Pharmacotherapy of allergic rhinitis: current options and future perspectives

Introduction: Allergic rhinitis (AR) is a very common disease, caused by environmental aeroallergen, and clinically expressed by sneezing, nasal itching, rhinorrhea and obstruction. It is often considered a mild illness, but actually it has a significant individual and social burden. The management of AR is based on allergen avoidance, pharmacological treatment and allergen specific immunotherapy. Areas covered: In this article, the authors summarize the current status of pharmacotherapy of AR, its possible options and the future perspective. Expert opinion: In most cases of AR, pharmacotherapy must be considered the cornerstone intervention. Particularly, antihistamines and intranasal corticosteroids should be the first-line agents. Other agents to be considered, depending on clinical features in single patients, are systemic corticosteroids, antileukotrienes, anticholinergics, nasal decongestants and mast cell stabilizers. Specific immunotherapy is able to reduce the drugs consumption and was shown to be effective in severe rhinitis uncontrolled with drugs. The future perspective include combination therapy with intranasal antihistamines and corticosteroids, the anti-IgE antibody omalizumab, histamine H3 and H4 receptor antagonists, cytokine inhibitors and toll-like receptors targeted treatment.