title: A treatment for allergic rhinitis: a view on the role of levocetirizine.
abstract: BACKGROUND
  Allergic rhinitis is a significant public health concern in many developed countries. However, despite evidence for a significant impact on patients' quality of life (QoL) including sleep disruption and reduced daytime performance, allergic rhinitis remains under-managed and hence poorly controlled. This is largely owing to lack of knowledge about, and poor adherence to, established treatment guidelines.
  
  
  METHODS
  The panel considered available evidence and focused on four published studies on the second-generation antihistamine, levocetirizine. Three of these studies explored the clinical impact of levocetirizine in a broad range of different clinical settings.
  
  
  RESULTS
  Levocetirizine demonstrated an increased benefit over other antihistamines in terms of a more durable antihistamine response: levocetirizine provided improved symptom relief at 24 hours compared to desloratadine or fexofenadine, two frequently prescribed second-generation antihistamines. Levocetirizine also maintained relief of the key symptoms of allergic rhinitis and improved patients' QoL over a treatment period of 6 months, in a real-life setting. The variable efficacy and durability of response of different antihistamines arise from differing modulatory effects on the H(1)-receptor. The speed of relief of symptoms with levocetirizine is supported by the pharmacokinetic data, which shows that steady state plasma concentrations are achieved in a shorter period of time than other second-generation histamines (additionally levocetirizine T(max) is reached in 0.9 h).
  
  
  CONCLUSIONS
  These findings support both the short-term and long-term use of levocetirizine in the clinical management of allergic rhinitis. The World Health Organization (WHO) ARIA Guidelines (Allergic Rhinitis and its Impact on Asthma), recommend using a combination of a non-sedating antihistamine with a decongestant, or glucocorticosteroids for treating allergic rhinitis - with the order and combination of treatment depending on severity and duration of symptoms.
authors: Southampton General Hospital, and University of Southampton, Southampton, UK. cav@soton.ac.uk
authors: Stephen
authors: S
authors: Holgate
authors: Richard
authors: R
authors: Powell
authors: Maureen
authors: M
authors: Jenkins
authors: Omar
authors: O
authors: Ali
mesh_terms: D017332:Cetirizine / Q000627:therapeutic use*; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use*; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D039563:Histamine H1 Antagonists, Non-Sedating; D010879:Piperazines; C472067:levocetirizine; D017332:Cetirizine