Quality of life scales in allergic rhinitis

Allergic rhinitis characterization in community pharmacy customers: a cross-sectional study

Background Allergic rhinitis represents a public health problem that is significantly prevalent in the global population and has been associated with asthma, a strong desire to sleep and a low quality of life. Objective This study aims to evaluate the prevalence, symptoms, control strategies and treatment, as well as the control of this condition and its impact on the quality of life of customers of community pharmacies with allergic rhinitis. Setting A questionnaire survey was carried out in nine community pharmacies in the city of Guarda, Portugal. Method In this cross-sectional study, data was collected by an interview between May 2014 and December 2014. The control of the illness and the impact of allergic rhinitis on the quality of life were assessed through a CARAT10 test and a WHOQOL-BREF instrument, respectively. Main outcome measure The impact of allergic rhinitis on the patient's quality of life. Results The estimated prevalence of allergic rhinitis was between 10.8% and 15.4%, from which 63 and 42 individuals were medically and symptomatically diagnosed, respectively, from a study population of 804 respondents. The majority of participants (57.1%) suffered from the symptoms more than twice a year. The symptoms, such as difficulty in falling asleep, repeated and continuous sneezing and bilateral nasal obstruction, were severe. There were patients with uncontrolled allergic rhinitis symptoms after the CARAT10 test, even when the individual's perception of the quality of life was good according to the WHOQOL-BREF score, with gender differences in the psychological domain. It should also be emphasized that there was a significant association between higher education levels with better control of the illness/quality of life. Additionally, most participants used pharmacological treatment (not alternative therapies) and the adoption of self-management measures to relieve their symptoms. Conclusions The findings of this study showed that the estimated prevalence of allergic rhinitis seems to be apparently lower in Guarda than that found in the general Portuguese population. From the data, some patients showed uncontrolled allergic rhinitis symptoms, strengthening the importance of the role of intervention by a health professional.

Rhinitis 2020: A practice parameter update

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.

A quality-of-life mapping function developed from a grass pollen sublingual immunotherapy trial to a tree pollen sublingual immunotherapy trial

Aims: Allergic rhinitis is caused by sensitivity to environmental allergens that can significantly impact quality-of-life. The objective of this analysis was to estimate health state utilities and quality-adjusted life days (QALDs) for a tree allergy immunotherapy trial, TT-04 (EudraCT No.2015-004821-15). Health-state utilities are a measure of patient preference for health states and are necessary to derive QALDs for cost-utility analysis. Preference-based utilities were not collected in the TT-04 trial, so a mapping algorithm was developed based on a similar grass allergy immunotherapy trial, GT-08 (EudraCT No. 2004-000083-27), to estimate utilities.Methods: A two-part model was developed to predict utilities for the GT-08 trial and applied to the TT-04 trial to estimate the difference in mean utility and QALDs between SQ tree sublingual immunotherapy (SLIT)-tablet and placebo.Results: Mean utility difference between SQ tree SLIT-tablet and placebo was 0.030 [95% CI = 0.015-0.046] during the birch pollen season (BPS), 0.019 [95% CI = 0.007-0.030] during the tree pollen season (TPS) and 0.018 [95% CI = 0.007-0.030] during the full trial. The treatment showed a QALD benefit of 1.26 [95% CI = 0.619-1.917] during the BPS, 1.90 [95% CI = 0.692-3.047] during the TPS, and 2.47 [95% CI = 0.930-4.101] during the full trial.Limitations: The generalizability of this algorithm is limited to allergy trials containing the same covariates as those present in the model. The analysis also assumes that grass and tree pollen allergy have the same relationship with EQ5D utilities, which is supported by the fact that both grass and tree pollen induce similar symptoms.Conclusions: Application of the mapping function enabled the calculation of QALDs associated with the treatment, with the caveat that data were extrapolated from grass seasonal allergy to tree seasonal allergy. The results showed a significant QALD benefit of the treatment over placebo in treatment of tree pollen-induced rhinoconjunctivitis.

RCAT reflects symptom control and quality of life in allergic rhinoconjunctivitis patients

BACKGROUND

The Global Allergy and Asthma European Network (GA² LEN) Taskforce has requested more data on correlations between various patient-reported outcomes (PROs) in clinical trials on allergy. We compared three tools-the Rhinitis Control Assessment Test (RCAT), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Rhinitis Total Symptom Score (RTSS)-to determine whether the RCAT alone is a sufficient primary outcome parameter in clinical trials on allergic rhinoconjunctivitis.

METHODS

In two double-blind, placebo-controlled immunotherapy studies, 33 patients allergic to grass pollen and 94 to birch pollen completed two questionnaires (RCAT and RQLQ) and kept their own symptom diary from which the RTSS was calculated.

RESULTS

Upon comparing RCAT and RQLQ results, we found strong correlations of r = -0.871 for grass pollen-allergic patients and r = -0.795 for birch pollen-allergic patients. The comparison between RCAT and RTSS results showed a strong correlation of r = -0.811 (grass pollen-allergic patients) and a moderate correlation of r = -0.539 (birch pollen-allergic patients). In the RCAT, 69.7% of grass pollen-allergic patients and 45.7% of birch pollen-allergic patients receiving guideline-concordant therapy were regarded as having insufficiently controlled symptoms.

CONCLUSION

The strong correlations suggest that the RCAT alone is equivalent to the RQLQ with respect to patients' symptom control and quality of life. Patients with uncontrolled symptoms can be identified using the RCAT. Hence, the physician can decide whether symptomatic therapy can be intensified or allergy immunotherapy should be administered.

The effect of nasal provocation with a single-dose allergen on the physical and cognitive performance of patients with ragweed allergy

Purpose This study aims to compare the impact of active allergic rhinitis on physical and cognitive abilities of trained allergic athletes to untrained allergic patients. Methods Cognitive, respiratory, and fitness functions were assessed before and after allergen exposure. Participants in both groups were provoked intranasally with ragweed allergen. Results The group of athletes revealed significantly higher average values in peak inspiratory flow and fitness index before and after provocation. In neuropsychological assessments, athletes performed significantly better after allergen provocation in complex working memory capacity. Due to single acute allergen exposure, the size of the nasal cavity and nasal inspiratory peak flow significantly decreased in both groups. The physical performance of both groups did not change after provocation. Executive functions and complex working memory capacity of athletes significantly improved resulting from provocation. Conclusions A single-shot allergen in high dose might cause an increase in mental concentration, which was more pronounced in the group of athletes. This study indicates that acute exposure to allergen cannot affect the physical performance and may result in increased mental focus in patients with allergy notwithstanding the declining respiratory functions.

Allergic Rhinitis Control Test questionnaire-driven stepwise strategy to improve allergic rhinitis control: a prospective study

BACKGROUND

Allergic Rhinitis Control Test (ARCT) has been validated for assessing allergic rhinitis (AR) control and identifying severe AR. The aim of the study was to assess the ARCT questionnaire as a tool for stepwise pharmacotherapy.

METHODS

A standard pharmacotherapy regimen from Step 1 (oral second-generation H1 antihistamine as needed) to Step 5 (oral corticosteroid) was carried out prospectively in a Chinese AR population. The AR patients were initiated with Allergic Rhinitis and its Impact on Asthma (ARIA) appropriate step treatment and assessed with ARCT every 15 days. If ARCT score was equal or above 20 (controlled AR) and maintained for 15 days, the patient would finish the study; if ARCT score was strictly <20 (uncontrolled AR), the patient would receive higher step treatment according to a predefined open design up to Step 5. The different AR control subgroups were compared.

RESULTS

A total of 255 patients were enrolled in the study; 5 patients dropped out and 2 (0.8%) were controlled at day 0, 85 (34.0%) at day 15, 177 (70.8%) at day 30, 222 (88.8%) at day 45, 241 (96.4%) at day 60 and 242 (96.8%) at day 75. Only 8 (3.2%) patients remained uncontrolled at the endpoint of the study. Patients with ARIA moderate/severe or persistent symptoms, moderate/severe impaired quality of life, asthma history, rhinorrhea and cough symptoms always needed up to Step 4 (nasal corticosteroid plus antihistamine) and prolonged treatments to achieve disease control.

CONCLUSIONS

The majority of AR can be controlled with standard stepwise treatment. ARCT offers an objective criterion for the stepwise pharmacotherapy of AR.

Mammalian-derived respiratory allergens - implications for diagnosis and therapy of individuals allergic to furry animals

Furry animals cause respiratory allergies in a significant proportion of the population. A majority of all mammalian allergens are spread as airborne particles, and several have been detected in environments where furry animals are not normally kept. The repertoire of allergens from each source belongs to a restricted number of allergen families. Classification of allergen families is particularly important for the characterization of allergenicity and cross-reactivity of allergens. In fact, major mammalian allergens are taken from only three protein families, i.e. the secretoglobin, lipocalin and kallikrein families. In particular, the lipocalin superfamily harbours major allergens in all important mammalian allergen sources, and cross-reactivity between lipocalin allergens may explain cross-species sensitization between mammals. The identification of single allergen components is of importance to improve diagnosis and therapy of allergic patients using component-resolved diagnostics and allergen-specific immunotherapy (ASIT) respectively. Major disadvantages with crude allergen extracts for these applications emphasize the benefits of careful characterization of individual allergens. Furthermore, detailed knowledge of the characteristics of an allergen is crucial to formulate attenuated allergy vaccines, e.g. hypoallergens. The diverse repertoires of individual allergens from different mammalian species influence the diagnostic potential and clinical efficacy of ASIT to furry animals. As such, detailed knowledge of individual allergens is essential for adequate clinical evaluation. This review compiles current knowledge of the allergen families of mammalian species, and discusses how this information may be used for improved diagnosis and therapy of individuals allergic to mammals.

Impact of sleep as a specific marker of quality of life in allergic rhinitis

Allergic rhinitis (AR) is a common disorder, which represents a considerable burden both on individual patients and society. It is associated with bothersome symptoms, which may impair usual daily activities, sleep quality, and productivity. Associated with impaired sleep, quality of life is significantly impaired in AR patients. AR significantly contributes to sleep-disordered breathing through multiple mechanisms, with the greatest impact mediated through nasal obstruction. Sleep impairment is very common in AR patients and has a significant impact on disease-specific measures of general health and quality of life. The degree of sleep disturbance is directly related to the severity of the disease. Nasal congestion also demonstrates circadian rhythm and positional variability, worsening during nighttime hours and in supine position. Increased sleep disordered events lead to poor sleep with fatigue and daytime somnolence, impaired performance, productivity and social functioning, and an increased risk of associated diseases.

Quality of life in allergic rhinitis

Allergic rhinitis is a global health problem that causes major illness and disability worldwide. Although nasal and nonnasal symptoms are directly attributable to inflammation in the upper respiratory tract, individuals also experience generalized symptoms that include fatigue, mood changes, depression, anxiety and impairments of work and school performance, and cognitive function. Health-related quality of life focuses on patients’ perceptions of their disease and measures impairments that have a significant impact on the patient. The burden of disease, as the patient perceives it, forms the basic motivation to seek medical aid or to undergo therapy. Adherence to therapy requires changes in health, perceived by patients as relevant and outweighing eventual disadvantages of intervention. Because so many factors are involved in health-related quality of life, there are multiple ways in which it can be measured. A variety of validated and standardized questionnaires have been developed including assessments of school performance, work performance, productivity, and other parameters that quantify the impact of allergic rhinitis and its treatment on quality of life. The aim of this review is to highlight the impact of allergic rhinitis on the quality of life and to analyze the most commonly used health-related quality of life instruments.

Evaluation of quality of life questionnaires for adult patients with moderate to severe allergic rhinitis

PURPOSE

The aim of the study was to compare the efficacy of instruments to assess quality of life (QoL) in patients with moderate to severe persistent allergic rhinitis (PAR) vs intermittent allergic rhinitis (IAR).

MATERIALS AND METHODS

There were 106 patients with PAR and 99 with IAR and 50 healthy subjects in the control group. Questionnaire results were obtained using the Medical Outcomes Survey Short Form 36 (SF-36), a visual analog scale (VAS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) and were analyzed using correlational analysis.

RESULTS

Correlations between the total scores and most domains of the 3 questionnaires were stronger in patients with PAR than in those with IAR, although the difference between groups was significant only for the RQLQ (P < .01). The QoL was worse in the PAR subgroup than in the IAR subgroup in the domains of social functioning in the SF-36 and for items of sleeping problems and activity limitations in the RQLQ. There were significant correlations between RQLQ and VAS-eye symptoms in the PAR subgroup but not in the IAR subgroup.

CONCLUSIONS

The 3 questionnaires differentiated patients with AR from the healthy population, with significant but weak correlation with each other. The correlations were higher in patients with PAR than in those with IAR. The moderate to severe PAR has a greater effect on quality of life than IAR. Eye symptoms affected the QoL more in patients with PAR than in those with IAR.

Psychometric validation of the rhinitis control assessment test: a brief patient-completed instrument for evaluating rhinitis symptom control

BACKGROUND

Allergic rhinitis is common, but a validated tool for comprehensive assessment of disease control is not available.

OBJECTIVE

To develop a simple patient-completed instrument (the Rhinitis Control Assessment Test [RCAT]) to help detect problems with control of rhinitis symptoms.

METHODS

During a visit to an allergy specialist, 410 patients with allergic rhinitis completed a Total Nasal Symptom Score (TNSS) assessment and the 26-item developmental RCAT. Physicians also completed a global assessment of rhinitis symptom control for each patient.

RESULTS

Stepwise regression methods identified 6 items from the developmental RCAT (frequency of nasal congestion, sneezing, and watery eyes; sleep interference; activity avoidance; and self-assessed control) that were most predictive of the allergist's global rating of rhinitis symptom control. A summated rating scale from these 6 items showed good convergent validity (r > 0.70) with scale scores from the TNSS. The discriminant validity of the 6-item scale was demonstrated as mean RCAT scale scores differed significantly across groups of patients differing in physician-rated disease severity (F = 54.4), TNSS severity (F = 193.8), and physician-recommended change in therapy (F = 50.6) (P < .001 for all).

CONCLUSIONS

The RCAT, a 6-item patient-completed instrument, has satisfactory psychometric properties and seems to be a valid tool for assessing control of allergic rhinitis. Further validation studies will provide confirmation.

Economic burden of rhinitis in managed care: a retrospective claims data analysis

BACKGROUND

Little is known about the specific cost effect of rhinitis on third-party payers. No recently reported studies have examined the economic burden of rhinitis in managed care. Furthermore, the direct costs of chronic rhinitis have not been evaluated and potential differences in health care use and costs of allergic rhinitis have not been examined.

OBJECTIVE

To evaluate the economic burden of allergic rhinitis and chronic rhinitis to third-party payers in a large US managed care plan.

METHODS

In a retrospective analysis using pharmacy and medical claims data from a US health plan covering approximately 15 million members, health care use and cost data were summarized for patients with allergic or chronic rhinitis (n = 301,001) for the 13-month study period (January 1, 2004, to January 31, 2005).

RESULTS

Average rhinitis-related total costs were $657 per patient each year ($319 in medical costs and $338 in pharmacy costs). Ambulatory visits were the primary contributor to rhinitis-related medical costs. Antihistamines were the most common rhinitis medication, followed by intranasal corticosteroids (INSs) and montelukast. Many patients (37% with at least 1 filled prescription for an antihistamine, an INS, or montelukast) used combination therapy. Of the 3 main pharmacotherapy categories, montelukast was associated with the highest pharmacy cost ($353 vs $198 for antihistamines and $231 for INSs per patient each year for monotherapy) and drove the average annual cost of combination therapy regardless of the concomitant medication(s). The most common comorbidities were sinusitis and asthma, present in 51.1% and 27.9% of patients, respectively. Comorbidities increased rhinitis-related health care costs.

CONCLUSIONS

Allergic rhinitis and chronic rhinitis imposed a significant financial burden on third-party payers in a large US managed care plan. The presence of comorbidities further increased the rhinitis-related treatment costs.

Allergic rhinitis and rhinosinusitis

A relationship between allergic rhinitis and acute and chronic rhinosinusitis has been postulated for many years. Epidemiologic evidence suggests that such a relationship is likely. In addition, evidence of a common pathophysiologic mechanism linking these diseases is compelling and continues to evolve. Although a clear and definitive causal relationship remains to be elucidated, an increasing number of studies support the plausibility of this link. The current paradigm of the "unified airway" and evidence to support this model further strengthen this link. This article reviews the literature relating allergic rhinitis and acute and chronic rhinosinusitis.

Quality-assessment of disease-specific quality of life questionnaires for rhinitis and rhinosinusitis: a systematic review

The aim of this systematic review was to give a quality-assessed review of the existing disease-specific health related quality of life (QOL) questionnaires concerning rhinitis and rhinosinusitis for adults. The quality is assessed by defining the characteristics of a QOL questionnaire with assessment criteria. The results of the construction, description, feasibility, and the psychometric performance of the instruments are provided. We finally provide a clinician's guide to choose a questionnaire based on the measurement goals, the discriminant validity, responsiveness and the points obtained in the quality assessment. Of the top scoring instruments regarding the overall quality assessment, only four health related QOL questionnaires for rhinitis and rhinosinusitis met our criteria for the discriminant validity and responsiveness.

Rhinitis, rhinosinusitis and quality of life in children

Quality of life (QoL) or, rather, health-related QoL, is currently regarded as a crucial aspect of the general well-being of patients and, in consequence, of the effects of a disease and its treatment. This is particularly true for respiratory allergy (asthma and rhinitis), which are chronic diseases and also for sinusitis (rhinosinusitis). A number of questionnaires (instruments), either generic or specific, have been developed and validated to assess the QoL in adults and children, for asthma and rhinitis, whereas there are few specific instruments for chronic rhinosinusitis. The literature provides strong evidence of the effects of allergic rhinitis, asthma and their treatments on QoL in paediatric patients, as well as in adults, whereas the number of experimental data on rhinosinusitis is limited, especially in children. Clinical trials evidenced some controversial points, mainly the weak correlation existing between QoL and traditional objective parameters. It has become clear that the QoL questionnaires measure the aspects of the disease that partially differ from the routinely evaluated parameters and that QoL should integrate, not replace, the objective measurements.

Assessing outcomes from the sleep disturbance associated with rhinitis

PURPOSE OF REVIEW

The purpose of this review is to identify which aspects of allergic rhinitis limit the quality of life in patients, to present information on how rhinitis affects sleep, and to review instruments available to assess the impact that rhinitis has on sleep.

RECENT FINDINGS

Subjective and objective instruments reveal patients with allergic rhinitis frequently suffer from sleep-disordered breathing, poor sleep quality, daytime somnolence, and fatigue. Sleep disturbances associated with allergic rhinitis can lead to decreased cognitive and psychomotor abilities, impaired work performance, decreased productivity, impaired learning, difficulty concentrating, and memory deficits.

SUMMARY

Objective and subjective instruments are available to measure the extent of compromise in quality of life in affected patients. Subjective measurements available to evaluate allergic rhinitis include general and disease specific quality of life questionnaires, including rhinitis specific and sleep specific questionnaires. Objective measurements available include evaluation of nasal patency and physiology in rhinitis, nasal inspiratory peak flow, acoustic rhinometry, rhinomanometry, polysomnography, the Multiple Sleep Latency Test, the Maintenance of Wakefulness Test, and learning and performance testing. The continued utilization of these and other available instruments is vital for further assessment on the effect of allergic rhinitis on sleep.

Skin test results and self-reported symptom severity in allergic rhinitis: the role of psychological factors

BACKGROUND

In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity.

OBJECTIVES

To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors.

METHODS

One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism.

CONCLUSIONS

The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.

Evaluating change in health-related quality of life in adult rhinitis: responsiveness of the Rhinosinusitis Disability Index

Background

The Rhinosinusitis Disability Index (RSDI) is a validated measure of health-related quality of life (HRQL) in rhinitis. Responsiveness of the RSDI to changes in health status over time has not been described.

Methods

We studied adults with a self-reported physician diagnosis of rhinitis identified through a national telephone survey. HRQL was assessed at baseline and at 24 months using the RSDI. Symptom severity, physical health status (SF-12 PCS), psychological mood (CES-D), and perceived control of symptoms were also assessed at the time of each interview. In addition, we ascertained specific health outcomes attributed to rhinitis, including days of restricted activity, job effectiveness, number of physician visits, and medication costs.

Results

Of 109 subjects interviewed at baseline, 69 (63%) were re-interviewed 24 months later. RSDI scores improved by = 0.5 standardized response mean in 13 (19%) subjects and worsened in 17 (25%). Change in the RSDI over time correlated with changes in symptom severity (r = 0.38, p = 0.001), physical health (r = -0.39, p = 0.001), mood (r = 0.37, p = 0.002) and perceived control of symptoms (r = -0.37, p = 0.01). In multivariate analyses adjusted for baseline health status, improvement in RSDI was associated with less restricted activity (p = 0.01), increased job effectiveness (p = 0.03), and decreased medication costs (p = 0.05), but was not associated with change in the number of physician visits from baseline (p = 0.45).

Conclusion

The RSDI is responsive to changes in health status and predicts rhinitis-specific health outcomes.

A treatment for allergic rhinitis: a view on the role of levocetirizine

BACKGROUND

Allergic rhinitis is a significant public health concern in many developed countries. However, despite evidence for a significant impact on patients' quality of life (QoL) including sleep disruption and reduced daytime performance, allergic rhinitis remains under-managed and hence poorly controlled. This is largely owing to lack of knowledge about, and poor adherence to, established treatment guidelines.

SCOPE

The panel considered available evidence and focused on four published studies on the second-generation antihistamine, levocetirizine. Three of these studies explored the clinical impact of levocetirizine in a broad range of different clinical settings.

FINDINGS

Levocetirizine demonstrated an increased benefit over other antihistamines in terms of a more durable antihistamine response: levocetirizine provided improved symptom relief at 24 hours compared to desloratadine or fexofenadine, two frequently prescribed second-generation antihistamines. Levocetirizine also maintained relief of the key symptoms of allergic rhinitis and improved patients' QoL over a treatment period of 6 months, in a real-life setting. The variable efficacy and durability of response of different antihistamines arise from differing modulatory effects on the H(1)-receptor. The speed of relief of symptoms with levocetirizine is supported by the pharmacokinetic data, which shows that steady state plasma concentrations are achieved in a shorter period of time than other second-generation histamines (additionally levocetirizine T(max) is reached in 0.9 h).

CONCLUSION

These findings support both the short-term and long-term use of levocetirizine in the clinical management of allergic rhinitis. The World Health Organization (WHO) ARIA Guidelines (Allergic Rhinitis and its Impact on Asthma), recommend using a combination of a non-sedating antihistamine with a decongestant, or glucocorticosteroids for treating allergic rhinitis - with the order and combination of treatment depending on severity and duration of symptoms.