Treatment of Allergic Rhinitis in Clinical Practice


Citar

Texto integral

Resumo

Allergic rhinitis is a prevalent condition among children, with its occurrence reaching up to 40% of the general population in some geographical areas. A type 2 immunity sustains allergic rhinitis. Consequently, type 2 inflammation leads to eosinophilic infiltrate of the nasal mucosa. Al- lergic inflammation causes the symptom occurrence. Typical nasal symptoms include nasal itch- ing, sneezing, watery rhinorrhea, and nasal congestion. Nasal congestion depends on vasodilation and increased mucus production. These conditions result in nasal obstruction. Nasal obstruction is closely associated with type 2 inflammation. Allergic rhinitis usually occurs in association with other allergic conditions, in particular allergic conjunctivitis and asthma. The effective manage- ment of allergic rhinitis involves avoiding triggering allergens and employing pharmacological treatments as per ARIA guidelines. These treatments may include intranasal/oral antihistamines or/and nasal corticosteroids. In particular, antihistamines are particularly indicated for symptoms consequent to mediators’ release, mainly concerning histamine. These histamine-dependent symp- toms include itching, sneezing, and rhinorrhea. Nasal obstruction, being associated with inflamma- tion, is responsive to corticosteroids, administered mostly intranasally. The fixed combination of a topical antihistamine plus a topical corticosteroid is very effective, but is indicated for adolescents only. However, nasal lavage is safe, cheap, and adequate, thus its use is prevalent. Namely, nasal la- vage allows to remove secretions, allergens, mediators. In addition, hypertonic solutions exert a de- congestant activity. On the other hand, the allergen-specific immunotherapy is still the only causal treatment. Nutraceuticals have also been used to relieve symptoms. The objective of this review is to explore and compare the traditional and new therapeutic approaches for pollen-induced allergic rhinitis in children.

Sobre autores

Maria Tosca

Allergy Center, IRCCS Istituto Giannina Gaslini

Email: info@benthamscience.net

Chiara Trincianti

Allergy Center, IRCCS Istituto Giannina Gaslin

Email: info@benthamscience.net

Matteo Naso

Allergy Center, IRCCS Istituto Giannina Gaslini

Email: info@benthamscience.net

Valentina Nosratian

Allergy Center, IRCCS Istituto Giannina Gaslini

Email: info@benthamscience.net

Giorgio Ciprandi

Allergy Clinic, IRCCS Istituto Giannina Gaslini

Autor responsável pela correspondência
Email: info@benthamscience.net

Bibliografia

  1. Wever C. The nasal airway: A critical review. Facial Plast Surg 2016; 32(1): 017-21. doi: 10.1055/s-0035-1570323 PMID: 26862959
  2. Walker A, Surda P, Rossiter M, Little S. Nasal function and dysfunction in exercise. J Laryngol Otol 2016; 130(5): 431-4. doi: 10.1017/S0022215116000128 PMID: 27095550
  3. Hamilton GS III. The external nasal valve. Facial Plast Surg Clin North Am 2017; 25(2): 179-94. doi: 10.1016/j.fsc.2016.12.010 PMID: 28340649
  4. Bansil R, Turner BS. The biology of mucus: Composition, synthesis and organization. Adv Drug Deliv Rev 2018; 124: 3-15. doi: 10.1016/j.addr.2017.09.023 PMID: 28970050
  5. Taherali F, Varum F, Basit AW. A slippery slope: On the origin, role and physiology of mucus. Adv Drug Deliv Rev 2018; 124: 16-33. doi: 10.1016/j.addr.2017.10.014 PMID: 29108861
  6. Klain A, Indolfi C, Dinardo G, et al. Comparing available treatments for pollen-induced allergic rhinitis in children. Expert Rev Clin Immunol 2022; 18(8): 835-43. doi: 10.1080/1744666X.2022.2093188 PMID: 35726790
  7. Rochereau N, Pavot V, Verrier B, et al. Delivery of antigen to nasal-associated lymphoid tissue microfold cells through secretory IgA targeting local dendritic cells confers protective immunity. J Allergy Clin Immunol 2016; 137(1): 214-222.e2. doi: 10.1016/j.jaci.2015.07.042 PMID: 26414879
  8. Pizzolla A, Wang Z, Groom JR, et al. Nasal-associated lymphoid tissues (NALTs) support the recall but not priming of influenza virus-specific cytotoxic T cells. Proc Natl Acad Sci 2017; 114(20): 5225-30. doi: 10.1073/pnas.1620194114 PMID: 28461487
  9. Trincianti C, Tosca MA, Ciprandi G. Updates in the diagnosis and practical management of allergic rhinitis. Expert Rev Clin Pharmacol 2023; 16(7): 669-76. doi: 10.1080/17512433.2023.2225770 PMID: 37314373
  10. Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: A literature review. Int Forum Allergy Rhinol 2014; 4(10): 834-8. doi: 10.1002/alr.21368 PMID: 25079504
  11. Ciprandi G, Mora F, Cassano M, Gallina AM, Mora R. Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis. Otolaryngol Head Neck Surg 2009; 141(4): 527-9. doi: 10.1016/j.otohns.2009.06.083 PMID: 19786224
  12. Birchenough GMH, Johansson ME, Gustafsson JK, Bergström JH, Hansson GC. New developments in goblet cell mucus secretion and function. Mucosal Immunol 2015; 8(4): 712-9. doi: 10.1038/mi.2015.32 PMID: 25872481
  13. Ciprandi G, Marseglia GL, Klersy C, Tosca MA. Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization. Allergy 2005; 60(7): 957-60. doi: 10.1111/j.1398-9995.2005.00664.x PMID: 15932388
  14. Gelardi M, Maselli Del Giudice A, Candreva T, et al. Nasal resistance and allergic inflammation depend on allergen type. Int Arch Allergy Immunol 2006; 141(4): 384-9. doi: 10.1159/000095465 PMID: 16943677
  15. Ciprandi G, Cirillo I. The lower airway pathology of rhinitis. J Allergy Clin Immunol 2006; 118(5): 1105-9. doi: 10.1016/j.jaci.2006.05.010 PMID: 17088136
  16. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014; 383(9918): 736-47. doi: 10.1016/S0140-6736(13)60734-5 PMID: 23910433
  17. King D. What role for saline nasal irrigation? Drug Ther Bull 2019; 57(4): 56-9. doi: 10.1136/dtb.2018.000023 PMID: 30858292
  18. Gelardi M, Taliente S, Piccininni K, Silvestre G, Quaranta N, Ciprandi G. Nasal irrigation with Nasir® in children: A preliminary experience on nasal cytology. J Biol Regul Homeost Agents 2016; 30(4): 1125-30. PMID: 28078863
  19. Piper KJ, Foster H, Susanto D, Maree CL, Thornton SD, Cobbs CS. Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage. Int J Infect Dis 2018; 77: 18-22. doi: 10.1016/j.ijid.2018.09.013 PMID: 30243910
  20. Fandino A, Douglas R. A historical review of the evolution of nasal lavage systems. J Laryngol Otol 2021; 135(2): 110-6. doi: 10.1017/S002221512100030X PMID: 33563344
  21. Principi N, Esposito S. Nasal irrigation: An imprecisely defined medical procedure. Int J Environ Res Public Health 2017; 14(5): 516. doi: 10.3390/ijerph14050516 PMID: 28492494
  22. Halawi AM, Smith SS, Chandra RK. Chronic rhinosinusitis: Epidemiology and cost. Allergy Asthma Proc 2013; 34(4): 328-34. doi: 10.2500/aap.2013.34.3675 PMID: 23883597
  23. Head K, Chong LY, Piromchai P, et al. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Libr 2016; 2016(4): CD011994. doi: 10.1002/14651858.CD011994.pub2 PMID: 27113482
  24. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): Adult sinusitis. Otolaryngol Head Neck Surg 2015; 152(2) (Suppl.): S1-S39. PMID: 25832968
  25. Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev 2007; 3(3): CD006394. doi: 10.1002/14651858.CD006394.pub2 PMID: 17636843
  26. Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: A systematic review. JAMA 2015; 314(9): 926-39. doi: 10.1001/jama.2015.7544 PMID: 26325561
  27. Little P, Stuart B, Mullee M, et al. Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: A pragmatic randomized controlled trial. CMAJ 2016; 188(13): 940-9. doi: 10.1503/cmaj.160362 PMID: 27431306
  28. Rudmik L, Soler ZM, Orlandi RR, et al. Early postoperative care following endoscopic sinus surgery: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2011; 1(6): 417-30. doi: 10.1002/alr.20072 PMID: 22144050
  29. Liu L, Pan M, Li Y, Tan G, Yang Y. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Rev Bras Otorrinolaringol 2020; 86(5): 639-46. PMID: 32534983
  30. Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334(7589): 358-61. doi: 10.1136/bmj.39092.679722.BE PMID: 17303885
  31. Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2012; 26(5): e119-25. doi: 10.2500/ajra.2012.26.3787 PMID: 23168142
  32. Head K, Snidvongs K, Glew S, et al. Saline irrigation for allergic rhinitis. Cochrane Database Syst Rev 2018; 6(6): CD012597. doi: 10.1002/14651858.CD012597.pub2
  33. Wang Y, Jin L, Liu SX, Fan K, Qin ML, Yu SQ. Role of nasal saline irrigation in the treatment of allergic rhinitis in children and adults: A systematic analysis. Allergol Immunopathol 2020; 48(4): 360-7. doi: 10.1016/j.aller.2020.01.002 PMID: 32331798
  34. King D, Mitchell B, Williams CP, Spurling GKP. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Libr 2015; 2015(4): CD006821. doi: 10.1002/14651858.CD006821.pub3 PMID: 25892369
  35. Šlapak I, Skoupá J, Strnad P, Horník P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg 2008; 134(1): 67-74. doi: 10.1001/archoto.2007.19 PMID: 18209140
  36. Velentza L, Maridaki Z, Blana E, Miligkos M. Antihistamines in the management of pediatric allergic rhinitis: A systematic review. Paediatr Drugs 2020; 22(6): 673-83. doi: 10.1007/s40272-020-00419-x PMID: 32936412
  37. Fitzsimons R, van der Poel LA, Thornhill W, du Toit G, Shah N, Brough HA. Antihistamine use in children. Arch Dis Child Educ Pract Ed 2015; 100(3): 122-31. doi: 10.1136/archdischild-2013-304446 PMID: 25147323
  38. Kaliner MA, Berger WE, Ratner PH, Siegel CJ. The efficacy of intranasal antihistamines in the treatment of allergic rhinitis. Ann Allergy Asthma Immunol 2011; 106(2) (Suppl.): S6-S11. doi: 10.1016/j.anai.2010.08.010 PMID: 21277531
  39. Church M, Church D. Pharmacology of antihistamines. Indian J Dermatol 2013; 58(3): 219-24. doi: 10.4103/0019-5154.110832 PMID: 23723474
  40. Shah SR, Nayak A, Ratner P, Roland P, Michael Wall G. Effects of olopatadine hydrochloride nasal spray 0.6% in the treatment of seasonal allergie rhinitis: A phase III, multicenter, randomized, double-blind, active- and placebo-controlled study in adolescents and adults. Clin Ther 2009; 31(1): 99-107. doi: 10.1016/j.clinthera.2009.01.016 PMID: 19243710
  41. Yonekura S, Okamoto Y, Sakurai D, et al. Efficacy of desloratadine and levocetirizine in patients with cedar pollen-induced allergic rhinitis: A randomized, double-blind study. Int Arch Allergy Immunol 2019; 180(4): 274-83. doi: 10.1159/000503065 PMID: 31618733
  42. Day JH, Briscoe MP, Rafeiro E, Ratz JD. Comparative clinical efficacy, onset and duration of action of levocetirizine and desloratadine for symptoms of seasonal allergic rhinitis in subjects evaluated in the Environmental Exposure Unit (EEU). Int J Clin Pract 2004; 58(2): 109-18. doi: 10.1111/j.1368-5031.2004.0117.x PMID: 15055856
  43. Juel-Berg N, Darling P, Bolvig J, et al. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 31(1): e19-28. doi: 10.2500/ajra.2016.30.4397 PMID: 28234147
  44. Yamamoto H, Yonekura S, Sakurai D, et al. Using an environmental challenge chamber, comparing nasal steroid with antihistamine in prophylactic treatment against pollinosis. Allergy Asthma Proc 2012; 33(5): 397-403. doi: 10.2500/aap.2012.33.3594 PMID: 23026181
  45. Bédard A, Basagaña X, Anto JM, et al. Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study. J Allergy Clin Immunol 2019; 144(1): 135-143.e6. doi: 10.1016/j.jaci.2019.01.053 PMID: 30951790
  46. Devillier P, Dreyfus JF, Demoly P, Calderón MA. A meta-analysis of sublingual allergen immunotherapy and pharmacotherapy in pollen-induced seasonal allergic rhinoconjunctivitis. BMC Med 2014; 12(1): 71. doi: 10.1186/1741-7015-12-71 PMID: 24885894
  47. Wang C, Zhang L. Specific immunotherapy for allergic rhinitis in children. Curr Opin Otolaryngol Head Neck Surg 2014; 22(6): 487-94. doi: 10.1097/MOO.0000000000000101 PMID: 25207858
  48. Matricardi PM, Kuna P, Panetta V, Wahn U, Narkus A. Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: A comparison based on meta-analyses. J Allergy Clin Immunol 2011; 128(4): 791-799.e6. doi: 10.1016/j.jaci.2011.03.049 PMID: 21620452
  49. Bousquet J, Pfaar O, Agache I, et al. ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy. Clin Transl Allergy 2021; 11(4): e12014. doi: 10.1002/clt2.12014 PMID: 34136127
  50. Mainardi T, Kapoor S, Bielory L. Complementary and alternative medicine: Herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol 2009; 123(2): 283-294.e10. doi: 10.1016/j.jaci.2008.12.023 PMID: 19203652
  51. El-Qutob López D. New methods of prevention and treatment of allergic diseases. Recent Pat Inflamm Allergy Drug Discov 2012; 6(1): 46-64. doi: 10.2174/187221312798889257 PMID: 22022924
  52. Derebery MJ, Dicpinigaitis PV. New horizons: Current and potential future self-treatments for acute upper respiratory tract conditions. Postgrad Med 2013; 125(1): 82-96. doi: 10.3810/pgm.2013.01.2605 PMID: 23391674
  53. Marseglia GL, Licari A, Ciprandi G. A polycentric, randomized, double blind, parallel-group, placebo-controlled study on Lertal®, a multicomponent nutraceutical, as add-on treatment in children with allergic rhinoconjunctivitis: Phase I during active treatment. J Biol Regul Homeost Agents 2019; 33(2): 617-22. PMID: 30968678
  54. Marseglia G, Licari A, Leonardi S, et al. A polycentric, randomized, parallel-group, study on Lertal®, a multicomponent nutraceutical, as preventive treatment in children with allergic rhinoconjunctivitis: Phase II. Ital J Pediatr 2019; 45(1): 84. doi: 10.1186/s13052-019-0678-y PMID: 31319883
  55. Miraglia Del Giudice M, Maiello N, Capristo C, et al. Resveratrol plus carboxymethyl-β-glucan reduces nasal symptoms in children with pollen-induced allergic rhinitis. Curr Med Res Opin 2014; 30(10): 1931-5. doi: 10.1185/03007995.2014.938731 PMID: 24983742
  56. Aragona SE, Ciprandi G. Probiotics for the management of upper respiratory diseases. J Biol Reg Hom Ag 2020; 34(S1): 1-4.

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Declaração de direitos autorais © Bentham Science Publishers, 2024