Rhinitis: Present Challenges & Treatment for Future; Therapeutic Options; Pharmacoeconomics & Quality of Life

At a symposium held on November 12-17, 1999, a group of experts met for the 1999 Annual Meeting of the American College of Allergy, Asthma, & Immunology in Chicago, Illinois. They discussed the therapeutic options in allergic rhinitis therapy, the similarities of asthma and rhinitis in terms of inflammatory activity, the relationship between rhinitis and lower airway disease, and finally, how pharmacoeconomics and quality of life parameters affect rhinitis.

This program is supported by an unrestricted educational grant from Carter-Wallace, Inc.

Therapeutic Options for Allergic Rhinitis Therapy: What�s new?

Allergic rhinitis affects tens of millions of people in the United States and has significant economic implications. In an effort to improve quality of care and manage costs, a more scientific approach to treatment has been proposed, including a better understanding of rhinitis, more effective therapies, and updated guidelines as new data emerge. �When reviewing the literature for allergic rhinitis, a variety of treatment algorithms have been published,� said Dr. Charles Siegal, Associate Clinical Professor, Department of Pediatrics, Division of Allergy and Immunology at the University of Missouri School of Medicine. As we know, rhinitis is a heterogeneous disorder with multiple triggers, the most important of which are allergens, bacterial or viral infections, airway irritants, sinusitis, and structural disease. Proper diagnosis and appropriate management are ongoing goals and are reviewed in an Executive Summary of the Joint Task Force Practice Parameters (Dykewicz and Fineman 1998). As more therapeutic options become available, however, defining the causes of rhinitis becomes even more important because different rhinitis syndromes may require different therapeutic approaches. According to Dr. Siegal, avoidance of responsible allergens, immunotherapy, and pharmacotherapy remain the overall options to therapy and have changed little over the years. (Table 1)

Avoidance Still Works

Perennial allergic rhinitis is caused by IgE-mediated reaction to perennial environmental aeroallergens. Avoiding inciting factors (house dust mites, molds, pets, pollens, and cockroaches), irritants, medications, remains the cornerstone of allergic rhinitis therapy. In a discussion of environmental control methods, Tovey expressed little confidence in chemical agents, specifically for pets and increased confidence in washing cat-contaminated items rather than the cat (source). �It may be more effective, �reiterated Dr. Siegal, �since cat and dog dander is ubiquitous, for those with significant cat exposure to change their clothing before entering the home.� Another interesting study showed that children with positive skin prick tests had negative tests after two and a half years of aggressive dust mite control measures. �With aggressive, environmental control, we may be able to affect the course of allergy, �said Dr. Siegal.