Adicciones en los adolescentes

Otolaryngol Clin N Am 41 (2008) 347–358

Allergic RhinitisdCurrent Pharmacotherapy
John H. Krouse, MD, PhD
Rhinology and Allergy, Department of Otolaryngology, Wayne State University, 540 E. Canfield, 5E-UHC, Detroit, MI 48201, USA

The treatment of allergic rhinitis (AR) relies on an integrated approach to patient management. The physician has several strategies to use in treating thepatient with AR, and the judicious use of these strategies will result in optimal therapeutic outcomes and improved symptoms and quality of life. Along with environmental control methods and immunotherapy, pharmacotherapy in treating patients with AR remains a reliable and efficacious management strategy. Medications have been used to treat AR for many years and continue to be prescribed frequently forpatients with symptoms of nasal disease. Medications available to treat AR come in a variety of forms, both oral and topical, and have differing degrees of efficacy in the treatment of various symptoms common among patients with AR. Surveys of patients with AR suggest that the primary attribute that leads a patient to prefer one medication over another is rapid and prolonged efficacy in symptom reliefcoupled with the freedom from significant adverse effects (Table 1) [1]. AR is an inflammatory disease of the upper airway that is biphasic in its pathophysiology and symptom presentation [2]. The early phase of the allergic response is primarily mediated by histamine, and acute symptoms related to allergen exposure are predominated by sneezing and itching, with rhinorrhea and congestion also presentbut often somewhat more delayed in their presentation. The late-phase response generally occurs 2 hours or more after an acute allergen exposure, and is mediated by T cell cytokines, such as interleukin-4 and interleukin-5, and cellular infiltration by eosinophils and basophils. These symptoms can be more prolonged than those triggered by histamine alone, and are often predominated by nasalcongestion and posterior rhinorrhea. Understanding the relevant inputs of the early- and late-phase allergic response and the symptom patterns provoked
E-mail address: jkrouse@med.wayne.edu 0030-6665/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.otc.2007.11.014

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Table 1 Patient concerns and preferences regarding characteristicsof allergy medications Concern or preference Wants medication that provides symptom relief Wants medication that provides long-lasting relief of symptoms Wants medication that provides rapid relief of symptoms Has concerns about side effects Wants medication with minimal side effects (other than causing little to no drowsiness) Wants medication that does not cause drowsiness Has concerns about costsWants medication covered by health insurance Wants medication that is inexpensive Wants medication that can be taken safely with other prescription medications Wants medication that is easy to take Wants medication that is not habit-forming Wants medication that accommodates flexible dosing (ie, can be taken on an as-needed basis) Wants medication that targets specific symptoms Wants medicationthat is steroid-free Wants medication that has no aftertaste Has other concerns or preferences about medications Percent of patients 96 88 85 93 84 81 89 82 65 88 75 75 54 53 51 47 1

Total survey population: 1214. Data from Asthma and Allergy Foundation of America (AAFA). Consumer survey 2005. Available at: www.aafa.org/display.cfm?id¼7&sub¼92&cont¼529. Accessed December 20, 2007.

by eachpathophysiologic mechanism can help the otolaryngologist select medications to alleviate patient symptoms and decrease the burden of disease. This article examines various classes of medications used for the treatment of AR. These medications affect various components of the allergic response, with some agents having significant anti-inflammatory benefits. While medications often have preferential effects...