Role of Antihistamine and Leukotriene Receptor Antagonist in Allergic Rhinitis Management: Newer Perspectives

Abstract

Allergic disorders are conditions induced by the immune system’s hypersensitivity to normally harmless chemicals known as allergens. The most common allergens include dust mites, pollution, grass pollens and food allergens such as milk, egg, soy, wheat, nut, or fish proteins. Allergic diseases include allergic rhinitis (AR), allergic asthma, urticaria, atopic dermatitis, contact allergies and food allergies. AR is the most common of all atopic diseases, afflicting 10%–30% of adults and up to 40% of children all over the world. The mechanisms underlying AR are highly complex and involve multiple immune cells, mediators
and cytokines such as histamine and leukotrienes. It is characterized by nasal symptoms such as sneezing, nasal itching, rhinorrhea, and nasal congestion. It is also, associated with non-nasal symptoms such as watery eyes, redness in the eyes or inflammation. It has a significant effect on one’s health, as well as the quality of one’s sleep, work productivity and academic performance. The management of AR includes allergen avoidance, pharmacotherapy, and immunotherapy. Complete avoidance of allergens that trigger AR symptoms is not possible. Current pharmacologic options include antihistamines (oral
and intranasal), Leukotriene Receptor Antagonists (LTRAs), Intranasal Corticosteroids (INCS), decongestants and oral and intranasal anticholinergics. Amongst other antihistamines, Bilastine has emerged as a new, non-sedating and well-tolerated antihistamine while Montelukast is an effective add-on LTRA option to an antihistamine with well-established literature in the management of moderate-severe AR. Immunotherapy is a treatment option for patients who have not responded to medication.