Treatment of congestion in upper respiratory diseases.
Congestion, as a symptom of upper respiratory tract diseases including seasonal and perennial allergic rhinitis, acute and chronic rhinosinusitis, and nasal polyposis, is principally caused by mucosal inflammation. Though effective pharmacotherapy options exist, no agent is universally efficacious; therapeutic decisions must account for individual patient preferences. Oral H(1)-antihistamines, though effective for the common symptoms of allergic rhinitis, have modest decongestant action, as do leukotriene receptor antagonists. Intranasal antihistamines appear to improve congestion better than oral forms. Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines. Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis. Immunotherapy and surgery may be used in some cases refractory to pharmacotherapy. Steps in congestion management include (1) diagnosis of the cause(s), (2) patient education and monitoring, (3) avoidance of environmental triggers where possible, (4) pharmacotherapy, and (5) immunotherapy (for patients with allergic rhinitis) or surgery for patients whose condition is otherwise uncontrolled.
Meltzer
Eli O
EO
Allergy and Asthma Medical Group and Research Center, San Diego, CA and Department of Pediatrics, University of California, San Diego, USA;
Caballero
Fernan
F
Fromer
Leonard M
LM
Krouse
John H
JH
Scadding
Glenis
G
Ann Allergy Asthma Immunol. 2005 Mar;94(3):348-54
15801245
J Allergy Clin Immunol. 2000 Jun;105(6 Pt 1):1101-7
10856142
Allergy. 1999 Jun;54(6):562-8
10435469
Int J Pediatr Otorhinolaryngol. 2009 Dec;73(12):1696-701
19786306
Clin Ther. 1995 May-Jun;17(3):479-92
7585852
Rhinology. 2005 Dec;43(4):291-5
16405274
Clin Allergy. 1986 May;16(3):195-201
3087656
Arch Otolaryngol Head Neck Surg. 1998 May;124(5):513-8
9604976
Clin Exp Allergy. 1989 Sep;19(5):569-73
2571403
Clin Ther. 1997 Nov-Dec;19(6):1330-9
9444443
Clin Exp Allergy. 2004 Jan;34(1):85-90
14720267
Laryngoscope. 2005 Dec;115(12):2199-205
16369166
Pediatrics. 2001 Feb;107(2):381-90
11158473
Ann Allergy Asthma Immunol. 2007 Jul;99(1):69-76
17650833
Rhinology. 1996 Jun;34(2):91-6
8876070
Respir Med. 1989 May;83 Suppl A:25-31
2514446
J Laryngol Otol. 1989 Aug;103(8):743-6
2671220
Clin Exp Allergy. 1999 Oct;29(10):1367-77
10520057
J Allergy Clin Immunol. 2005 Dec;116(6):1275-81
16337459
J Clin Pharmacol. 1999 Jul;39(7):695-702
10392324
J Allergy Clin Immunol. 1999 Jul;104(1):100-6
10400846
Rhinology. 2005 Sep;43(3):205-9
16218514
J Allergy Clin Immunol. 2004 Oct;114(4):838-44
15480324
J Allergy Clin Immunol. 1988 Sep;82(3 Pt 1):447-55
3170993
Ann Allergy Asthma Immunol. 2006 Jun;96(6):851-7
16802774
Clin Exp Allergy. 1998 Jun;28 Suppl 2:3-10
9678821
BMJ. 1991 Feb 2;302(6771):265-9
1998791
J Pediatr. 1991 Jan;118(1):125-30
1670783
Clin Exp Allergy. 1995 Feb;25(2):149-58
7750007
Clin Exp Allergy. 2002 Jul;32(7):1020-8
12100048
Clin Exp Allergy. 2008 Feb;38(2):260-75
18167126
J Allergy Clin Immunol. 2006 Jul;118(1):128-33
16815148
J Investig Allergol Clin Immunol. 2006;16(3):148-55
16784007
N Engl J Med. 2005 Nov 3;353(18):1934-44
16267324
Mayo Clin Proc. 2002 Apr;77(4):350-4
11936930
Ann Allergy Asthma Immunol. 1998 Oct;81(4):354-8
9809500
J Allergy Clin Immunol. 2000 Oct;106(4 Suppl):S179-90
11032642
Ear Nose Throat J. 1999 Aug;78(8):604-6, 608, 613, passim
10485156
Laryngoscope. 2005 Aug;115(8):1385-90
16094110
Allergy. 2005 Jan;60(1):4-12
15575924
Am J Respir Crit Care Med. 1999 Jun;159(6):1814-8
10351924
J Allergy Clin Immunol. 1992 Sep;90(3 Pt 1):285-91
1527313
Eur Arch Otorhinolaryngol. 2000;257(5):256-9
10923938
Ann Allergy. 1991 Dec;67(6):593-7
1750722
Allergy. 1999 Nov;54(11):1173-80
10604553
Ann Intern Med. 2001 Mar 20;134(6):498-505
11255528
Ann Allergy Asthma Immunol. 2002 Sep;89(3):271-8
12269647
Int J Pediatr Otorhinolaryngol. 1998 Aug 1;44(3):215-20
9780066
Arch Otolaryngol Head Neck Surg. 2006 Feb;132(2):164-72
16490874
Allergy. 2000 Feb;55(2):116-34
10726726
Allergy. 2001 Nov;56(11):1077-80
11703222
J Allergy Clin Immunol. 1996 Oct;98(4):724-31
8876546
Otolaryngol Head Neck Surg. 2008 Jan;138(1):30-7
18164990
Arch Otolaryngol Head Neck Surg. 2006 Sep;132(9):990-3
16982976
J Allergy Clin Immunol. 1987 Apr;79(4):585-90
2951426
J Allergy Clin Immunol. 1998 Jun;101(6 Pt 1):726-31
9648698
Ann Allergy Asthma Immunol. 2005 Sep;95(3):272-82
16200819
N Engl J Med. 1999 Aug 12;341(7):468-75
10441602
J Allergy Clin Immunol. 1995 Aug;96(2):139-47
7636050
Allergy Asthma Proc. 1998 Sep-Oct;19(5):285-94
9801742
J Allergy Clin Immunol. 1996 Mar;97(3):749-55
8613630
Postgrad Med. 2004 Jan;115(1):13-9
14755871
Curr Med Res Opin. 1985;9(8):560-7
2863090
Ann Allergy Asthma Immunol. 2002 Apr;88(4):385-90
11995670
Clin Exp Allergy. 1994 Dec;24(12):1144-50
7889428
Ann Allergy Asthma Immunol. 2005 Dec;95(6):551-7
16400895
Acta Otorhinolaryngol Belg. 2001;55(4):305-12
11859651
Am J Respir Crit Care Med. 1995 Jun;151(6):1734-9
7767514
J Laryngol Otol. 1998 Nov;112(11):1042-6
10197141
Rhinology. 1997 Jun;35(2):67-73
9299654
J Allergy Clin Immunol. 1989 Feb;83(2 Pt 1):411-6
2563743
Ann Allergy Asthma Immunol. 1997 Jun;78(6):573-80
9207721
Clin Drug Investig. 1997 Jun;13(6):291-8
27519490
J Laryngol Otol. 2007 Dec;121(12):1156-60
17697437
Pediatr Infect Dis J. 1988 Mar;7(3):223-8
2895909
J Allergy Clin Immunol. 2007 Jun;119(6):1430-7
17418384
Otolaryngol Head Neck Surg. 2005 Dec;133(6):972-8
16360523
J Allergy Clin Immunol. 1989 Mar;83(3):627-33
2494249
Ann Allergy. 1992 Apr;68(4):348-53
1348405
Clin Exp Allergy. 2000 Jun;30(6):891-9
10848909
J Pediatr. 1997 Mar;130(3):463-6
9063425
Ann Allergy Asthma Immunol. 2007 Feb;98(2):175-81
17304887
Allergy. 1988 Jul;43(5):386-91
3046408
Clin Exp Allergy. 2000 Oct;30(10):1460-8
10998024
Br J Clin Pract. 1989 Jan;43(1):11-4
2574054
ORL J Otorhinolaryngol Relat Spec. 2005;67(3):148-53
15925911
Allergy. 1998 Oct;53(10):969-75
9821477
Ann Allergy Asthma Immunol. 2005 Nov;95(5):474-9
16312171
Clin Pediatr (Phila). 1996 Sep;35(9):457-60
8877243
Clin Exp Allergy. 1991 Sep;21(5):595-600
1742652
J Allergy Clin Immunol. 1993 Dec;92(6):812-23
8258615
Allergy. 2004 May;59(5):491-7
15080829
BMJ. 1998 Dec 12;317(7173):1624-9
9848901
Rhinology. 1993 Dec;31(4):159-64
7908144
Arzneimittelforschung. 2001 Nov;51(11):904-10
11765592
Allergy. 1997 Jun;52(6):650-5
9226059
J Fam Pract. 2002 Dec;51(12):1049-55
12540331
Clin Exp Allergy. 1997 Jul;27(7):796-801
9249272
Arch Otolaryngol Head Neck Surg. 2006 Feb;132(2):179-85
16490876
Rhinology. 2000 Dec;38(4):157-66
11190749
Clin Infect Dis. 2001 Nov 1;33(9):1483-8
11588693
J Laryngol Otol. 1987 Nov;101(11):1136-9
3320236
N Engl J Med. 1990 Dec 20;323(25):1745-8
1701029
J Pharm Pharmacol. 1990 Sep;42(9):652-4
1981905
Laryngoscope. 2006 May;116(5):729-34
16652079
Pediatrics. 2000 Feb;105(2):E23
10654983
J Allergy Clin Immunol. 2008 Aug;122(2 Suppl):S1-84
18662584
J Allergy Clin Immunol. 2000 May;105(5):917-22
10808172
Rhinology. 2001 Mar;39(1):17-22
11340690
Allergy. 2007 Aug;62(8):958-61
17620076
J Pediatr. 1994 Oct;125(4):628-34
7931889
Allergy. 1992 Aug;47(4 Pt 1):313-7
1443451
J Allergy Clin Immunol. 1985 Jun;75(6):720-7
2861220
Allergy. 1998;53(41 Suppl):1-31
9543546
Ear Nose Throat J. 2004 Mar;83(3):163-4
15086009
Thorax. 1984 Sep;39(9):668-72
6147905
Treat Respir Med. 2005;4(6):439-46
16336028
Ann Allergy Asthma Immunol. 1997 Jun;78(6):598-601
9207726
Ann Allergy Asthma Immunol. 2004 Jan;92(1):73-9
14756468
J Allergy Clin Immunol. 2001 Nov;108(5 Suppl):S147-334
11707753
Arch Otolaryngol Head Neck Surg. 1997 Jul;123(7):675-8
9236583
Ann Allergy Asthma Immunol. 2006 Jun;96(6):779-86
16802764
J Am Osteopath Assoc. 2000 Jul;100(7 Suppl):S8-13
10948809
J Allergy Clin Immunol. 1999 Jul;104(1):107-14
10400847
J Allergy Clin Immunol. 2000 Oct;106(4):630-7
11031332
Am J Med. 2006 Mar;119(3):230-7
16490466
Clin Exp Allergy. 2000 Dec;30(12):1792-8
11122219
Pediatrics. 2000 Feb;105(2):E22
10654982
J Allergy Clin Immunol. 2005 Dec;116(6):1289-95
16337461
J Clin Pharmacol. 1993 Sep;33(9):816-22
8227478
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006394
17636843
Rhinology. 2001 Mar;39(1):9-12
11340701
Ann Allergy Asthma Immunol. 2003 Jan;90(1):56-62
12546339
Rhinol Suppl. 2007;20:1-136
17844873
Chest. 2001 May;119(5):1533-46
11348965
Pediatr Allergy Immunol. 2004 Jun;15(3):253-60
15209959
Curr Allergy Asthma Rep. 2002 Nov;2(6):494-9
12359120
Prim Care Respir J. 2008 Jun;17(2):79-89
18438594
Ther Clin Risk Manag. 2007 Oct;3(5):885-92
18473012
Ann Allergy Asthma Immunol. 1997 Mar;78(3):270-6
9087151
JAMA. 2001 Dec 26;286(24):3097-105
11754675
Clin Allergy Immunol. 2002;17:337-88
12113223
Clin Exp Allergy. 1999 Aug;29(8):1143-7
10457120
ORL J Otorhinolaryngol Relat Spec. 2001 Mar-Apr;63(2):76-81
11244365
Ann Allergy Asthma Immunol. 2002 Nov;89(5):479-84
12452206
Ann Allergy. 1994 Dec;73(6):497-502
7998664
Allergy. 2001 Nov;56(11):1068-70
11703220
Auris Nasus Larynx. 2005 Dec;32(4):369-74
16043320
J Allergy Clin Immunol. 1996 Apr;97(4):915-21
8655886
Am J Rhinol. 2005 Jan-Feb;19(1):25-31
15794071
Allergy Asthma Proc. 2005 Sep-Oct;26(5):391-6
16450574
Ann Allergy Asthma Immunol. 1997 Oct;79(4):370-8
9357385
Ann Allergy Asthma Immunol. 2006 Nov;97(5):657-63
17165276
Arch Otolaryngol Head Neck Surg. 2004 Mar;130(3):329-33
15023842
Otolaryngol Head Neck Surg. 1999 Nov;121(5):567-71
10547471
Allergy. 1997 Apr;52(4):445-50
9188929
J Otolaryngol. 2005 Jun;34(3):189-93
16089223
J Allergy Clin Immunol. 1992 Aug;90(2):242-9
1386857
J Allergy Clin Immunol. 2007 Dec;120(6):1338-45
17935764
Ann Allergy. 1991 Jan;66(1):43-7
1702944
Rhinology. 2004 Jun;42(2):57-62
15224630
Ann Allergy. 1989 Oct;63(4):336-9
2529799
Ann Allergy Asthma Immunol. 2003 May;90(5):536-42
12775135
Ann Allergy. 1988 Aug;61(2):151-6
3400902
Ann Pharmacother. 2005 Dec;39(12):1984-9
16278257
Allergy Asthma Proc. 1998 Nov-Dec;19(6):379-83
9876778
Chest. 2005 Oct;128(4):1910-20
16236835
Curr Allergy Asthma Rep. 2003 May;3(3):210-4
12662469
Am J Rhinol. 1998 Nov-Dec;12(6):427-33
9883300
Ann Allergy Asthma Immunol. 2001 Jan;86(1):28-35
11206234
J Allergy Clin Immunol. 2003 Mar;111(3):617-22
12642846
Ann Allergy Asthma Immunol. 1998 Nov;81(5 Pt 2):478-518
9860027
J Allergy Clin Immunol. 2006 Aug;118(2):434-40
16890769
J Allergy Clin Immunol. 1999 Nov;104(5):927-33
10550734
Am J Med. 2004 Mar 1;116(5):338-44
14984820
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001953
17253470
Eur Arch Otorhinolaryngol. 1996;253(4-5):237-9
8737776
Ann Allergy Asthma Immunol. 2005 Dec;95(6):600-6
16400902
Otolaryngol Head Neck Surg. 1998 May;118(5):648-54
9591864
J Otolaryngol. 2004 Apr;33(2):98-103
15518097
Clin Exp Allergy. 2005 Feb;35(2):207-12
15725193
Expert Opin Emerg Drugs. 2005 Nov;10(4):689-705
16262558
Allergy. 2007 Aug;62(8):954-7
17620075
Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90
15054368
Allergy. 1983 Oct;38(7):517-24
6139040