The onset of allergic rhinitis not only brings many troubles to the patient’s work and life, but also may cause serious adverse reactions to patients due to irrational use of drugs. The following authors talk about the differences between commonly used drugs for the treatment of allergic rhinitis according to domestic and foreign guidelines.
I. Commonly used drugs for allergic rhinitis
Allergic rhinitis is an IgE-mediated nasal mucosal inflammatory reaction. The main symptoms include: nasal congestion, nasal itching, clear watery sputum, and sneezing. Commonly used treatments:
Three types of drugs: nasal glucocorticoids, oral or nasal second-generation antihistamines, oral anti-leukotriene receptor antagonists, are first-line treatments for allergic rhinitis, recommended.
Three types of drugs: oral or nasal mast cell membrane stabilizer, nasal decongestant, nasal anticholinergic, a second-line treatment for allergic rhinitis, as appropriate.
Two types of drugs: oral glucocorticoids, oral decongestants, in addition to severe allergic rhinitis, generally not recommended.
II. First-line treatment drugs
1. Nasal glucocorticoids
Commonly used drugs: mometasone furoate, fluticasone propionate, budesonide, and the like.
Function characteristics: 1 recognized as the most effective and most important drugs; 2 continuous medication is significantly better than discontinuous medication, the course of treatment is not less than 2 weeks; 3 efficacy peaks within 1 week, if there is no obvious effect after 1 week of medication, then May be invalid.
Special reminder: Clinical studies have shown that mometasone furoate, fluticasone propionate and budesonide have less systemic absorption.
2. Oral or nasal second-generation antihistamines
Oral drugs: cetirizine, loratadine, fexofenadine, etc.; nasal drugs: azelastine, levocabastine and the like.
Function characteristics: 1 curative effect is not as good as nasal glucocorticoid, but can effectively control mild, and most of the moderate-to-severe allergic rhinitis; 2 has good effect on nasal itching, sneezing and salivation, limited effect on nasal congestion; 3 fast onset , can be administered “on demand”.
Special reminder: The first generation of antihistamines (chlorpheniramine, ketotifen, etc.) have central inhibition and anticholinergic effects and are not recommended for children, the elderly and drivers.
3. Oral leukotriene receptor antagonists
Commonly used drugs: montelukast
Function characteristics: 1 relieve nasal symptoms should be weaker than nasal hormones; 2 improve nasal congestion, better than second-generation oral antihistamines; 3 apply to allergic rhinitis with asthma.
III. Second-line treatment drugs
1. Mast cell membrane stabilizer
Commonly used drugs: sodium cromoglycate, pyrimilast and tranilast.
Function characteristics: 1 improve the nasal congestion effect is not obvious; 2 slow onset, need to use 2 weeks in advance; 3 short duration of action, 3 to 4 times a day.
2. Nasal decongestant
Commonly used drugs: 0.05% oxymetazoline, 0.05% celazoline.
Function characteristics: 1 can quickly relieve nasal congestion, no effect on other nasal symptoms; 2 strict control of the number of medications, the course of treatment is not more than 7 days; 3 can be combined with nasal hormones for short-term use.
3. Nasal anticholinergic drugs
Commonly used drugs: 0.03% ipratropium bromide.
Function characteristics: 1 can effectively reduce nasal secretions, no obvious effect on other symptoms; 215~30 minutes, the effect is maintained for 4~8 hours; 3 rarely systemic absorption, safety is better.
IV. Treatment of allergic rhinitis with asthma
Nearly 50% of asthma patients with allergic rhinitis, 10% to 40% of patients with allergic rhinitis with asthma.
For patients with allergic rhinitis with asthma, it is recommended to use: nasal glucocorticoids, or oral leukotriene antagonists.
V. Combination therapy
1. Nasal hormone + nasal antihistamine
Moderate-severe allergic rhinitis: nasal hormone + nasal antihistamine, fast onset and good curative effect. However, nasal hormone + oral antihistamines have not proven to have additional clinical benefit.
2. Nasal hormone + oral leukotriene antagonist
Moderate-severe allergic rhinitis: Oral leukotriene antagonists may be added to patients who have not been well controlled after treatment with a single nasal glucocorticoid.
3. Oral antihistamine + oral leukotriene antagonist
Seasonal allergic rhinitis: The efficacy of oral antihistamines + oral leukotriene antagonists is better than oral antihistamines alone or oral leukotriene receptor antagonists alone.