Upon completion of the chapter, the reader will be able to:
Describe the basic pathophysiology of allergic rhinitis (AR).
List the four typical symptoms of AR and identify the one that is usually the most troublesome.
List at least three reasons for referral to an allergy specialist.
Differentiate the categories of pharmacotherapy choices for treatment of AR.
Rank the pharmacotherapy choices for efficacy in treating the usual single most troublesome symptom of AR.
Describe an approach for treatment of mild AR with over-the-counter (OTC) drugs.
Create a therapy plan for treatment of moderate–severe AR.
Describe how to monitor patients treated for AR.
Identify the differences in approach to the treatment of AR for children, pregnant women, and the elderly compared with the routine approach in adults.
Rhinitis is inflammation of the lining of the nose and contiguous parts of the upper respiratory tract.1,2,3,4 Allergy is only one of numerous causes of rhinitis.1,2,3,4,5 The most common causes of nonallergic rhinitis are shown in Table 63–1.1,2,3,4,5 Some patients suffer concurrently from both allergic rhinitis (AR) and one or more types of nonallergic rhinitis (NAR). This is sometimes called mixed rhinitis (MR).1,3 AR will be emphasized in this chapter, but some mention will be made of NAR. Because ocular symptoms frequently occur in association with AR, some sources use the term allergic rhinoconjunctivitis. This acknowledges involvement of the bulbar and palpebral conjunctivae in the allergic process.
Table 63–1Types of Rhinitis |Favorite Table|Download (.pdf) Table 63–1Types of Rhinitis
Allergic (see Table 63–2 for details)
Vasomotor (also known as perennial nonallergic, idiopathic, and autonomic rhinitis) (triggered by irritants, cold air, exercise/running, or unidentified factors)
Food/meal related (gustatory)
NARES (nonallergic rhinitis with eosinophilia syndrome)
Occupational (caused by protein allergens (IgE-mediated) or by irritants (probably non–IgE-mediated)
Hormonally related (hypothyroidism, pregnancy, menstrual cycle related, and some drugs [see below])
Angiotensin-converting enzyme inhibitors (ACEIs)
α1-Blockers (used for treatment of BPH and HT)
Phosphodiesterase-5 inhibitors (used for treatment of ED)
Aspirin and other NSAIDs (as an isolated side effect of AERD)
Oral contraceptives and hormone replacement therapy
Miscellaneous agents have been implicated (calcium channel blockers, some diuretics, centrally acting α-2 agonists, risperidone, gabapentin)
Rhinitis associated with inflammatory or immunologic diseases (eg, granulomatous infections, SLE, Wegener granulomatosis, sarcoidosis, Churg–Strauss syndrome)
Combination of allergic and nonallergic manifestations
KEY CONCEPT AR is an allergen-induced, immunoglobulin E (IgE)-mediated inflammatory condition of the lining of the nose and ...