Allergic rhinitis is a common condition that affects 10%-20% of general population.
Seasonal allergic rhinitis is a subset of allergic rhinitis mediated by histamine, proteases, leukotrienes, prostaglandins, platelet-activating factor (PAF) and cytokines.
These mediators are released from mucosal mast cells which degranulate after cross linking of pollen with mast cell-bound specific IgE. Signs and symptoms of allergic rhinitis include sneezing, itching: (nose, eyes, ears, palate), rhinorrhoea, postnasal drip, congestion, anosmia, headache, earache, tearing, red eyes, eye swelling, fatigue, and drowsiness, malaise.
Nasal features of allergic rhinitis can include the following:
- Nasal crease: A horizontal crease across the lower half of the bridge of the nose; caused by repeated upward rubbing of the tip of the nose by the palm of the hand
- Thin, watery nasal secretions
- Deviation or perforation of the nasal septum: May be associated with chronic rhinitis, although there can be other, unrelated causes. Manifestations of allergic rhinitis affecting the ears, eyes, and oropharynx include the following:
- Ears: Retraction and abnormal flexibility of the tympanic membrane
- Eyes: Injection and swelling of the palpebral conjunctivae, with excess tear production; Dennie-Morgan lines (prominent creases below the inferior eyelid); and dark circles around the eyes (‘allergic shiners’), which are related to vasodilation or nasal congestion
- Oropharynx: ‘Cobblestoning’, that is, streaks of lymphoid tissue on the posterior pharynx; tonsillar hypertrophy; and malocclusion (overbite) and a high-arched palate.
Allergic rhinitis is a common condition of children and adults that, although not life-threatening, can significantly impair quality of life and cause increased direct and indirect health care costs. A recently published analysis determined that patients with allergic rhinitis averaged three additional office visits, nine more prescriptions filled, and $1500 in incremental healthcare costs in one year than similar patients without allergic rhinitis.
Treatment of symptoms of allergic rhinitis will improve patients’ performance and quality of life, and reduce overall health care related costs. Seasonal allergic rhinitis is a subset of allergic rhinitis caused by exposure to pollen(s) leading to mucosal mast cell degranulation and release of mediators causing allergic inflammation. Rupatadine is a nonsedating, selective antihistamine with antiPAF properties. The dual action is a unique property of rupatadine among other nonsedating anithistamines. Rupatadine is a once a day antihistamine and was found to have a sustained 24-hour effect.
Rupatadine effectively reduces nasal obstruction in patients suffering from seasonal allergic rhinitis symptoms. In treatment of seasonal allergic rhinitis, rupatadine 10mg and 20mg was found to be significantly better than placebo and similarly effective as other non sedating antihistamines such cetirizine sebastine and loratadine, with probable faster effect in controlling allergic rhinitis symptoms than cetirizine. Longterm safety profile of rupatadane 10mg over 12 months has been established.
It has no proarrythmic potential and does not affect driving performance. Rupatadine represents a sound firstline antihistamine for treatment of seasonal allergic rhinitis.
References available on request.