OPTIMUM TREATMENT OF RHINITIS IN THE ELDERLY

With aging, multiple physiological changes occur in the connective tis sue and vasculature of the nose which may predispose or contribute to chronic rhinitis, Accurate differentiation of allergic from nonallergi c causes of rhinitis requires skin testing or in vitro measures of spe cific IgE. Empiric treatment with over-the-counter first generation an tihistamines and oral decongestants frequently results in CNS, anticho linergic and cardiovascular adverse effects. While newer second genera tion histamine antagonists do not cause these problems, selected drugs in this class may cause electrocardiographic QT prolongation and, in rare cases, ventricular arrhythmias, Topical therapies including sodiu m cromoglycate (cromolyn sodium), corticosteroids and ipratropium brom ide are all well-tolerated with minimal adverse effects. Avoidance of allergens and/or irritants is an important adjunct in treating patient s with allergic and vasomotor rhinitis. If all other therapies fail in patients with confirmed allergic rhinitis, immunotherapy can be safel y instituted in most older patients.