Pharmacotherapy of allergic rhinitis

Pathogenetic rationale for therapy

To make a competent choice of medications, it is necessary to clearly understand the nature of the pathological process. The basic pathogenetic foundation of the disease is exclusively allergic inflammation.

During differential diagnosis and selection of the therapeutic target, it is important for the physician to remember that the inflammatory response in this pathology is induced exclusively by the exposure to specific clinically relevant allergens. It fundamentally differs from other types of inflammatory reactions encountered in the clinical practice of an otorhinolaryngologist or pediatrician:

• It is not an infectious inflammation (does not require routine prescription of antibacterial or antiviral agents).
• It is not a neurogenic inflammation (has different mechanisms of vascular and tissue reaction).
• It does not belong to classical autoimmune inflammation.

It is precisely the targeted effect on the allergic response cascade that determines the effectiveness of all prescribed pharmacological groups.

Treatment approaches depending on severity

Patient management tactics are strictly stratified depending on the severity of clinical symptoms. Pharmacotherapy is stepwise in nature.

Mild therapy In a mild course of the disease, basic medication support is prescribed. The drugs of choice (the basis of basic therapy) in this clinical situation are 2nd generation antihistamines. A key feature of their use at this stage is the systemic route of administration — they are prescribed in oral (tablet) form. This effectively blocks receptors and relieves the initial manifestations of the allergic response without the need for heavier drug groups.

Severe exacerbation therapy A completely different approach is required when pronounced symptoms develop. Using severe exacerbation of seasonal allergic rhinitis as an example, it is shown that the capabilities of oral antihistamines become insufficient. In such cases, the therapy of choice is the prescription of glucocorticoids. To minimize systemic side effects and achieve the maximum concentration of the active substance in the focus of inflammation, these drugs are used exclusively in a topical (intranasal) form.

Regulatory framework and clinical guidelines

Modern pharmacotherapy is not based on the empirical experience of an individual physician, but is strictly regulated by authoritative consensus documents. The practicing specialist must rely on current national and international guidelines that summarize the principles of evidence-based medicine.

In pediatric and allergological practice, two key documents serve as fundamental guides:

1. Russian RADAR program (Allergic rhinitis in children: guidelines and algorithm). This national consensus adapts global practices to the realities of domestic healthcare and provides clear management algorithms for children.
2. International ARIA document (Allergic Rhinitis and its Impact on Asthma). This global initiative emphasizes the systemic nature of the allergic process and focuses physicians' attention on the inextricable link between upper respiratory tract pathology and the risks of developing or exacerbating bronchial asthma.

Class and exam questions

What else to study on this topic

• Mechanisms of action of 2nd generation antihistamines
• Pharmacodynamics of topical intranasal glucocorticoids
• Detailed analysis of treatment algorithms according to the RADAR program
• Pathogenetic relationship between allergic rhinitis and bronchial asthma (ARIA concept)

Other topics in "Chapter 5. Allergic Diseases"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.