Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria.
Expert Opin Pharmacother. 2021 May;22(7):849-855. doi: 10.1080/14656566.2020.1808622. Epub 2020 Aug 18.
Allergic rhinitis (AR) is a global health problem in adults as well as the younger population, continuously increasing and posing a significant problem for patients, health care systems and economies. For the younger population, some aspects differ from treatment of adults, namely, prevention, compliance and adherence.
This narrative review summarizes all the pharmacotherapeutic options with special focus on the pediatric population. Moreover, it elucidates prevention strategies as well as future developments of AR treatment. Currently, symptomatic therapy in the form of steroids and antihistamines is applied topically and systemically where steroids need to be administered with caution and for a very short term. The only disease-modifying and causal treatment is allergen immunotherapy administered sublingually and subcutaneously. Future and current novel therapeutic options are human monoclonal antibodies.
The greatest potential for future developments currently lie in allergen immunotherapy and here in different routes of administration and modification of (recombinant) allergens as well as immune-modulating adjuvants and nanoparticles. Secondly, monoclonal antibodies are promising molecules blocking and/or interfering with up- and downstream immune mechanisms. Another important aspect lies in prevention of allergic sensitization and disease progression through both AIT and biologics which is particularly true for the pediatric population.
变应性鼻炎(AR)是一个全球性的健康问题,无论是在成年人还是在年轻人群中,其发病率都在不断上升,给患者、医疗保健系统和经济都带来了重大问题。对于年轻人群而言,有些方面与成人的治疗方法不同,即预防、依从性和顺应性。
本篇综述性文章总结了所有的药物治疗选择,特别关注儿科人群。此外,还阐述了预防策略以及 AR 治疗的未来发展。目前,以类固醇和抗组胺药为代表的对症疗法主要通过局部和全身途径给药,而类固醇的给药需要谨慎且疗程非常短。唯一的疾病修正和病因治疗是皮下和舌下给予变应原免疫治疗。未来和当前的新型治疗选择是人类单克隆抗体。
目前,未来发展的最大潜力在于变应原免疫治疗,特别是不同的给药途径、(重组)变应原的修饰以及免疫调节佐剂和纳米颗粒。其次,单克隆抗体是一种很有前途的分子,可以阻断和/或干扰上下游免疫机制。另一个重要方面是通过 AIT 和生物制剂预防过敏致敏和疾病进展,这在儿科人群中尤为重要。