The evolution of pharmacotherapy for rhinitis and urticaria

The efficacy of antihistamines in the treatment of allergic rhinitis and ur ticaria is compared. In treating allergic rhinitis, the new second- and thi rd-generation. antihistamines have multiple advantages including rapid onse t of action, extended duration of action, and efficacy for nearly all the s ymptoms that are produced by allergen sensitization. These include non-nasa l and nasal symptoms. These agents are generally nonsedating and can be adm inistered either once or twice daily. There is minimal potentiation for QTC prolongation, and they are safe and effective as first-line therapies for seasonal allergic rhinitis. They are especially effective when combined vit h topical corticosteroids in reducing the whole constellation of symptomato logy of allergic rhinitis. The treatment of chronic idiopathic urticaria sh ould include second- and third-generation antihistamines as primary therapy . Additional therapy may include H-2 antagonists, antihistamine-decongestan t combinations, tricyclic antidepressants such as doxepin, and beta -adrene rgic agonists including albuterol and epinephrine for acute angioedema. Cor ticosteroids may be required to treat significant exacerbations of chronic urticaria and/or to break a long-standing cycle of urticaria. Miscellaneous therapeutic agents include leukotriene antagonists combined with H-1 H-2 a ntagonists, calcium channel antagonists, plasmapheresis, cyclosporin and me thotrexate.