SNOT-22 better than the group receives only medical care. Conclusion: KOS treatment, in combination with medical therapy, improves nasal flow more effectively than medical treatment alone in persistent moderate to severe AR. In particular, the local nasal symptoms were significantly reduced. Patients undergoing the KOS treatment report improvement in their nasal rhinitis symptoms within a few days, which improve further, also in our experience, after a second boost application.

Intranasal antihistamines in the treatment of idiopathic non-allergic rhinitis: a systematic review and meta-analysis.

Idiopathic rhinitis (IR), previously known as vasomotor rhinitis (VMR), is the most common type of non-allergic rhinitis (NAR) which affects around 100 million people worldwide. The treatment of patients with IR is not standardized. Intranasal antihistamines (INAH) are potent drugs in the treatment of allergic rhinitis but are frequently prescribed in the treatment of IR. This systematic review of the literature and meta-analysis aims to assess the effects of INAH on IR. A comprehensive review of the literature was conducted on Medline, Embase and Cochrane library. Randomized, controlled trials and non-randomized comparative parallel group trials comparing INAH to placebo or different INAHs were included. The primary outcome was the change in disease specific quality of life questionnaires, total nasal symptom score (TNSS). The secondary outcomes were other reported nasal symptom scores, individual symptom scores and adverse events. Six trials out of 987 assessing a total of 675 participants were deemed relevant for inclusion. Compared to placebo, INAH decreased total nasal symptom scores. One study also reported reduction of symptoms recorded on a visual analogue scale. There was no difference between the INAHs in terms of efficacy. Bitter taste sensation was the most frequently reported adverse event. INAHs seem to have benefit over placebo on nasal symptoms improvement in the treatment of NAR. No superiority between INAHs was identified.

Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis.

Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%–89% of the chronic rhinitis cases, affecting 1%–50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%–67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.

Diagnosis and management of nonallergic rhinitis with eosinophilia syndrome using cystatin SN together with symptoms

BackgroundThe diagnosis and treatment of nonallergic rhinitis with eosinophilia syndrome (NARES) remain controversial. The aim of this study was to evaluate whether Cystatin SN together with symptoms can be used to diagnose NARES and to measure the efficiency of medical treatment. MethodsSeventy-five patients with chronic rhinitis (CR) and 18 control subjects were enrolled. Their clinical characteristics were reviewed and laboratory parameters were evaluated. The concentration of Cystatin SN in nasal secretions was determined using the enzyme-linked immunosorbent assay. The histological assessment of Cystatin SN in the nasal mucosa was conducted by hematoxylin and eosin staining. The logistic regression and receiver operating characteristic curves were used to assess the predictive value of parameters for NARES. ResultsNasal obstruction, sneezing, loss of smell, and total visual analogue scale (VAS) score were significantly different among the patients with CR. In particular, olfaction score was higher in patients with NARES than in those without NARES (AR, LAR, or IR). Similarly, the Cystatin SN level was significantly different between the control subjects and patients with CR. After treatment for 2 weeks, the Cystatin SN level and VAS score were significantly decreased in the NARES group. The accuracy of Cystatin SN together with local sIgE and loss of smell to diagnose NARES was up to 0.987 (sensitivity, 100%; specificity, 93.1%). ConclusionsCystatin SN with local sIgE and loss of smell may serve as one of the reliable and alternative biomarkers for the diagnosis of NARES and be used to evaluate disease severity and NARES treatment efficacy.

Is capsaicin an effective treatment of nonallergic rhinitis?

Is capsaicin an effective treatment of nonallergic rhinitis?

An update regarding the treatment of nonallergic rhinitis.

The review presents some information on known options for treatment of nonallergic rhinitis (NAR) with introduction to new therapies. The merits and limitations of recent advancements in pharmacotherapy of this common problem are briefly discussed as well. Intranasal corticosteroids are first-line therapy for NAR. Fluticasone propionate and beclomethasone remain the only topical corticosteroids approved for NAR. The use of azelastine - another first-line option - has also been found to be effective even though NAR is a nonallergic entity by definition. Combination of fluticasone propionate and azelastine is a promising option in achieving better symptom reduction. Coadministration of intranasal corticosteroid and topical decongestants is an attractive topic that requires additional safety studies before recommending treatment. Although promising, no scientifically valid recommendation can be made for treatment of NAR with capsaicin. Surgical options in patients with refractory NAR are limited. New studies demonstrate a lack of correlation between objective outcome of radiofrequency ablation of the inferior turbinate and subjective patient symptoms. The heterogeneity in clinical presentation makes NAR treatment a daily challenge for otolaryngologists. The diversity of clinical studies with use of unique outcome measures limit systematic reviews which may be instrumental in providing strong recommendations.

Radiofrequency turbinoplasty for nonallergic rhinitis in geriatric patients.

Radiofrequency (RF) turbinoplasty may be effective in treating nonallergic rhinitis in elderly patients. The present study evaluated the efficacy of nasal turbinate surgery with RF for the treatment of nonallergic rhinitis in elderly patients refractory to medical therapy. A total of 35 consecutive patients older than 65 years of age (mean subject age, 75.5 ± 9.6 [standard deviation] years) with nonallergic rhinitis refractory to medical therapy who underwent RF turbinate surgery were enrolled in this study. The efficacy of RF turbinoplasty in treating nonallergic rhinitis in elderly patients was evaluated by using rhinoscopy and a visual analog scale score of nasal symptoms. The response rate of primary RF turbinate surgery for nonallergic rhinitis refractory to medical therapy was 68.6%. Postoperative symptom scores for rhinorrhea and nasal obstruction were significantly improved. Persistent crust formation developed in seven patients (20.0%). No patient experienced major complications (e.g., septal hematoma, abscess, septal perforation), but partial bone necrosis was observed in one patient. RF turbinoplasty appeared to be effective for treating some nonallergic rhinitis symptoms in elderly patients, including rhinorrhea and nasal obstruction. These preliminary results are encouraging and warrant further investigation.

Capsaicin for non-allergic rhinitis.

There are many forms of rhinitis. Patients are diagnosed with non-allergic rhinitis when anatomic, infectious and allergic aetiologies have been excluded. The symptoms, including nasal congestion, blockage or obstruction, clear rhinorrhoea, sneezing and, less frequently, nasal itching, can range from mild to debilitating. It affects between 25% and 50% of patients with rhinitis. Several medications are widely used in the treatment of non-allergic rhinitis, including oral and topical nasal antihistamines, intranasal and (rarely) systemic corticosteroids, and anticholinergics. Capsaicin, the active component of chili peppers, delivered intranasally, is considered a treatment option for non-allergic rhinitis. To assess the effectiveness of capsaicin in the management of non-allergic rhinitis compared with no therapy, placebo or other topical or systemic medications, or two or more of the above therapies in combination, or different capsaicin regimens. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 24 June 2015. Randomised controlled trials in adult patients with non-allergic rhinitis comparing intranasal capsaicin with no therapy, placebo or other topical or systemic medications, or their combinations. We used the standard methodological procedures expected by The Cochrane Collaboration. We included four studies (five publications) involving 302 participants with idiopathic non-allergic rhinitis. All the included studies described patients with moderately severe, idiopathic non-allergic rhinitis who were between the ages of 16 and 65. Studies had follow-up periods ranging from four to 38 weeks. The overall risk of bias in the studies was either high or unclear (two studies had overall high risk of bias, while two others had low to unclear risk of bias). Using the GRADE system we assessed the evidence as being of low to moderate quality. A meta-analysis was not possible, given lack of similarity of the reported outcomes.Two studies compared capsaicin with placebo. One study reported that capsaicin resulted in an improvement of overall nasal symptoms (a primary outcome) measured on a visual analogue scale (VAS) of 0 to 10. There was a mean difference (MD) of -3.34 (95% confidence interval (CI) -5.24 to -1.44), MD -3.73 (95% CI -5.45 to -2.01) and MD -3.52 (95% CI -5.55 to -1.48) at two, 12 and 36 weeks post-treatment, respectively. Another study reported that, compared to placebo, capsaicin (at 4 µg/puff) was more likely to produce overall symptom resolution (reduction in nasal blockage, sneezing/itching/coughing and nasal secretion measured with a daily record chart) at four weeks post-treatment (a primary outcome). The risk ratio (RR) was 3.17 (95% CI 1.38 to 7.29).One study compared capsaicin to budesonide (an intranasal corticosteroid). This study found that patients treated with capsaicin had a better overall symptom score compared to those treated with budesonide (MD 2.50, 95% CI 1.06 to 3.94, VAS of 0 to 10). However, there were no differences in the individual symptom scores for headache, postnasal drip, rhinorrhoea, nasal blockage, sneezing and sore throat assessed during the last three days of a four-week treatment.One study compared two different regimens of capsaicin administration: five treatments in one day versus five treatments given every two to three days during two weeks. Using daily record charts, the study reported significant improvement of individual symptom scores for rhinorrhoea in patients treated five times per day, however numerical data were not presented. There were no improvements in the other outcomes: rhinorrhoea, nasal obstruction, sneezing and overall nasal symptoms, measured on a VAS.Finally, one of these studies also compared three doses of capsaicin (to placebo). Patients treated with a 1 µg versus 4 µg per puff dose of capsaicin had a worse daily record chart overall symptom score resolution (RR 0.63, 95% CI 0.34 to 1.16).Only one study attempted to measure adverse effects (a primary outcome), however due to methodological issues with the assessment we are unable to draw any conclusions.We sought to include other secondary outcomes (e.g. quality of life measures, treatment dropouts, endoscopic scores, turbinate or mucosal size, cost of therapy), but none of these were measured or reported in the included studies. Capsaicin may be an option in the treatment of idiopathic non-allergic rhinitis. It is given in the form of brief treatments, usually during the same day. It appears to have beneficial effects on overall nasal symptoms up to 36 weeks after treatment, based on a few, small studies (low-quality evidence). Well-conducted randomised controlled trials are required to further advance our understanding of the effectiveness of capsaicin in non-allergic rhinitis, especially in patients with non-allergic rhinitis of different types and severity, and using different methods of capsaicin application.

Clinically relevant outcome measures of novel pharmacotherapy for nonallergic rhinitis.

The purpose of this review is to briefly provide the current understanding of the pathogenesis of nonallergic rhinitis (NAR), currently available pharmacotherapies as well as some recent advancement in pharmacotherapy for this condition. With this background on NAR, we then describe and contrast outcome measures used in previous NAR and allergic rhinitis clinical trials. Finally, we conclude with a brief discussion on which of these outcomes might be most suitable for future NAR clinical trials. NAR is a heterogeneous condition in which multiple mechanisms have been postulated to be involved. Patients with NAR commonly experience chronic nasal congestion and anterior and/or posterior drainage, which significantly affects their quality of life. Current standard of care is primarily symptom based, as specific therapies that target the underlying mechanisms of this condition are lacking. As there are no current treatment algorithms for NAR, clinical response and outcomes can vary widely between patients. Intranasal corticosteroids and intranasal antihistamines have been found to be effective in well designed clinical trials in the treatment of NAR and are therefore considered first-line therapies. Recently, studies investigating a combination of intranasal antihistamine/corticosteroid and an intranasal decongestant and with an intranasal corticosteroid have shown promise for allergic rhinitis and may also be more effective than monotherapy for NAR. Multiple outcome measures have been used in previous NAR trials, the most common being variations of nasal symptoms scores. Given the differences in prominent symptoms typically experienced by allergic rhinitis and NAR, accurate clinical outcomes used to evaluate new treatments for these two patient groups will likely differ. Further studies specifically designed to investigate the efficacy of various therapeutic agents in NAR are required to improve the management and outcomes of this chronic condition. Further research is required to expand our understanding of the pathobiology of NAR that should lead to novel therapeutic approaches for managing this condition. It will be necessary to have well established validated NAR outcomes that can be used to study these novel therapies.

Kinetic oscillation stimulation as treatment of non-allergic rhinitis: an RCT study

Conclusion: Kinetic oscillation stimulation (KOS) of nasal mucosa at low frequency seems to be a possibly effective and safe short-term treatment of non-allergic nasal stuffiness. Objective: To assess the relief of rhinitis symptoms, especially stuffiness, by comparing active treatment, i.e. KOS at low frequency of the nasal mucosa, with placebo. Methods: Patients were randomized to active or placebo treatment in this double-blinded parallel design study. Treatment with an inflatable oscillating catheter was administered on day 0, and symptom scores (stuffiness, secretion, and itching) were graded daily until day 14. An overall grading of symptoms from 1 week before treatment and during 14 days thereafter was made at day 14. Eighty-six patients (52 with non-allergic perennial rhinitis, NAR; 34 with rhinitis medicamentosa, RM) were randomized, and 71 were evaluated (active treatment, n = 35; placebo, n = 36). Results: Patients with either NAR or RM who received active treatment reported reduced symptom scores by some measures, e.g. median RQSS stuffiness measure fell from 2 to 1 on a scale from 0 to 3 during the week following treatment. No significant effect was observed for patients treated with placebo. Mild side effects were reported.

Clinical study on the acupuncture of "zhibi 3" in the treatment of non-allergic rhinitis

Objective To observe the Clinical study on the acupuncture ot zhibi 3 in the treatment of non-allergic rhinitis.Methods 20 individuals over 15 years old with non-allgergic rhinitis were prospectively recruited from rhinology clinic and ward of Beijing TongRen Hospital from December 2008 to August 2009.Acupuncture points of treat nasal 3 and the compatibility of Fengchi,Hegu were performed by once a week for 7 weeks.The changes of the total nasal symptom score (TNSS) and the Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (Mini-RQLQ) were observed at baseline and recertification every week.Results After 7 weeks treatment,we found the fourth week of score in fatigue (0.5±0.2; 2.6±1.2,respectively),embarrassed (1.0±0.3; 3.7-0.3,respectively),sleep (0.8±0.1; 4.1±0.9,respectively)、the quality of life (1.0±0.4; 3.8±0.7,respectively),congestion (0.6±0.4; 2.6± 1.0,respectively),rhinorrhea (1.2±0.5; 4.4±0.7,respectively),sneezing (1.6±0.5; 5.0±0.6,respectively),nasal itching (1.7±0.6; 4.4±0.9,respectively) were significantly improved over 75％ (15/20) compared with the baseline (P＜0.05).However,at the sixth week,congestion,rhinorrhea,sneezing were recurring,especially rhinorrhea,but the benefit effects of acupuncture were more than 55％ comparing with baseline.Contusion Acupuncture of zhibi 3,and Fengchi,Hegu may have the effective effects on non-allergic rhinitis. Key words: Non-allergic rhinitis; Acupuncture ofzhibi 3; TNSS; Mini-RQLQ

Efficacy and safety of once daily triamcinolone acetonide aqueous nasal spray in adults with non-allergic and allergic rhinitis

BackgroundThe efficacy of corticosteroid has not been thoroughly studied in the treatment of non-allergic rhinitis. This study was designed to compare the efficacy of nasal corticosteroid in patients with allergic rhinitis (AR), and non-allergic rhinitis (NAR). MethodsThe efficacy of triamcinolone acetonide nasal spray (TANS) on total nasal symptom scores (TNSS), and nasal peak inspiratory flow rate (nPIFR) was studied in a six-week parallel-group trial of NAR (n: 25), and AR (n: 16) patients. Health-related quality of life (HRQoL) and Epworth Sleepiness Scale (ESS) were also analysed. ResultsThe TNSSs, and symptom scores of conjunctivitis, snoring, and postnasal drainage were significantly improved in both groups, after two and six weeks of treatment. In contrast to AR, patients with NAR had statistically significant improvement in nasal obstruction, and postnasal drainage beginning from two weeks of the treatment. nPIFR slightly increased in both groups. Scores of generic (SF-36), rhinitis specific (MiniRQLQ) and ESS questionnaires generally improved better in AR than NAR. TANS was well-tolerated in AR and NAR groups with minor adverse events including headache, nasal burning, and bitter mouth taste. ConclusionsOur study disproved the idea of ineffectiveness of corticosteroid treatment in NAR, and showed that triamcinolone acetate may be an alternative drug in the treatment of NAR.

Management of Rhinitis: Allergic and Non-Allergic

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.

Diagnosis and treatment of non-allergic rhinitis

目前,对于非变应性鼻炎（non-allergic rhinitis,NAR）的病因、发病机制等还不是十分清楚,国内还没有统一的分类、诊断和治疗的标准,国际上对NAR的分类及治疗亦有不同见解.2009年9月经本刊编辑委员会鼻科核心组专家讨论决定拟订我国 ,并进行了起草分工.但经过几次专家会议讨论,专家意见不统一,难以达成共识.

Clinical study on mometasone furoate nasal spray in the treatment of non-allergic rhinitis

To evaluate the outcome of mometasone furoate nasal spray (MFNS) used for 3 months on non-allergic rhinitis (NAR). In this multicenter study, NAR patients were enrolled from eight hospitals and received MFNS 200 microgram once daily for 3 months. The patients were followed-up for three times (at baseline, month 1 and month 3) to record the symptom scores and nasal endoscopic appearances. At the same time, the adverse events frequency was recorded and analyzed. A total of 188 NAR cases were enrolled in the study. The total nasal symptom score assessment descended significantly at month 1 (1.70 ± 0.75) and month 3 (0.95 ± 0.79) visits versus at baseline (2.67 ± 0.68, Z value were from -11.603 to -10.491, all P < 0.01). The individual symptoms, including nasal stuffiness, nasal discharge, nasal stuffiness-related dizziness or headache, hyposmia, sleep quality, daily life activity, work or study efficiency, mental status, and whole body fatigue, also showed less scores at month 1 and month 3 visits versus at baseline (Z value were from -11.313 to -6.802, all P < 0.01). At the same time, nasal mucosal appearances assessed by endoscopy had lower scores at month 1 (1.40 ± 0.62) and month 3 (0.75 ± 0.71) visits versus at baseline (2.27 ± 0.73, Z value were from -11.484 to -10.002, all P < 0.01). Additionally, adverse events were only observed in 5.3% cases with light rhinorrhagia and nasal dryness. No other side effect was found. A 3-months administration of intranasal mometasone can effectively and safely improve NAR patients' clinical symptom and nasal mucosal appearances.

Supplemental material

Olopatadine is a tricyclic compound with antihistaminic, mast cell-stabilizing, and anti-inflammatory properties. In the United States olopatadine is approved as a b.i.d. ophthalmic solution, Patanol (Alcon Laboratories, Inc., Fort Worth, TX) to treat all signs and symptoms of allergic conjunctivitis and as a q.d. formulation, Pataday (Alcon Laboratories, Inc.), to treat itching associated with allergic conjunctivitis. A nasal spray, Patanase (Alcon Laboratories, Inc.), was approved in 2008 for treatment of the symptoms of seasonal allergic rhinitis. The available data on olopatadine was assessed with regard to future uses through a comprehensive literature review and a Roundtable Discussion held at the 2009 meeting of the American Academy of Allergy Asthma and Immunology. The unique mechanisms of action of olopatadine still under study include mast cell stabilization, potent H(1)-anthistaminic activity, and anti-inflammatory effects. Data support consideration of nasal olopatadine for as-needed use for episodic symptoms of allergic rhinitis, for treatment of nonallergic rhinitis, and for use in combination with topical steroids for patients with moderate-to-severe allergy symptoms.

Local mucosal immunoglobulin E production: does allergy exist in non‐allergic rhinitis?

In this review, we critically evaluate the evidence for local IgE production in allergic rhinitis mucosa and the concept of local allergy in non-atopic idiopathic rhinitis. Significantly, fewer studies have focused on the disease pathways associated with non-allergic rhinitis compared with their allergic counterparts. Recently, there's been a revival of the hypothesis concerning the existence of local tissue-specific allergic disease confined to the nasal mucosa of some systemically non-atopic rhinitis subjects. Providing the evidence for local mucosal IgE production in allergic rhinitis is a pre-requisite to reviewing its existence in non-allergic rhinitis. In addition, practical and theoretical approaches useful in the detection of allergy in non-allergic rhinitis will be discussed. Furthermore, successful therapeutic regimens used in the treatment of non-allergic rhinitis will be examined as these could provide an insight into the underlying pathophysiology of this common but poorly understood disease.

Preclinical evidence of azelastine hydrochloride activity

Background: Second-generation antihistamines are characterized by reduced lipophilicity, large size, and extensive protein binding, with specificity for the histamine-1 (H 1) receptor. These characteristics translate into reduced penetration of the central nervous system, accounting for fewer of the dopaminergic, serotonergic, and cholinergic side effects associated with the firstgeneration antihistamines. Azelastine hydrochloride is the only topically administered antihistamine currently approved in the United States for use in both allergic (seasonal) and nonallergic (vasomotor) rhinitis. Objective: The purpose of this report is to review evidence from in vitro and animal studies for the breadth of azelastine's activity on a range of mediators and thus enhance understanding of the mechanisms underlying its activity in the treatment of rhinitis. Methods: Relevant studies were identified through a MEDLINE search of the literature published in the previous 15 years. The search terms used were azelastine, allergic rhinitis, nonallergic rhinitis, and anti-inflammatory activity. Results: In addition to having H 1-blocking activity, azelastine has broadbased anti-inflammatory activity, probably accounting for its utility in the treatment of nonallergic rhinitis. The mechanisms governing its antiinflammatory activity include prevention of mast cell and basophil degranulation, down-regulation of adhesion molecules, suppression of eosinophil chemotaxis, suppression of leukotriene synthesis, and reduction in the manufacture of such inflammatory cytokines as interleukin-1 and tumor necrosis factor-α. Conclusion: Because inflammation undoubtedly results from the actions of multiple cells and a cascade of mediators, a drug such as azelastine that possesses complementary antiallergic, antihistaminic, anti-inflammatory, and antiasthmatic activities may be of greater clinical benefit than an agent that interferes with a single mediator.