Seasonal allergic rhinitis. Newer treatment approaches.

Improved treatment approaches for seasonal allergic rhinitis are based on the increasing knowledge about allergic inflammation and on the improved efficacy of newer drugs. The current management concept includes an individualised composition of the different approaches including allergen avoidance, topical treatment and the use of systemic drugs and specific immunotherapy. Allergen avoidance, supported by pollen information, leads to a remarkable reduction of daily challenge situations. There is an increasing trend towards topical use of corticosteroids (e.g. budesonide and fluticasone) and mast cell stabilisers [e.g. sodium cromoglycate (cromolyn sodium), nedocromil and isospaglumic acid (N-acetylaspartylglutamic acid)] because of the potency of these drugs to impair the destructive activity of allergic inflammation. Potent histamine H1-receptor antagonists (e.g. azelastine and levocabastine) are approved for local treatment and lead to prompt relief of troublesome symptoms. A new generation of orally active antihistamines (e.g. astemizole, cetirizine, loratadine and terfenadine) have tended to be called 'antiallergics' because of activity other than H1-blockade. Furthermore, these newer compounds are less likely to cause sedation. Immunotherapy is still an integrated component in the treatment strategy. Standardised allergen extracts of high quality raise the treatment efficacy and safety. Overall, forming an individual combination of treatment approaches gives the best result.