**8. Conclusions**

100 Otolaryngology

The ARIA document clearly states that immunotherapy (IT) is considered effective in AR, and that it is the only treatment that can change the natural course of the disease and

IT, both subcutaneous and sublingual, is an effective treatment for adults and children with severe AR that does not respond to conventional pharmacotherapy and allergen avoidance measures. The efficacy of IT depends on correct patient selection, the type of allergen and the product chosen for treatment. Each vaccine requires individual assessment before recommendation for routine use. In support of the conclusions of recent meta-analyses, data have provided further evidence for the efficacy of Sublingual immunotherapy (SLIT) at least

Due to the increased prevalence of AR, its impact on quality of life, its societal costs and the fact that it is a predisposing factor for asthma, new therapeutic options are being sought. Studies are being performed with anti-leukotrienes, anti-immunoglobulin E antibodies,

Schultz et al state that, in addition to the well established therapeutic guidelines in the treatment of rhinitis with antihistamines, corticosteroids, nasal decongestants, etc., there are an increasingly number of new therapeutic alternatives, such as anti-leukotrienes, antiimmunoglobulin E antibodies, phosphodiesterase inhibitors and intranasal heparin, as well as new specific immunotherapies (recombinant). There are promising results, but more

Bjermer and Diamant observed that, although inhaled corticosteroids are currently considered first-line drugs in the anti-inflammatory control of asthma and rhinitis, there are studies with anti-leukotrienes and anti-immunoglobulin E that are highly promising. Clinical trials are being performed with modified cytokines (Bjermer & Diamant, 2004).

Koreck et al reported on *low intensity UVB, UVA and visible light phototherapy* as treatment for AR (3 times per week for three weeks). The authors reported that there was a significant reduction in the number of eosinophils, ECP and IL-5 in the nasal lavage. They also found inhibition in the RBL-2H3 mediator release of basophils. Phototherapy is a new option in the treatment of immunologically mediated mucosal diseases, including allergic rhinitis (Koreck

Kirchhoff et al used the *H1-receptor antagonist dimethindene maleate* topically on patients with seasonal allergic rhinitis for 2 weeks and compared it with placebo. With this antagonist, they achieved statistically significantly better results in the quality of life questionnaires for

Unal et al investigated the potential benefits of the *toxin botulinum type A* on nasal symptoms of allergic rhinitis, and compared it to an isotonic saline solution as placebo. The results were significantly better in patients treated with botulinum toxin, especially in rhinorrhoea, nasal obstruction and sneezing. In selected cases, the injection of intranasal toxin botulinum

**7. Therapeutic developments in the treatment of allergic rhinitis (AR)** 

phosphodiesterase inhibitors, and others, which seem to confirm promising results.

studies are needed to confirm these initial data (Schultz et al, 2003).

rhinitis than with placebo (Kirchhoff et al, 2003).

may help control allergic rhinitis symptoms (Unal et al, 2003).

prevent its evolution into asthma (Bousquet et al, 2008).

for grass pollen-induced (Table 2).

et al, 2005).

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

