Management of allergic rhinitis in the era of effective over-the-counter treatments

ABSTRACT

Allergic rhinitis (AR) may be regarded as a trivial issue unworthy of the doctor’s time, and with the availability of many different over-the-counter (OTC) treatments, up to two thirds of patients self-manage AR before seeking medical care. Yet, AR can have a significant impact on health-related quality of life and is associated with a greater detriment to work productivity than other chronic diseases such as diabetes and hypertension. For many patients, the impact on quality of life is greater than suggested by reported symptoms and should also be a focus of treatment.

Although many patients can effectively manage AR symptoms independently, a significant percentage will need direction from a physician to obtain optimal results. The availability of several different classes of treatment – including decongestants, sedating and non-sedating antihistamines, and more recently intranasal corticosteroids (INS) – has increased the complexity of self-management, leaving patients confused about the best approach to treatment. Treatment guidelines universally classify INS as the most effective medical agents available for use in the OTC and primary care settings. Many patients are unaware that INS are available OTC and that they are more effective than other therapies. Patients may have negative perceptions about the safety of INS and may have experienced unpleasant taste, scent, and feel with nasal sprays. Unless a patient volunteers the information, healthcare professionals (HCPs) may be unaware that the patient has significant AR and is using one or more OTC AR therapies. To address this gap in communication, HCPs must be proactive in identifying, assessing, and advising patients with AR, including best strategies to assess allergen trigger symptoms, which treatments are appropriate, and when and how to use them. Proper use of delivery devices is especially important. This article reviews the primary care management of AR in the context of the availability of effective OTC medicines.

KEYWORDS:

• Allergic rhinitis
• antihistamine, intranasal
• antihistamine, oral
• cromolyn sodium
• decongestant
• immunotherapy
• intranasal corticosteroid
• leukotriene receptor antagonist

Acknowledgments

Medical writing assistance was provided by James Street, PhD and Diane Sloan, PharmD, of Peloton Advantage and was funded by GlaxoSmithKline Consumer Healthcare. GlaxoSmithKline Consumer Healthcare provided a full review of the article.

Declaration of interest

W Carr is a consultant for Boehringer Ingelheim, Genentech, Mylan, and Teva, and a speaker for Alcon, AstraZeneca, Boehringer Ingelheim, Meda, and Teva. B Yawn is a consultant for ThermoFischer for developing guidelines for use of ImmunoCap in patients with asthma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Supplemental data

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was sponsored by GlaxoSmithKline Consumer Healthcare.