**6. Vasoconstrictors (α-adrenergics)**

74 Otolaryngology


The dose is 20-40 mg every 6 hours in each nostril. Therapeutic non-compliance with the

It is effective in the treatment of AR, especially in patients with high IgE (Okuda et al, 1985).

DSCG performs better than placebo in studies on pollen-sensitized patients. In a doubleblind study that included 104 patients and took place over 6 weeks, authors found




A pyrano quinoline dicarboxylic acid, nedocromil sodium has a half-life of 90 minutes, and is eliminated by the liver and kidneys. It acts extracellularly because it does not pass through the lipid membranes due to its physicochemical properties. It acts by blocking the chloride channels that are responsible for cellular activity. It inhibits the release of

Although its mechanism of action is similar to DSCG, nedocromil sodium acts on other types of cells: eosinophils, neutrophil, macrophages, platelets and monocytes (Kaulbach et al, 1992). Side effects are rare, similar to those of DSCG, although nausea, vomiting, dizziness and headaches have been reported. It is administered by inhalation in doses of 4 mg twice a day. This lower frequency of administration is an advantage over DSCG. Studies demonstrated

The magnesium salts of N-acetylaspartylglutamate (NAAGA) acid are effective in the

Althaus performed a multicentre double-blind study for 4 weeks in pollen-allergic patients. Sixty-three patients were treated with NAAGA, 63 others with cromolyn sodium and 64

phosphodiesterase and regulating the calcium retention mechanism.

no significant side effects have been reported in long-term treatments.

dosage is the main cause for the lack of spectacular results.

It is important to note that during administration: - The container should be protected from light.

usually temporary and lasts only a short time.

essential.

severe symptoms.

**5.2 Nedocromil sodium** 

its clinical efficacy in allergic rhinitis.

**5.3 N-acetylaspartylglutamate acid** 

treatment of seasonal allergic rhinitis.

It works to prevent sneezing and rhinorrhoea, but not obstruction.

significant improvement with minimal side effects (Handelman et al, 1977).


histamine, leukotriene C4, prostaglandin D2 and chemotactic factors.

histamines and eosinophil/neutrophil chemotactic factors. It has no effect on basophils (Okuda et al, 1985). It increases the intracellular level of cyclic AMP, inhibiting

> Vasoconstrictors are sympathomimetic drugs may act on α-receptors, causing vasoconstriction, or on β-receptors (vasodilation). The use of α-adrenergics in rhinitis is based on its ability to cause vasoconstriction, reducing blood flow in vessels and reducing secretions.

They are widespread in Spain, and should not be administered without medical supervision.

Those that are used topically are imidazole derivatives: oxymetazoline, naphazoline and xylometazoline. They should not be administered for more than 7 days as their prolonged use causes the onset of a rebound effect by secondary hyperaemia. This effect occurs a few hours after administration and may be interpreted by the patient as a sign of illness, which may make them increase the dose.

Vasoconstrictors have a significant effect on nasal obstruction, but continued use may cause drug-induced rhinitis, creating a dependence on nasal drops. Administration to children less than 1 year of age is dangerous.

Based on their study, Graf and Juto recommended avoiding the use of oxymetazoline in nasal spray for more than 10 days due to it causing hyperreactivity in the nasal mucosa, thus increasing susceptibility to histamines (Graf & Juto, 1994). These authors showed the lack of rebound with xylometazoline in nasal spray, when used at the recommended dosage, even over twice the recommended time period (Graf & Juto, 1995).

In the same time, other authors demonstrated the benefit of oxymetazoline above all, and xylometazoline somewhat less, in the topical treatment of nasal inflammation of rhinitis, due to its antioxidant properties (Westerveld et al, 1995).

Graf et al, in a study of oxymetazoline, benzalkonium chloride and placebo in nasal spray, found that prolonged use (more than recommended) induced an increase in nasal hyperreactivity and the feeling of nasal obstruction, developing into secondary druginduced rhinitis. This may be related to the presence of benzalkonium in decongestant nasal sprays, which can produce or exacerbate drug-induced rhinitis (Graf & Hallen, 1996). Other authors performed a 4 to 8-week study with oxymetazoline and showed that it was safe, if used once a day, preferably at night (Yoo et al, 1997).

Moreover, it was confirmed that oxymetazoline and xylometazoline were beneficial in the treatment of upper respiratory tract inflammation, due to their dose-dependent inhibitory effects on nitric oxide synthase activity (Westerveld et al, 2000)

Stubner studied the efficacy of cetirizine associated with pseudoephedrine, comparing it to xylometazoline at 0.1% in nasal spray. With the exception of nasal obstruction, which improved quickly with xylometazoline nasal spray, the rest of the rhinitis symptoms (mainly the reduction of nasal secretions) clearly improved with the combination of anti-Hl and pseudoephedrine (Stubner et al, 2001).

Treatment of Allergic Rhinitis:

Electronic ISSN 1097-6825.

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## **7. Conclusions**

Considering the reviewed data, and unifying the above-mentioned opinions on the treatment of AR, we provide the following guidelines:


#### **8. References**


Wellington compared the efficacy of the cetirizine-pseudoephedrine combination (5/120), administered twice a day with 100 micrograms of intranasal budesonide for 23 weeks. The study found that the cetirizine-pseudoephedrine combination was clearly more effective than monotherapy, significantly reducing the score symptoms for both allergic and

Considering the reviewed data, and unifying the above-mentioned opinions on the





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**7. Conclusions** 

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**8. References** 

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**6** 

*Talavera de la Reina* 

*Spain* 

**Treatment of Allergic Rhinitis:** 

Jesús Jurado-Palomo1, Irina Diana Bobolea2,

*3Centro de Salud La Solana, Talavera de la Reina* 

**Specific-Allergen Immunotherapy** 

María Teresa Belver González2, Álvaro Moreno-Ancillo1, Ana Carmen Gil Adrados3 and José Manuel Morales Puebla4 *1Department of Allergology, Nuestra Señora del Prado General Hospital,* 

**Anticholinergics, Glucocorticotherapy,** 

**Leukotriene Antagonists, Omalizumab and** 

*2Department of Allergology, Hospital La Paz Health Research Institute (IdiPAZ), Madrid* 

Throughout history, various classifications of rhinitis have emerged, many of which originated from expert groups. We would have to go back to 1994 to find the "*International Consensus Report on Diagnosis and Management of Rhinitis*" (International Rhinitis Management Working Group, 1994), which was subsequently modified in the 2000 "*Consensus statement on the treatment of allergic rhinitis*. *EAACI Position paper"* (Van Cauwenberge et al, 2000). Of particular interest is the "*Executive Summary of Joint Task Force Practice Parameters on Diagnosis and Management of Rhinitis"* of 1998 (Dykewicz & Fineman, 1998). In 2001, a group of experts, the *"Allergic Rhinitis and its Impact on Asthma (ARIA) Workshop Expert Panel"*, met to develop guidelines on the diagnosis and treatment of rhinitis, which also dealt with other inflammatory processes interrelated/associated with asthma. The acronym "ARIA" comes from "Allergic Rhinitis and its Impact on Asthma". ARIA is a document from a non-governmental organisation of the World Health Organization (WHO), endorsed by numerous scientific societies, such as the International Association of Allergology and Clinical Immunology (IAACI) and the World Allergy Organization (WAO)

It was established as an educational program as the "Guidelines for recommendations for the diagnosis and comprehensive handling of patients with rhinitis", associated with

In this chapter, we revised others modalities of treatment for AR; anticholinergics, glucocorticotherapy, leukotriene antagonists, omalizumab and specific-allergen

asthma and other interrelated processes (sinusitis, conjunctivitis and otitis).

**1. Introduction** 

(Bousquet et al, 2001).

immunotherapy.

*4Department of Otorhinolaryngology, University General Hospital, Ciudad Real* 

