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Antihistamines for the Treatment of Allergic Rhino-conjunctivitis

  • Allergic Rhinitis (M Calderon, Section Editor)
  • Published:
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Opinion statement

Histamine plays an important role in the pathogenesis of allergic rhino-conjunctivitis (ARC). First generation antihistamines are sedative, they cause cognitive and psychomotor impairment, and they are not indicated for the treatment of ARC. Second generation H1-antihistamines, with their improved safety profile and faster and longer duration of action, meet many of the ARIA (Allergic Rhinitis and its Impact on Asthma) optimal antihistamine prerequisites for the treatment of ARC. They are recommended as first line therapy for the treatment of children and adults with ARC and are efficacious in rapidly reducing itching, sneezing and rhinorrhoea. However, they offer suboptimal relief to patients with significant nasal congestion. They are available as oral, intranasal and ocular preparations. Oral preparations are more effective when used continuously and have demonstrated a greater or similar efficacy to leukotriene receptor antagonists (LTRA), with a potentiated effect when used simultaneously. Second generation H1-antihistamines are recommended for both intermittent and persistent ARC and in combination with intranasal steroids (INS) for severe disease. Intranasal H1-antihistamine preparations have the advantage of being delivered directly to the nasal mucosa with faster onset of action (15 vs 60 min) and may be preferable when rapid symptom relief is desirable or for on-demand therapy. They are recommended for mild/intermittent disease. A better outcome is achieved when used in combination with INS. In particular, a single formulation of fluticasone with azelastine nasal spray has demonstrated superiority to monotherapy with either compound in patients with moderate/severe disease. Its use is recommended when monotherapy has proven insufficient and for the treatment of moderate/persistent disease. Ophthalmic preparations are efficacious in ameliorating ocular symptoms and can be used when oral antihistamines fail. In the management of ARC, second generation H1-antihistamine treatment reduces symptoms, improves quality of life, lessens the overall burden of disease and reduces disease-associated costs.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011;378:2112–22.

    Article  PubMed  Google Scholar 

  2. Undem BJ, Taylor-Clark T. Mechanisms underlying the neuronal-based symptoms of allergy. J Allergy Clin Immunol. 2014;133:1521–34. A comprehensive overview of the mechanisms underlining neurogenic inflammation in allergy.

    Article  PubMed  Google Scholar 

  3. Baroody FM, Foster KA, Markaryan A, deTineo M, Naclerio RM. Nasal ocular reflexes and eye symptoms in patients with allergic rhinitis. Ann Allergy Asthma Immunol. 2008;100:194–9.

    Article  PubMed  Google Scholar 

  4. Simons FE, Simons KJ. Histamine and H1-antihistamines: celebrating a century of progress. J Allergy Clin Immunol. 2011;128:1139–50.

    Article  CAS  PubMed  Google Scholar 

  5. Simons FE. Advances in H1-antihistamines. N Engl J Med. 2004;351:2203–17.

    Article  CAS  PubMed  Google Scholar 

  6. Shirasaki H, Kanaizumi E, Seki N, Himi T. Localization and upregulation of the nasal histamine H1 receptor in perennial allergic rhinitis. Mediat Inflamm. 2012;2012:951316.

    Google Scholar 

  7. Bakker RA, Wieland K, Timmerman H, Leurs R. Constitutive activity of the histamine H(1) receptor reveals inverse agonism of histamine H(1) receptor antagonists. Eur J Pharmacol. 2000;387:R5–7.

    Article  CAS  PubMed  Google Scholar 

  8. Church MK, Maurer M, Simons FE, Bindslev-Jensen C, Van CP, Bousquet J, et al. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy. 2010;65:459–66.

    Article  CAS  PubMed  Google Scholar 

  9. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8–160.

    Article  PubMed  Google Scholar 

  10. Roberts G, Xatzipsalti M, Borrego LM, Custovic A, Halken S, Hellings PW, et al. Paediatric rhinitis: position paper of the European Academy of allergy and clinical immunology. Allergy. 2013;68:1102–16. An evidence based, comprehensive review of the diagnostic and therapeutic approaches to allergic rhinitis in children.

    CAS  PubMed  Google Scholar 

  11. Patou J, De SH, Van CP, Bachert C. Pathophysiology of nasal obstruction and meta-analysis of early and late effects of levocetirizine. Clin Exp Allergy. 2006;36:972–81.

    Article  CAS  PubMed  Google Scholar 

  12. Nakaya M, Takeuchi N, Kondo K. Immunohistochemical localization of histamine receptor subtypes in human inferior turbinates. Ann Otol Rhinol Laryngol. 2004;113:552–7.

    Article  PubMed  Google Scholar 

  13. North ML, Walker TJ, Steacy LM, Hobsbawn BG, Allan RJ, Hackman F, et al. Add-on histamine receptor-3 antagonist for allergic rhinitis: a double blind randomized crossover trial using the environmental exposure unit. Allergy Asthma Clin Immunol. 2014;10:33.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Daley-Yates P, Ambery C, Sweeney L, Watson J, Oliver A, McQuade B. The efficacy and tolerability of two novel H(1)/H(3) receptor antagonists in seasonal allergic rhinitis. Int Arch Allergy Immunol. 2012;158:84–98.

    Article  CAS  PubMed  Google Scholar 

  15. Thurmond RL. The histamine H4 receptor: from orphan to the clinic. Front Pharmacol. 2015;6:65. A comprehensive review of the current knowledge on Histamine receptor 4 and its potential antagonists.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Church DS, Church MK. Pharmacology of antihistamines. World Allergy Organ J. 2011;4:S22–7.

    PubMed  PubMed Central  Google Scholar 

  17. Boyle J, Eriksson M, Stanley N, Fujita T, Kumagi Y. Allergy medication in Japanese volunteers: treatment effect of single doses on nocturnal sleep architecture and next day residual effects. Curr Med Res Opin. 2006;22:1343–51.

    Article  PubMed  Google Scholar 

  18. Vuurman EF, van Veggel LM, Uiterwijk MM, Leutner D, O’Hanlon JF. Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy. 1993;71:121–6.

    CAS  PubMed  Google Scholar 

  19. Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case–control study. J Allergy Clin Immunol. 2007;120:381–7.

    Article  PubMed  Google Scholar 

  20. Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175:401–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126:466–76.

    Article  PubMed  Google Scholar 

  22. Woosley RL. Cardiac actions of antihistamines. Annu Rev Pharmacol Toxicol. 1996;36:233–52.

    Article  CAS  PubMed  Google Scholar 

  23. Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003;89:1363–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Antonelli D, Atar S, Freedberg NA, Rosenfeld T. Torsade de pointes in patients on chronic amiodarone treatment: contributing factors and drug interactions. Isr Med Assoc J. 2005;7:163–5.

    PubMed  Google Scholar 

  25. Davila I, Del CA, Mullol J, Jauregui I, Bartra J, Ferrer M, et al. Use of second generation H1 antihistamines in special situations. J Investig Allergol Clin Immunol. 2013;23 Suppl 1:1–16.

    CAS  PubMed  Google Scholar 

  26. Donado E, Izquierdo I, Perez I, Garcia O, Antonijoan RM, Gich I, et al. No cardiac effects of therapeutic and supratherapeutic doses of rupatadine: results from a ‘thorough QT/QTc study’ performed according to ICH guidelines. Br J Clin Pharmacol. 2010;69:401–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hekkala AM, Swan H, Vaananen H, Viitasalo M, Toivonen L. The effect of antihistamine cetirizine on ventricular repolarization in congenital long QT syndrome. J Cardiovasc Electrophysiol. 2007;18:691–5.

    Article  PubMed  Google Scholar 

  28. Hulhoven R, Rosillon D, Letiexhe M, Meeus MA, Daoust A, Stockis A. Levocetirizine does not prolong the QT/QTc interval in healthy subjects: results from a thorough QT study. Eur J Clin Pharmacol. 2007;63:1011–7.

    Article  CAS  PubMed  Google Scholar 

  29. Pratt C, Brown AM, Rampe D, Mason J, Russell T, Reynolds R, et al. Cardiovascular safety of fexofenadine HCl. Clin Exp Allergy. 1999;29 Suppl 3:212–6.

    Article  CAS  PubMed  Google Scholar 

  30. Tyl B, Kabbaj M, Azzam S, Sologuren A, Valiente R, Reinbolt E, et al. Lack of significant effect of bilastine administered at therapeutic and supratherapeutic doses and concomitantly with ketoconazole on ventricular repolarization: results of a thorough QT study (TQTS) with QT-concentration analysis. J Clin Pharmacol. 2012;52:893–903.

    Article  CAS  PubMed  Google Scholar 

  31. Szewczyk J, Kruszewsky J. The influence of antihistamines on the cardiovascular system. Alerg Astma Imunologia. 2001;4:135–141.

  32. De VC, Mitchev K, Pinelli ME, Derde MP, Boev R. Non-interventional study comparing treatment satisfaction in patients treated with antihistamines. Clin Drug Investig. 2008;28:221–30.

    Article  Google Scholar 

  33. Ferrer M, Morais-Almeida M, Guizova M, Khanferyan R. Evaluation of treatment satisfaction in children with allergic disease treated with an antihistamine: an international, non-interventional, retrospective study. Clin Drug Investig. 2010;30:15–34.

    Article  CAS  PubMed  Google Scholar 

  34. Hoyte FC, Katial RK. Antihistamine therapy in allergic rhinitis. Immunol Allergy Clin North Am. 2011;31:509–43.

    Article  PubMed  Google Scholar 

  35. Bousquet J, Van CP, Bachert C, Canonica GW, Demoly P, Durham SR, et al. Requirements for medications commonly used in the treatment of allergic rhinitis. European Academy of Allergy and Clinical Immunology (EAACI), Allergic Rhinitis and its Impact on Asthma (ARIA). Allergy. 2003;58:192–7.

    Article  PubMed  Google Scholar 

  36. Mansmann Jr HC, Altman RA, Berman BA, Buchman E, Dockhorn RJ, Leese PT, et al. Efficacy and safety of cetirizine therapy in perennial allergic rhinitis. Ann Allergy. 1992;68:348–53.

    PubMed  Google Scholar 

  37. Meltzer EO, Weiler JM, Widlitz MD. Comparative outdoor study of the efficacy, onset and duration of action, and safety of cetirizine, loratadine, and placebo for seasonal allergic rhinitis. J Allergy Clin Immunol. 1996;97:617–26.

    Article  CAS  PubMed  Google Scholar 

  38. Compalati E, Baena-Cagnani R, Penagos M, Badellino H, Braido F, Gomez RM, et al. Systematic review on the efficacy of fexofenadine in seasonal allergic rhinitis: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Int Arch Allergy Immunol. 2011;156:1–15.

    Article  CAS  PubMed  Google Scholar 

  39. Kuna P, Bachert C, Nowacki Z, Van CP, Agache I, Fouquert L, et al. Efficacy and safety of bilastine 20 mg compared with cetirizine 10 mg and placebo for the symptomatic treatment of seasonal allergic rhinitis: a randomized, double-blind, parallel-group study. Clin Exp Allergy. 2009;39:1338–47.

    Article  CAS  PubMed  Google Scholar 

  40. Compalati E, Canonica GW. Efficacy and safety of rupatadine for allergic rhino-conjunctivitis: a systematic review of randomized, double-blind, placebo-controlled studies with meta-analysis. Curr Med Res Opin. 2013;29:1539–51.

    Article  CAS  PubMed  Google Scholar 

  41. Benninger M, Farrar JR, Blaiss M, Chipps B, Ferguson B, Krouse J, et al. Evaluating approved medications to treat allergic rhinitis in the United States: an evidence-based review of efficacy for nasal symptoms by class. Ann Allergy Asthma Immunol. 2010;104:13–29.

    Article  PubMed  Google Scholar 

  42. Devillier P, Dreyfus JF, Demoly P, Calderon MA. A meta-analysis of sublingual allergen immunotherapy and pharmacotherapy in pollen-induced seasonal allergic rhinoconjunctivitis. BMC Med. 2014;12:71.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Skoner DP, LaForce CF, Nathan RA, Urdaneta ER, Zielinski MA, Sacavage SD, et al. Effect of cetirizine on symptom severity and quality of life in perennial allergic rhinitis. Allergy Asthma Proc. 2014;35:338–45.

    Article  CAS  PubMed  Google Scholar 

  44. Bousquet J, Demarteau N, Mullol J, van den Akker-van Marle ME, Van GE, Bachert C. Costs associated with persistent allergic rhinitis are reduced by levocetirizine. Allergy. 2005;60:788–94.

    Article  CAS  PubMed  Google Scholar 

  45. Walter CG, Bousquet J, Van HG, Bachert C, Durham SR, Klimek L, et al. Levocetirizine improves health-related quality of life and health status in persistent allergic rhinitis. Respir Med. 2006;100:1706–15.

    Article  Google Scholar 

  46. Mosges R, Konig V, Koberlein J. The effectiveness of modern antihistamines for treatment of allergic rhinitis—an IPD meta-analysis of 140,853 patients. Allergol Int. 2013;62:215–22.

    Article  PubMed  Google Scholar 

  47. Mosges R, Konig V, Koberlein J. The effectiveness of levocetirizine in comparison with loratadine in treatment of allergic rhinitis—a meta-analysis. Allergol Int. 2011;60:541–6.

    Article  CAS  PubMed  Google Scholar 

  48. Yang YH, Lin YT, Lu MY, Tsai MJ, Chiang BL. A double-blind, placebo-controlled, and randomized study of loratadine (Clarityne) syrup for the treatment of allergic rhinitis in children aged 3 to 12 years. Asian Pac J Allergy Immunol. 2001;19:171–5.

    CAS  PubMed  Google Scholar 

  49. Yamamoto H, Yamada T, Sakashita M, Kubo S, Susuki D, Tokunaga T, et al. Efficacy of prophylactic treatment with montelukast and montelukast plus add-on loratadine for seasonal allergic rhinitis. Allergy Asthma Proc. 2012;33:e17–22.

    Article  CAS  PubMed  Google Scholar 

  50. Canonica GW, Tarantini F, Compalati E, Penagos M. Efficacy of desloratadine in the treatment of allergic rhinitis: a meta-analysis of randomized, double-blind, controlled trials. Allergy. 2007;62:359–66.

    Article  CAS  PubMed  Google Scholar 

  51. Passalacqua G, Canonica GW. A review of the evidence from comparative studies of levocetirizine and desloratadine for the symptoms of allergic rhinitis. Clin Ther. 2005;27:979–92.

    Article  CAS  PubMed  Google Scholar 

  52. Bousquet J, Bachert C, Canonica GW, Mullol J, Van CP, Jensen CB, et al. Efficacy of desloratadine in persistent allergic rhinitis—a GA(2)LEN study. Int Arch Allergy Immunol. 2010;153:395–402.

    Article  PubMed  Google Scholar 

  53. Bousquet J, Bachert C, Canonica GW, Mullol J, Van CP, Bindslev JC, et al. Efficacy of desloratadine in intermittent allergic rhinitis: a GA(2)LEN study. Allergy. 2009;64:1516–23.

    Article  CAS  PubMed  Google Scholar 

  54. Horak F, Zieglmayer P, Zieglmayer R, Lemell P. The effects of bilastine compared with cetirizine, fexofenadine, and placebo on allergen-induced nasal and ocular symptoms in patients exposed to aeroallergen in the Vienna challenge chamber. Inflamm Res. 2010;59:391–8.

    Article  CAS  PubMed  Google Scholar 

  55. Bachert C, Kuna P, Sanquer F, Ivan P, Dimitrov V, Gorina MM, et al. Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patients. Allergy. 2009;64:158–65.

    Article  CAS  PubMed  Google Scholar 

  56. Sastre J, Mullol J, Valero A, Valiente R. Efficacy and safety of bilastine 20 mg compared with cetirizine 10 mg and placebo in the treatment of perennial allergic rhinitis. Curr Med Res Opin. 2012;28:121–30.

    Article  CAS  PubMed  Google Scholar 

  57. Ratner P, Falques M, Chuecos F, Esbri R, Gispert J, Peris F, et al. Meta-analysis of the efficacy of ebastine 20 mg compared to loratadine 10 mg and placebo in the symptomatic treatment of seasonal allergic rhinitis. Int Arch Allergy Immunol. 2005;138:312–8.

    Article  CAS  PubMed  Google Scholar 

  58. Mullol J, Bousquet J, Bachert C, Canonica GW, Gimenez-Arnau A, Kowalski ML, et al. Update on rupatadine in the management of allergic disorders. Allergy. 2015;70 Suppl 100:1–24. A comprehensive review on Rupatidine.

    Article  CAS  PubMed  Google Scholar 

  59. Munoz-Cano R, Valero A, Roca-Ferrer J, Bartra J, Sanchez-Lopez J, Mullol J, et al. Platelet-activating factor nasal challenge induces nasal congestion and reduces nasal volume in both healthy volunteers and allergic rhinitis patients. Am J Rhinol Allergy. 2013;27:e48–52.

    Article  PubMed  Google Scholar 

  60. Munoz-Cano R, Valero A, Izquierdo I, Sanchez-Lopez J, Domenech A, Bartra J, et al. Evaluation of nasal symptoms induced by platelet activating factor, after nasal challenge in both healthy and allergic rhinitis subjects pretreated with rupatadine, levocetirizine or placebo in a cross-over study design. Allergy Asthma Clin Immunol. 2013;9:43.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Fantin S, Maspero J, Bisbal C, Agache I, Donado E, Borja J, et al. A 12-week placebo-controlled study of rupatadine 10 mg once daily compared with cetirizine 10 mg once daily, in the treatment of persistent allergic rhinitis. Allergy. 2008;63:924–31.

    Article  CAS  PubMed  Google Scholar 

  62. Valero A, Izquierdo I, Giralt J, Bartra J, Del CA, Mullol J. Rupatadine improves nasal symptoms, quality of life (ESPRINT-15) and severity in a subanalysis of a cohort of Spanish allergic rhinitis patients. J Investig Allergol Clin Immunol. 2011;21:229–35.

    CAS  PubMed  Google Scholar 

  63. Valero A, Ferrer M, Sastre J, Navarro AM, Monclus L, Marti-Guadano E, et al. A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the allergic rhinitis and its impact on asthma severity items. J Allergy Clin Immunol. 2007;120:359–65.

    Article  PubMed  Google Scholar 

  64. Ciprandi G, Passalacqua G, Mincarini M, Ricca V, Canonica GW. Continuous versus on demand treatment with cetirizine for allergic rhinitis. Ann Allergy Asthma Immunol. 1997;79:507–11.

    Article  CAS  PubMed  Google Scholar 

  65. Canonica GW, Fumagalli F, Guerra L, Baiardini I, Compalati E, Rogkakou A, et al. Levocetirizine in persistent allergic rhinitis: continuous or on-demand use? A pilot study. Curr Med Res Opin. 2008;24:2829–39.

    Article  CAS  PubMed  Google Scholar 

  66. Xu Y, Zhang J, Wang J. The efficacy and safety of selective H1-antihistamine versus leukotriene receptor antagonist for seasonal allergic rhinitis: a meta-analysis. PLoS One. 2014;9, e112815. A meta-analysis evaluating the Efficacy and Safety of second generation oral H1-Antihistamine versus Leukotriene Receptor Antagonist for Seasonal Allergic Rhinitis.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kurowski M, Kuna P, Gorski P. Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis: influence on clinical symptoms and nasal allergic inflammation. Allergy. 2004;59:280–8.

    Article  CAS  PubMed  Google Scholar 

  68. Meltzer EO, Malmstrom K, Lu S, Prenner BM, Wei LX, Weinstein SF, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000;105:917–22.

    Article  CAS  PubMed  Google Scholar 

  69. Meltzer EO. Role for cysteinyl leukotriene receptor antagonist therapy in asthma and their potential role in allergic rhinitis based on the concept of “one linked airway disease”. Ann Allergy Asthma Immunol. 2000;84:176–85.

    Article  CAS  PubMed  Google Scholar 

  70. Keskin O, Alyamac E, Tuncer A, Dogan C, Adalioglu G, Sekerel BE. Do the leukotriene receptor antagonists work in children with grass pollen-induced allergic rhinitis? Pediatr Allergy Immunol. 2006;17:259–68.

    Article  PubMed  Google Scholar 

  71. Del CA, Sastre J, Montoro J, Jauregui I, Davila I, Ferrer M, et al. Allergic conjunctivitis and H1 antihistamines. J Investig Allergol Clin Immunol. 2009;19 Suppl 1:11–8.

    Google Scholar 

  72. Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy. 1991;21:77–83.

    Article  CAS  PubMed  Google Scholar 

  73. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  74. Meltzer EO, Nathan RA, Seiner JC, Storms W. Quality of life and rhinitic symptoms: results of a nationwide survey with the SF-36 and RQLQ questionnaires. J Allergy Clin Immunol. 1997;99:S815–9.

    Article  Google Scholar 

  75. Pariente PD, LePen C, Los F, Bousquet J. Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis. Pharmacoeconomics. 1997;12:585–95.

    Article  CAS  PubMed  Google Scholar 

  76. Sullivan PW, Navaratnam P, Lorber R, Shekar T. The cost-effectiveness of treatment with desloratadine in patients with persistent allergic rhinitis. Curr Med Res Opin. 2010;26:1389–97. This study examines in depth the cost-effectiveness of treating patients according to the ARIA definition of Persistent Allergic Rhinitis with desloratadine compared to placebo.

    Article  CAS  PubMed  Google Scholar 

  77. Bernstein JA, Prenner B, Ferguson BJ, Portnoy J, Wheeler WJ, Sacks HJ. Double-blind, placebo-controlled trial of reformulated azelastine nasal spray in patients with seasonal allergic rhinitis. Am J Rhinol Allergy. 2009;23:512–7.

    Article  PubMed  Google Scholar 

  78. Bielory L. Role of antihistamines in ocular allergy. Am J Med. 2002;113(Suppl 9A):34S–7.

    Article  CAS  PubMed  Google Scholar 

  79. Bielory L, Buddiga P, Bigelson S. Ocular allergy treatment comparisons: azelastine and olopatadine. Curr Allergy Asthma Rep. 2004;4:320–5.

    Article  PubMed  Google Scholar 

  80. Lumry W, Prenner B, Corren J, Wheeler W. Efficacy and safety of azelastine nasal spray at a dose of 1 spray per nostril twice daily. Ann Allergy Asthma Immunol. 2007;99:267–72.

    Article  CAS  PubMed  Google Scholar 

  81. Ellis AK, Zhu Y, Steacy LM, Walker T, Day JH. A four-way, double-blind, randomized, placebo controlled study to determine the efficacy and speed of azelastine nasal spray, versus loratadine, and cetirizine in adult subjects with allergen-induced seasonal allergic rhinitis. Allergy Asthma Clin Immunol. 2013;9:16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Yanez A, Rodrigo GJ. Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2002;89:479–84.

    Article  CAS  PubMed  Google Scholar 

  83. Carr WW, Ratner P, Munzel U, Murray R, Price D, Canonica GW, et al. Comparison of intranasal azelastine to intranasal fluticasone propionate for symptom control in moderate-to-severe seasonal allergic rhinitis. Allergy Asthma Proc. 2012;33:450–8.

    Article  CAS  PubMed  Google Scholar 

  84. Klimek L, Bachert C, Mosges R, Munzel U, Price D, Virchow JC, et al. Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: results from a noninterventional study. Allergy Asthma Proc. 2015;36:40–7.

    Article  CAS  PubMed  Google Scholar 

  85. Bousquet J, Bachert C, Bernstein J, Canonica GW, Carr W, Dahl R, et al. Advances in pharmacotherapy for the treatment of allergic rhinitis; MP29-02 (a novel formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) fills the gaps. Expert Opin Pharmacother. 2015;16:913–28.

    Article  CAS  PubMed  Google Scholar 

  86. Carr W, Bernstein J, Lieberman P, Meltzer E, Bachert C, Price D, et al. A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. J Allergy Clin Immunol. 2012;129:1282–9.

    Article  CAS  PubMed  Google Scholar 

  87. Price D, Shah S, Bhatia S, Bachert C, Berger W, Bousquet J, et al. A new therapy (MP29-02) is effective for the long-term treatment of chronic rhinitis. J Investig Allergol Clin Immunol. 2013;23:495–503.

    CAS  PubMed  Google Scholar 

  88. Meltzer E, Ratner P, Bachert C, Carr W, Berger W, Canonica GW, et al. Clinically relevant effect of a new intranasal therapy (MP29-02) in allergic rhinitis assessed by responder analysis. Int Arch Allergy Immunol. 2013;4:369–77.

    Article  Google Scholar 

  89. Plaza Moral V. GEMA(4.0). Guidelines for asthma management. Arch Bronconeumol. 2015;51 Suppl 1:2–54.

    Article  PubMed  Google Scholar 

  90. Shah SR, Nayak A, Ratner P, Roland P, Michael WG. Effects of olopatadine hydrochloride nasal spray 0.6% in the treatment of seasonal allergic rhinitis: a phase III, multicenter, randomized, double-blind, active- and placebo-controlled study in adolescents and adults. Clin Ther. 2009;31:99–107.

    Article  CAS  PubMed  Google Scholar 

  91. Castillo M, Scott NW, Mustafa MZ, Mustafa MS, Azuara-Blanco A. Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis. Cochrane Database Syst Rev. 2015;6:CD009566. A comprehensive systematic review with meta-analysis of topical antihistamines and mast cell stabilisers for treating seasonal and persistent allergic conjunctivitis.

    PubMed  Google Scholar 

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  1. Royal National Throat Nose and Ear Hospital part of University College Hospitals, 330 Gray’s Inn Road, London, WC1X 8DA, UK

    Giuseppina Rotiroti MD & M. Radcliffe MD

  2. Royal Free Hospital, London, UK

    Giuseppina Rotiroti MD & M. Dziadzio MD

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Rotiroti, G., Dziadzio, M. & Radcliffe, M. Antihistamines for the Treatment of Allergic Rhino-conjunctivitis. Curr Treat Options Allergy 3, 1–17 (2016). https://doi.org/10.1007/s40521-016-0073-5

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  • DOI: https://doi.org/10.1007/s40521-016-0073-5

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