The efficacy of intranasal antihistamines in the treatment of allergic rhinitis.

OBJECTIVES: To discuss the new use of intranasal antihistamines as first-line therapies, compare and contrast this class of medication with the traditionally available medications, and discuss the potential for intranasal antihistamines to provide relief superior to second-generation oral antihistamines. DATA SOURCES: Review articles and original research articles were retrieved from MEDLINE, OVID, PubMed (1950 to November 2009), personal files of articles, and bibliographies of located articles that addressed the topic of interest. STUDY SELECTION: Articles were selected for their relevance to intranasal antihistamines and their role in allergic rhinitis. Publications included reviews, treatment guidelines, and clinical studies (primarily randomized controlled trials) of both children and adults. RESULTS: This panel was charged with reviewing the place of intranasal antihistamines in the spectrum of treatment for allergic rhinitis. Intranasal antihistamines have been shown in numerous randomized, placebo-controlled trials to be more efficacious than the oral antihistamines. Although intranasal corticosteroids are considered by some to be superior to intranasal antihistamines, multiple studies have shown an equal effect of the 2 classes of medication. Both intranasal corticosteroids and intranasal antihistamines have been shown to reduce all symptoms of allergic rhinitis. In addition, some intranasal antihistamines have a more rapid onset of action than intranasal corticosteroids. CONCLUSIONS: The future of allergy treatment will likely involve a combination of both intranasal corticosteroids and intranasal antihistamines because of the benefits of local administration and their additive effect on efficacy.

Impact of respiratory symptoms on health-related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers.

BACKGROUND: Respiratory symptoms associated with allergy and asthma cause substantial health care burden. OBJECTIVE: This observational pilot study compared internal medicine/family practice (IM/FP) and pediatric primary care providers with allergists in the diagnosis, treatment, and health-related quality of life (HRQL) outcomes of adults and children with respiratory symptoms. METHODS: Two allergists, 2 IM/FP, and 2 pediatricians enrolled 242 patients with respiratory symptoms ages 5 to 16 years old (n = 123) and 17 to 70 years old (n = 119). HRQL questionnaires were completed at enrollment and quarterly for 1 year. The adult questionnaire included SF-36, respiratory symptom role productivity, ITG Asthma Short Form, and allergy symptom index (ASI) scales. The child questionnaire included CHQ-PF28, respiratory symptom family impact, ITG Child Asthma Short Form, and ASI scales. HRQL changes were evaluated over the study period. RESULTS: Adults treated by allergists reported significantly greater improvement in HRQL on 5 of 8 SF-36 scales, the respiratory symptom role productivity scale, 3 of 5 ITG Asthma Short Form scales, and 2 of 4 ASI scales compared with adults treated by an IM/FP (P < 0.05). Pediatric patients treated by allergists had significantly greater improvement on 3 of 15 CHQ-PF28 scales, the respiratory symptom family impact scale, and one ASI scale compared with patients treated by pediatricians (P < 0.05). CONCLUSIONS: Compared with patients treated by primary care physicians, patients treated by allergists reported greater improvement in HRQL in a number of scales. Additional research is required to further evaluate the impact of provider specialty and patterns of care on outcomes of respiratory symptoms patients.