The treatment of rhinitis will depend on the type of rhinitis that is suffered. If it is allergic rhinitis, the first line of treatment will be to avoid contact with the allergen trigger agent. However, in cases where it is not sufficient to avoid exposure to the allergen, the patient should be treated with drugs or with immunological therapy .
Treatment of rhinitis: pharmacological
The treatment of rhinitis of pharmacological type varies according to the severity and the persistence of the symptoms. The characteristics that the ideal medicine for rhinitis should present are the following:
- Same efficacy in the symptoms of the acute phase as in the late phase.
- Form of administration that ensures compliance.
- Direct release on the nasal mucosa.
- Little adverse effects
- Fast action
The antihistamine H1 (AH1), nasal decongestants, corticosteroids and mast cell membrane stabilizers are distinguished within the pharmacological treatment of rhinitis.
Histamine is the substance responsible for the processes of allergy and rhinitis. Therefore, one of the objectives of the treatment will be to inhibit the secretion of this substance.
When rhinitis occurs with nasal obstruction, they are usually associated with decongestants.
Within the oral AH1, we have the following classification:
- 1st generation These produce sedation, constipation or tachycardia, as they are able to reach the brain through the blood-brain barrier. In this group are:
- 2nd generation. They do not usually induce sedation and have less affinity for histamine receptors in the central nervous system. These drugs are:
- Cetirizine: This drug does produce sedation.
In general, the AH1 of 2nd generation are a great advantage in patients who need a high degree of alertness in their work. In addition, they help to improve therapeutic compliance since their administration schedule is every 12-24 hours.
In children these antihistamines are associated with cromoglycate, this combination therapy is considered the treatment of choice in childhood. However, the 2nd generation AH1 are not exempt from problems but can develop cardiac or hepatic pathologies, which is why they are contraindicated in heart patients and patients with liver insufficiencies.
Topical H1 antihistamines
To this group of drugs belong azelastine and levocastins, which have an efficacy similar to that of oral AH1 and a lower incidence of nasal congestion. However, azelastine is not effective against ocular symptoms and, despite belonging to the 2nd generation AH1, produces sedation.
Topical AH1s are suitable for pregnant women and nursing mothers since they are not absorbed and do not enter the bloodstream
Oral AH1 are less potent than intranasal coticosteroids to improve the general symptoms of allergic rhinitis, but they relieve eye symptoms to a greater extent. Topical AH1 have an efficacy similar to cromoglycate.
These are agents that are administered topically or orally and that have the ability to very effectively reduce the nasal congestion of the various types of rhinitis. Oral decongestants, phenylephrine or pseudoefredia, despite their effectiveness, can produce:
Nasal decongestants are suitable for the elderly and pregnant women (although its use during the first trimester is discouraged due to possible defects in the fetus). Topicals such as phenylephrine, oxymetazoline or xylometazoline produce nasal vasoconstriction, decreasing edema. Its prolonged use can produce rebound rhinitis.
Corticosteroids are the most effective for the treatment of all symptoms of allergic rhinitis, except for ocular symptoms. All thanks to its anti-inflammatory action.
Nasal administration corticosteroids modulate the cellular and humoral immune mechanism. They present a greater efficacy than the rest of the medicines used for the treatment of rhinitis. Despite the above characteristics, they have a slower onset of action.
Sometimes they are associated with topical AH1 in severe allergic rhinitis , or decongestant in case of marked nasal obstruction. On the other hand, systemic corticosteroids are administered as an alternative to nasal in the case of very serious allergic rhinitis or refectaria to other treatments.
Mast cell membrane stabilizers
These drugs, specifically sodium cromoglycate have no antihistamine effect, but act on mast cells, so they provide for the release of the factors that trigger the allergic reaction.
Although the frequency of administration can hinder compliance, the good safety profile of cromoglycate makes it considered as a topical rhinitis treatment of choice in the elderly, children and pregnant women.
Within this group we highlight the ipratropium bromide that is able to reduce cholinergic hyperactivity by decreasing secretions, although it has no effect on the remaining nasal symptoms.