The management of allergic rhinitis involves a combination of allergen avoidance, pharmacotherapy, and allergen immunotherapy.
Allergen avoidance
Allergen avoidance is a crucial part of the management strategy. Patients should be instructed to minimize exposure to known allergens such as pollen, dust mites, and pet dander
Pharmacotherapy
Pharmacotherapy is the cornerstone of allergic rhinitis management, and includes:
- Intranasal corticosteroids: These are highly effective in reducing nasal inflammation and symptoms. They can be offered alone or in combination with oral or intranasal antihistamines in patients with seasonal or perennial allergic rhinitis
- Oral antihistamines: These are useful for controlling sneezing and itching. They can be offered either alone or in combination with leukotriene receptor antagonists in patients with seasonal allergic rhinitis
- Combination therapy: For patients with moderate or severe seasonal allergic rhinitis and perennial allergic rhinitis resistant to pharmacologic monotherapy, a combination of intranasal corticosteroids and intranasal antihistamines can be considered
Allergen immunotherapy
Allergen immunotherapy involves the administration of increasing doses of the causative allergen, subcutaneously or sublingually, to induce clinical and immunologic tolerance. It is recommended for patients with allergic rhinitis, with or without allergic asthma, inadequately controlled with medical therapy, allergen avoidance, or both, or expressing a preference for immunomodulation
- Subcutaneous and sublingual immunotherapy: Patients eligible for immunotherapy should be counseled regarding the differences between subcutaneous and sublingual (aqueous and tablet) immunotherapy, including risks, benefits, convenience, and costs
- Duration of therapy: Treatment should be continued for at least 3 years in patients experiencing symptomatic control with allergen immunotherapy, with ongoing treatment duration based on treatment response
In conclusion, the management of allergic rhinitis requires a comprehensive approach that involves allergen avoidance, pharmacotherapy, and allergen immunotherapy. The choice of treatment depends on the severity and frequency of symptoms, patient preference, and the presence of comorbid conditions.