Pharmacologic and anti‐IgE treatment of allergic rhinitis ARIA update (in collaboration with GA²LEN)

Abstract

The pharmacologic treatment of allergic rhinitis proposed by ARIA is an evidence‐based and step‐wise approach based on the classification of the symptoms. The ARIA workshop, held in December 1999, published a report in 2001 and new information has subsequently been published. The initial ARIA document lacked some important information on several issues. This document updates the ARIA sections on the pharmacologic and anti‐IgE treatments of allergic rhinitis. Literature published between January 2000 and December 2004 has been included. Only a few studies assessing nasal and non‐nasal symptoms are presented as these will be discussed in a separate document.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Several chapters of ARIA were extensively reviewed in an evidence-based model, and papers were published (or submitted) in peerreviewed journals: tertiary prevention of allergy, complementary and alternative medicine, pharmacotherapy and anti-IgE treatment, allergen-specific immunotherapy, links between rhinitis and asthma and mechanisms of rhinitis (24)(25)(26)(27)(28). There was then a need for a global document based on the published papers to highlight the interactions between the upper and the lower airways and to:…”

Allergic Rhinitis: an Overview

“…Intranasal corticosteroids (INSs) are recommended in current guidelines as first-line therapy for patients with moderate to severe Allergic Rhinitis, particularly when nasal congestion is the prominent symptom [3]. INSs inhibit the onset of the inflammatory response and reduce nasal mucosa permeability, the number of inflammatory cells and the release of mediators.…”

Ebastine in allergic rhinitis and chronic idiopathic urticaria

“…The role of histamine in the pathophysiology of both allergic rhinitis and chronic urticaria is well established, and antihistamines are a key element of the management of symptoms in patients with these conditions (5,21,95). The first generation of antihistamines, such as chlorphenamine, were effective at relieving symptoms, but were associated with significant adverse effects, including sedation and anticholinergic effects, and had to be administered up to four times daily (4).…”

“…Subsequently, newer antihistamines were developed that were effective with once or twice-daily administration and had minimal sedative effects. These Ôsecond-generationÕ antihistamines include ebastine as well as cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, mizolastine and rupatadine (95).…”