**1. Introduction**

82 Otolaryngology

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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) (Bousquet et al, 2001).

It was established as an educational program as the "Guidelines for recommendations for the diagnosis and comprehensive handling of patients with rhinitis", associated with asthma and other interrelated processes (sinusitis, conjunctivitis and otitis).

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

Treatment of Allergic Rhinitis: Anticholinergics, Glucocorticotherapy,

depending on the type of injection (Ohlander et al, 1980)

the 3 groups in the first two days following the injection.

(Brown et al, 1960).

(Laursen et al, 1987).

weeks (Ganderton & James, 1970).

Leukotriene Antagonists, Omalizumab and Specific-Allergen Immunotherapy 85

methylprednisolone in one-week intervals, achieved significant improvement of symptoms

In the decade of the 70´s, other authors prescribed 2 injections of 80 mg of methylprednisolone with 14-day intervals to 8 patients with seasonal AR. Cortisol levels decreased after the injection, and patients began to recover and return to normal after 3

McMillin scheduled an 80 mg injection of triamcinolone acetonide to 18 patients with severe AR, and measured morning plasmatic cortisol levels for 21 days. Although the levels descended on several occasions, the initial values were recovered after 3 weeks (Mc Millim, 1971).

In the decade of the 80´s, various clinicians studied the results of administering an injection of 5 mg of betamethasone dipropionate, another of 3 mg of betamethasone phosphate, with 3 mg of betamethasone acetate, and a third of 40 mg of methylprednisolone. These injections were administered to 60 patients with significant AR, who were divided into 3 groups

Methylprednisolone and beclomethasone dipropionate (BDP) reduced the production of endogenous cortisol for at least 14 days, while the combination of phosphate and betamethasone acetate did not suppress plasma cortisol in 12 days. Glycaemia increased in

Hedner et al, prescribed an injection of 80 mg of methylprednisolone to 14 patients with AR. Baseline cortisol and plasma cortisol response to hypoglycaemia had moderate but significant reductions at 2 weeks, although they returned to normal in 4 weeks (Hedner & Persson, 1981). Almost in parallel, Borum et al performed two trials in 24 patients with AR. In the first, they gave an injection of 80 mg of methylprednisolone at the start of the pollen season, and in the second, they gave it at the peak of the pollen season (Borum et al, 1987). In the first group, the effect lasted the entire season (at least 5 weeks), with all symptoms disappearing. In the second group, the injection had a rapid effect on nasal obstruction, which disappeared and did not return in the remaining 5 weeks of pollen season. Rhinorrhoea and sneezing did not disappear as noticeably as in the first group and reappeared in a few weeks. The use of

rescue anti-Hl, however, was clearly inferior in both groups, compared to placebo.

rhinoconjunctivitis symptoms, compared to placebo and topical steroid treatment.

Laursen et al studied the effect of a 5 g injection of betamethasone dipropionate and 2 mg of betamethasone, immediately before the start of the birch pollen season (study was performed in Denmark). They found that these patients had fewer symptoms, especially nasal obstruction, than patients treated with placebo, with the effect lasting 4 weeks

In 1988, the following year, these same authors performed a double-blind placebo-controlled trial with 30 adults with rhinoconjunctivitis (RC) who were allergic to seasonal birch pollen (Laursen et al, 1988). The patients were treated with 100 micrograms of BDP in each nostril twice a day for 4 weeks. Patients received either a placebo or an injection of 5 mg of BDP and 2 mg of betamethasone phosphate, immediately before the start of the birch pollen season. The authors concluded that an injection of BDP and betamethasone phosphate immediately before the birch pollen season produced a significant reduction in
