Many physicians consider oral antihistaminesto be the first-line therapyfor allergic rhinitis. While theseagents effectively reduce the symptomsof itching, sneezing, and rhinorrhea,they do not have much ofan effect on nasal congestion. Intranasalantihistamines appear tohave an edge over the oral agents inthat they do reduce nasal congestionand they have a rapid onset ofaction. A recent review of the literatureprovides additional evidence ofthe efficacy of intranasal antihistaminesin the treatment of both allergicrhinitis and vasomotor rhinitis,which is the most common formof nonallergic rhinitis. Kaliner reviewed articles publishedbetween 1995 and 2007 thataddressed the use of the intranasalantihistamine azelastine in patientswith rhinitis. The results of severalrandomized, placebo-controlled trialssupport the efficacy and safety ofthis agent in the treatment of allergicrhinitis and vasomotor rhinitis.Treatment with azelastine resultedin sustained improvement in rhinitis,nasal congestion, and othersymptoms. Studies also showedthat the combination of azelastineand an intranasal corticosteroid improvedthe efficacy of treatment ofallergic rhinitis by more than 40%,compared with use of either therapyalone. Kaliner concluded that the use ofintranasal azelastine is effective inmanaging both allergic rhinitis andnonallergic vasomotor rhinitis. Intranasalantihistamines may be especiallyuseful if nasal congestion isa major symptom or if rapid symptomrelief is needed.
