THERAPY OF ALLERGIC RHINITIS

Nasal allergy is due to a change in the immunoreactivity of an individ ual. B-lymphocytes produce allergen-specific IgE antibodies after the antigen is presented to T-helper cells. IgE bound to mast cells leads to mast cell activation in the case of antigen contact. Mast cells rel ease mediators and induce local inflammation. The symptoms of allergic rhinitis are caused by various factors and are different in individua ls, and hence therapy must be in accordance with the necessities in th e individual. There are four principles of therapy in allergic rhiniti s. The first and best is allergen avoidance. It is the first choice in animal allergy and important in mite allergy. It is difficult for mol d allergy and impossible for pollen allergy. The second is immunothera py. Immunotherapy is a specific form of controlled allergen admission that changes immunoreactivity into allergen tolerance in a major part of patients. Immunotherapy is a very important tool if performed by a physician with experience. The third principle is drug therapy. With t odays drugs, it is still symptomatic. alpha-sympathomimetic vasoconstr ictors administered systemically (and, still better, locally) relieve nasal stuffiness. Parasympatholytic drugs can abort pathological secre tions. Cromoglycate (DNCG) is a local prophylactic drug improving all symptoms of allergic rhinitis. DNCG is the first choice in pollinosis. Antihistamines are usually given systemically, and the modem drugs ha ve no sedative effect. Clinical effects are comparable to DNCG, and th ere are new substances available for local therapy. Steroids given sys temically improve all symptoms of allergy and inflammation after a cer tain delay. Due to side effects, local steroids are preferred today. T he fourth principle in the therapy of allergic rhinitis is nasal surge ry. It is often required in sinusitis due to mucosal swelling and can relieve chronic nasal obstruction by correcting the turbinates. In con clusion, the otorhinolaryngologist today has the ability of treating a lmost every aspect in nasal allergy by different therapeutic methods.