Licari Amelia, Castagnoli Riccardo, Bottino Chiara, Marseglia Alessia, Marseglia GianLuigi, Ciprandi Giorgio
a Department of Pediatrics, Foundation IRCCS Policlinico San Matteo , University of Pavia , Pavia , Italy.
b Department of Medicine , IRCCS-A.O.U. San Martino di Genova , Genoa , Italy.
Expert Opin Emerg Drugs. 2016;21(1):57-67. doi: 10.1517/14728214.2016.1139082. Epub 2016 Jan 25.
Allergic rhinitis is a worldwide health problem, currently affecting up to 40% of the general population, and characterized by the following symptoms in a variable degree of severity and duration: nasal congestion/obstruction, rhinorrhea, itchy nose and/or eyes, and/or sneezing. General symptoms like fatigue, reduced quality of sleep, impaired concentration and reduced productivity, if left untreated, may significantly affect quality of life. In addition, of being associated to various comorbidities, allergic rhinitis is also an independent risk factor for the development and worsening of asthma. Perennial allergic rhinitis is caused by allergens present around the year.
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines currently recommend a stepwise therapeutic approach that combines patient education with specific allergen avoidance, symptomatic pharmacotherapy and allergen immunotherapy. The available treatment strategies provide suboptimal symptom relief in patients with moderate-to-severe disease who continue to experience symptoms while treated, even on multiple therapies.
New insights into current therapy have been provided with the development of new symptomatic drugs with improved pharmacokinetics and safety. However, the ultimate research goal is beyond symptomatic treatment, and is mainly directed at modifying the immune response to allergens and prevent the progression of allergic rhinitis towards asthma. In this direction, promising advances are expected in the fields of allergen immunotherapy and biological drugs, such as omalizumab. Finally, significant research efforts are also focused on the growing number of new specific molecular targets involved in the Th2 pathway inflammation of allergic diseases.
过敏性鼻炎是一个全球性的健康问题，目前影响着高达40%的普通人群，其特征为程度和持续时间各异的以下症状：鼻塞/鼻阻塞、流涕、鼻和/或眼瘙痒，和/或打喷嚏。疲劳、睡眠质量下降、注意力不集中和生产力降低等一般症状若不治疗，可能会显著影响生活质量。此外，过敏性鼻炎与多种合并症相关，也是哮喘发生和恶化的独立危险因素。常年性过敏性鼻炎由全年存在的过敏原引起。
《过敏性鼻炎及其对哮喘的影响》（ARIA）指南目前推荐一种逐步治疗方法，该方法将患者教育与特定过敏原回避、对症药物治疗和过敏原免疫治疗相结合。现有的治疗策略在中重度疾病患者中提供的症状缓解效果欠佳，这些患者即使接受多种治疗仍会持续出现症状。
新型对症药物的研发带来了药代动力学和安全性改善，为当前治疗提供了新见解。然而，最终的研究目标并非仅为对症治疗，主要是针对改变对过敏原的免疫反应并预防过敏性鼻炎发展为哮喘。在这一方向上，预计在过敏原免疫治疗和生物药物（如奥马珠单抗）领域会取得有前景的进展。最后，大量研究工作也聚焦于越来越多参与过敏性疾病Th2途径炎症的新特定分子靶点。
