New treatments for allergic rhinitis.
OBJECTIVE
To review new treatments for allergic rhinitis.


METHODS
Most studies supporting the principles in this paper are double-blind, placebo-controlled trials. Good evidence supports use of antihistamines, nasal steroid sprays, and immunotherapy. Fewer trials have been done on the new antileukotrienes.


RESULTS
Allergic rhinitis causes significant morbidity, which can be successfully treated. Newer antihistamines, developed to replace terfenadine and astemizole which have potential side effects, include loratadine, cetirizine, and the newest, fexofenadine. Intranasal steroid sprays are also effective, particularly for people with nasal stuffiness. One study showed some growth retardation in children using beclomethasone over a prolonged period (1 year). The newer steroid sprays, such as fluticasone, budesonide, and mometasone furoate aqueous, however, have not been studied in the same way and are usually recommended for shorter periods. The newest group of medications showing real promise are the antileukotrienes, including zafirlukast and montelukast. Taken orally, these medications avoid the discomfort of nasal sprays and seem to have few side effects. Immunotherapy offers a new option: a short-course, preseasonal series of six to 11 injections that reduces the burden on patients for year-round therapy. Combinations of these therapies are also possible.


CONCLUSIONS
With new medications and immunotherapy options, family physicians can offer effective treatment to patients with allergic rhinitis.
Tkachyk
S J
SJ
Baker Clinic, Edmonton, Alta.
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D018849:Controlled Clinical Trials as Topic; D004311:Double-Blind Method; D005938:Glucocorticoids; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008875:Middle Aged; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000628:therapy*; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006633:Histamine Antagonists; D020024:Leukotriene Antagonists