Role of Antihistamine and Leukotriene Receptor Antagonist in Allergic Rhinitis Management: Newer Perspectives
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Allergic disorders are conditions induced by the immune system’s hypersensitivity to normally harmless chemicals known as allergens. The most common allergens include dust mites, pollution, grass pollens and food allergens such as milk, egg, soy, wheat, nut, or fish proteins. Allergic diseases include allergic rhinitis (AR), allergic asthma, urticaria, atopic dermatitis, contact allergies and food allergies. AR is the most common of all atopic diseases, afflicting 10%–30% of adults and up to 40% of children all over the world. The mechanisms underlying AR are highly complex and involve multiple immune cells, mediators and cytokines such as histamine and leukotrienes. It is characterized by nasal symptoms such as sneezing, nasal itching, rhinorrhea, and nasal congestion. It is also, associated with non-nasal symptoms such as watery eyes, redness in the eyes or inflammation. It has a significant effect on one’s health, as well as the quality of one’s sleep, work productivity and academic performance. The management of AR includes allergen avoidance, pharmacotherapy, and immunotherapy. Complete avoidance of allergens that trigger AR symptoms is not possible. Current pharmacologic options include antihistamines (oral and intranasal), Leukotriene Receptor Antagonists (LTRAs), Intranasal Corticosteroids (INCS), decongestants and oral and intranasal anticholinergics. Amongst other antihistamines, Bilastine has emerged as a new, non-sedating and well-tolerated antihistamine while Montelukast is an effective add-on LTRA option to an antihistamine with well-established literature in the management of moderate-severe AR. Immunotherapy is a treatment option for patients who have not responded to medication.
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- Pawankar R, Mori S, Ozu C, Kimura S. Overview on the pathomechanisms of allergic rhinitis. Asia Pac. Allergy. 2011;1:157-167.
- Kim H, Bouchard J, Renzi P M. The link between allergic rhinitis and asthma: A role for antileukotrienes? Can Respir J.2008;15(2):91-98.
- Bhargava S, Sheth K, Bharathi MB, Dabholkar Y, Pendakur A, Desai A, et al. Indian guidelines on diagnosis and mange ment of Allergic Rhinitis- A consensus approach.
- Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. World Allergy Organization (WAO) White Book on Allergy: Update. 2013.
- Chandrika D. Allergic rhinitis in India: an overview. Int J Otorhinolaryngol Head Neck Surg. 2017;3(1):1-6.
- Valovirta E. Pawankar R. Survey on the impact of comorbid allergic rhinitis in patients with asthma. BMC Pulm. Med.2006;6:1–10.
- Bjermer L, Westman M, Holmstrom M, Wickman MC. The complex pathophysiology of allergic rhinitis: Scientific rationale for the development of an alternative treatment option. Allergy, Asthma Clin. Immunol.2019;15:1–15.
- Giavina BP, Aun MV, Takejima P, Kalil J, Agondi RC. United airway disease: current perspectives. Journal of Asthma and Allergy.2016;9:93–100.
- Jaggi V, Dalal A, Ramesh BR, Tikkiwal S, Chaudhry A, Kothari N,et al. Coexistence of allergic rhinitis and asthma in Indian patients: The CARAS survey. Lung India.2019;36:411-6.
- Bergeron C, Qutayba H. Relationship between Asthma and Rhinitis: Epidemiologic, Pathophysiologic, and Therapeutic Aspects. Allergy, Asthma, and Clinical Immunology.2005; 1(2):81-87.
- Small P, Keith PK, Kim H. Allergic rhinitis. Allergy, Asthma and Clinical Immunology.2018;14(2):31-41.
- Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, et al. The skin prick test – European standards. Clinical and Translational Allergy.2013;3:3.
- Min YG. The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis. Allergy, Asthma Immunol Res. 2010;2(2):6576.
- Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Tuyet Le LT, et al. Allergic Rhinitis and its impact on asthma update (ARIA 2008) - Western and Asian-Pacific Perspective. Asia Pacific Journal of Allergy and Immunology.2009;27:237-243.
- Krouse JH. Allergic Rhinitis- Current Pharmacotherapy. Otolaryngol Clin N Am. 2008;41:347–358.
- Hossenbaccus L, Linton S, Garvey S, Ellis AK. Towards definitive management of allergic rhinitis: best use of new and established therapies. Allergy, Asthma Clin Immunol.2020;16:39.
- Ridolo E, Montagni M, Bonzana L, Incorvaia C, Canonica GW. Bilastine: New insight into antihistamine treatment. Clinical and Molecular Allergy.2015;13:1.
- Valk PJ, Simons RM, Valiente R, Labeaga L. Cognitive Performance Effects of Bilastine 20 mg During 6 Hours at 8000 ft Cabin Altitude. Aerospace Medicine and Human Performance. 2016;87(7):622-627.
- Horak F. Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis. Therapeutics and Clinical Risk Management 2008;4(5):1009–1022.
- Yu Xu, Zhang J, Wang J. The Efficacy and Safety of Selective H1-Antihistamine versus Leukotriene Receptor Antagonist for SeasonalAllergic Rhinitis: A Meta-Analysis.PLOS ONE.2014;9(11):e112815.
- Okubo K, et al. Efficacy and safety of bilastine in Japanese patients with perennial allergic rhinitis: A multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III study. Allergology International.2016:1-9.
- Kuna P, Bachert C, Nowacki Z, Cauwenbergew P, Agache I, Fouquert L, et al. Efficacy and safety of bilastine 20 mg compared with cetirizine 10 mg and placebo for the symptomatic treatment of seasonal allergic rhinitis: a randomized, double-blind, parallel-group study. Clinical & Experimental Allergy.2009;39:1338–1347.
- Bachert C, Kuna P, Sanquer F, Ivan P, Dimitrov V, Gorina M, et al. Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patients. Allergy.2009: 64: 158–165.
- Rajput MS, Arain AA, Rajput AA, Mohammad A, Ghaffar S, et al. Effect of montelukast on the Symptom Severity Score of Allergic Rhinitis. Cureus12(3):e7403.
- Philip G, Malmstrom K, Hampel FC, Weinstein SF, LaForce CF, Ratner PH, et al. Montelukast for treating seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial performed in the spring. Clin Exp Allergy. 2002;32:1020- 1028.
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