Allergies—should you fix your immune system instead of taking pills for a runny nose?

Aim of the study: Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used to treat allergic rhinitis (AR). However, assessments of treatment effects have varied, and few studies have interpreted these outcomes alongside measures of nasal airflow.

Results: Twenty-two studies involving 4673 patients with AR were identified: 5 trials of INCS, 8 of POAH, and 9 of ASIT. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [P = .0007]). POAH improved quality of life as assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. Overall, INCS led to clinically and statistically meaningful improvements in symptom scores and physiological measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their effects on nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly in mild AR. Future studies should assess the effect of treatment on each of these patient-reported measures.

Aim of the study: This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods.

Results: Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis is also a risk factor for developing asthma and may be eosinophilic and steroid-responsive, or neurogenic and non-inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidosis. Infective rhinitis can be caused by viruses and, less commonly, by bacteria, fungi, and protozoa.

Aim of the study: Allergy is a significant health problem in industrialized countries, and its prevalence continues to rise. In 1906, when Clemens von Pirquet introduced the term “allergy” to describe overwhelming pathological reactions of the body caused by contact with antigens, less than 1% of the population was affected.

Results: Allergy is a significant health problem in industrialized countries, and its prevalence continues to rise. In 1906, when Clemens von Pirquet introduced the term “allergy” to describe overwhelming pathological reactions of the body caused by contact with antigens, less than 1% of the population was affected. Today, more than 25% of people in industrialized countries suffer from allergic rhinitis, conjunctivitis, asthma, dermatitis, or food allergies. Allergic symptoms can be eased with corticosteroids, antihistamines, cromones, decongestants, antimuscarinics, or leukotriene antagonists. However, only immunotherapy can change the course of allergic disease and bring long-term improvement that lasts for years after treatment is stopped.

Aim of the study: Allergic rhinitis (AR) affects more than 400 million people worldwide, making it one of the most common chronic diseases. Childhood AR is becoming more common, and almost half of patients with AR develop symptoms before the age of 6.

Results: Drug treatment for AR has expanded, with many intranasal corticosteroids, intranasal antihistamines, and second-generation oral antihistamines approved for use in children. Allergen immunotherapy, in both subcutaneous and sublingual forms, is approved for children and modifies the disease, potentially reducing further allergen sensitization and progression to asthma. Many currently available biological therapies indicated for pediatric asthma and/or atopic diseases also reduce AR symptoms. Children with moderate to severe or refractory AR, or those with other health conditions, should be referred to allergists for diagnostic testing and expanded treatment options, including immunotherapy and possible biological treatment.

Aim of the study: Allergic rhinitis is a common condition strongly linked to asthma and conjunctivitis. It is usually long-lasting and often goes undetected in primary care.

Results: A thorough medical history, physical examination, and allergen skin testing are important for diagnosing allergic rhinitis. Second-generation oral antihistamines and intranasal corticosteroids are the main treatments. Allergen immunotherapy is an effective treatment that modifies the immune system. It should be recommended if drug treatment for allergic rhinitis does not work or is not tolerated, or if the patient chooses it. This article provides an overview of the causes, diagnosis, and appropriate management of this condition.