Management of Allergic Rhinitis

A Review for the Community Pharmacist

J. Russell May, William K Dolen

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

Purpose Allergic rhinitis is a highly prevalent disease affecting the quality of life of millions of North Americans. The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy. Current pharmacologic options include oral and intranasal antihistamines, intranasal corticosteroids, oral and intranasal decongestants, oral and intranasal anticholinergics, and leukotriene receptor antagonists. Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment, with practice guidelines recommending intranasal corticosteroids as first-line treatment for moderate to severe allergic rhinitis. Methods Clinical trials studying a widely used intranasal corticosteroid, fluticasone propionate, in comparison with second-generation oral antihistamines, cetirizine, loratadine, or montelukast, were selected to support the comparative review of the efficacy and tolerability of these 2 classes of medications. Studies evaluating the combination of fluticasone propionate with an oral antihistamine were also included to review the efficacy and tolerability of combination therapy to treat allergic rhinitis. Findings Studies comparing fluticasone propionate with cetirizine had mixed findings; fluticasone propionate was found to have equal or greater efficacy in reducing nasal symptom scores. Combination therapy of fluticasone propionate and the oral antihistamine, loratadine, was found to have efficacy comparable with that of intranasal corticosteroid alone. Implications Many of these medications are available over the counter in the pharmacy, and the community pharmacist plays an important role as part of the patient's health care team in managing this disease. Pharmacotherapy is patient-specific, based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference. This article aims to provide an overview of the pathophysiology, available treatment options, guideline recommendations, and role of the pharmacist for this disease.

Original languageEnglish (US)
Pages (from-to)2410-2419
Number of pages10
JournalClinical Therapeutics
Volume39
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Pharmacists
Adrenal Cortex Hormones
Histamine Antagonists
Non-Sedating Histamine H1 Antagonists
Loratadine
Cetirizine
Patient Care Team
montelukast
Therapeutics
Nasal Decongestants
Leukotriene Antagonists
Drug Therapy
Patient Preference
Cholinergic Antagonists
Nose
Practice Guidelines
Immunotherapy
Allergens
Allergic Rhinitis
Comorbidity

Keywords

  • allergic rhinitis
  • antihistamines
  • community pharmacy
  • corticosteroids
  • pharmacists

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Management of Allergic Rhinitis : A Review for the Community Pharmacist. / May, J. Russell; Dolen, William K.

In: Clinical Therapeutics, Vol. 39, No. 12, 01.12.2017, p. 2410-2419.

Research output: Contribution to journalReview article

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