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Otorinolaringologia 2010 June;60(2):53-64

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

An update on the management of allergic rhinitis

Shintani Smith S. 1, Smith S. B. 2, Chandra R. K. 1, Kern R. C. 1

1 Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 2 Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA


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Allergic rhinitis (AR) is one of the most common medical conditions worldwide. Though numerous treatment modalities exist, AR frequently is unrecognized and under-treated, leading to significant morbidity. The otorhinolaryngologist provides unique medical and surgical expertise to manage the spectrum of AR, from mild intermittent to severe persistent disease. Management should be designed to target the frequency and severity of symptoms in a step-wise fashion. Because AR is an atopic disease, avoidance of allergic stimuli should be the first-line therapy, followed by antihistamines or decongestants on an as-needed basis. Intranasal corticosteroids are the next step for patients with more persistent or severe disease. As the severity of symptoms increases, the anti-leukotriene therapies should be considered as an addition to the above first-line therapies, especially for patients with both AR and asthma. Surgery can be considered for specific populations, especially those with nasal polyposis or anatomic deformities that contribute to persistent symptoms. Finally, immunotherapy should be considered for patients with the most persistent and severe symptoms that are refractory to the aforementioned strategies.

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