Rhinitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]


Rhinitis is a heterogegeous disorder that is frequently undertreated or ignored.[1] It is a highly prevalent disease that can significantly affect the quality of life of individuals affected. Chronic rhinitis is also one of the most common diseases seen by physicians. A thorough understanding of the pathophysiologic mechanisms involved and the various treatment modalities, would ultimately result in both patient and physician satisfaction.


Treatment of Allergic Rhinitis

The treatment of allergic rhinitis includes the following key components:[2][3][4]


The choice of pharmacotherapy in allergic rhinitis is based on the severity and persistence of the disease, as depicted in the table below.

Medical Treatment of Allergic Rhinitis
Severity of Rhinitis Medication

(Use in conjunction with allergen avoidance and saline douching)

Treatment Failure

(Ensure patient adherence to treatment before making changes to the treatment plan)

Evaluation and treatment of associated conditions
Mild Nonsedating oral/intranasal antihistamine Consider intranasal steroids
Moderate Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine) Persistent/uncontrolled symptoms after 2-4weeks of treatment:
  • Increase dose of intranasal steroid
  • Consider targeted medications such as Ipratropium for rhinorrhea, short-term(not >5 days) intranasal decongestant for nasal obstruction, non-sedating antihistamine for primary complaints of sneezing and itching, etc
  • +/- short course of oral corticosteroids in patients who continue to have persistent, severe symptoms (especially when very significant edema of the nasal mucosa is seen)

Failure of medical therapy:

Severe Intranasal corticosteroid (+/- nonsedating oral or intranasal antihistamine)

Other Medications

  • Leukotriene receptor antagonists: These can be prescribed for children with allergic rhinitis and concomitant asthma. It can also be of benefit in children with seasonal allergic rhinitis. They are not recommended for use in adults with persistent allergic rhinitis, and they should not be offered as primary therapy for the treatment of allergic rhinitis.[5][2][3]

Allergen-Specific Immunotherapy[6]

This entails the repeated administration of specific allergens to patients with IgE-mediated conditions in order to provide protection against the allergic symptoms and inflammatory reactions that are associated with the natural exposure to the allergens. Allergen immunotherapy is effective in the management of allergic disorders such as allergic rhinitis, allergic conjunctivitis, asthma, and stinging insect hypersensitivity. It can be administered via the subcutaneous or the sublingual routes. For immunotherapy to be considered, positive skin/RAST test results for specific IgE antibodies should correlate with the suspected allergen and patient exposure. Some of the indications for immunotherapy are:

  • Poor control of symptoms with medications and allergen avoidance
  • Unacceptable adverse effect of medication
  • Patient's desire to reduce the long-term use of medications

Treatment of Nonallergic Rhinitis

Nonallergic rhinitis comprises a heterogeneous group of disorders that are not completely understood.[7] There are no specific guidelines for most forms of nonallergic rhinitis. Known triggers of rhinitis should be avoided when possible. Nasal irrigation with saline also helps alleviate the symptoms and patients should be properly educated on how to perform saline douching. Each form of nonallergic rhinitis should be treated individually.[8]

Infectious Rhinitis[9]

The treatment is usually supportive but medications such as glucocorticoids, antibiotics, and other therapeutic measures are sometimes necessary when severe or complicated rhinosinusitis ensues.[9]

Vasomotor Rhinitis[8]

Vasomotor rhinitis can be treated with intranasal antihistamines such as Azelastine and/or intranasal corticosteroids.

Gustatory Rhinitis

Gustatory rhinitis can be treated effectively with intranasal anticholinergic medications when necessary.[10][8] However, the avoidance of the implicated food is the first line treatment modality.[10] Vidian nerve neurectomy is sometimes used as a last resort in the management of patients,[11] this approach is however not recommended because it is usually short-lasting and has frequent unpleasant side effects.[10]

Nonallergic Rhinitis with Eosinophilic Syndrome (NARES)[8]

Patients with NARES show good response to topical intranasal steroids. However, NARES is now an uncommon diagnosis as physicians seldom do nasal cytologic examinations.


  1. Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
  2. 2.0 2.1 2.2 Lee S (2014). "Practical clinical approaches to the allergic rhinitis patient". Int Forum Allergy Rhinol. 4 Suppl 2: S66–9. doi:10.1002/alr.21389. PMID 25182359.
  3. 3.0 3.1 Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
  4. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
  5. 5.0 5.1 Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: Allergic rhinitis". Otolaryngol Head Neck Surg. 152 (1 Suppl): S1–43. doi:10.1177/0194599814561600. PMID 25644617.
  6. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I; et al. (2011). "Allergen immunotherapy: a practice parameter third update". J Allergy Clin Immunol. 127 (1 Suppl): S1–55. doi:10.1016/j.jaci.2010.09.034. PMID 21122901.
  7. Sin B, Togias A (2011). "Pathophysiology of allergic and nonallergic rhinitis". Proc Am Thorac Soc. 8 (1): 106–14. doi:10.1513/pats.201008-057RN. PMID 21364228.
  8. 8.0 8.1 8.2 8.3 Kaliner MA (2011). "Nonallergic rhinopathy (formerly known as vasomotor rhinitis)". Immunol Allergy Clin North Am. 31 (3): 441–55. doi:10.1016/j.iac.2011.05.007. PMID 21737036.
  9. 9.0 9.1 Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA; et al. (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin Infect Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350 PMID 22438350 Check |pmid= value (help).
  10. 10.0 10.1 10.2 Jovancevic L, Georgalas C, Savovic S, Janjevic D (2010). "Gustatory rhinitis". Rhinology. 48 (1): 7–10. doi:10.4193/Rhin07.153. PMID 20502728.
  11. Georgalas C, Jovancevic L (2012). "Gustatory rhinitis". Curr Opin Otolaryngol Head Neck Surg. 20 (1): 9–14. doi:10.1097/MOO.0b013e32834dfb52. PMID 22143339.

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