Therapeutic target
Improvement of symptomatology
Therapy recommendations
- Allergy cares
- In addition to allergen abstinence, specific immunotherapy (SIT; synonyms: allergen-specific immunotherapy, hyposensitization, allergy vaccination) should be performed as early as possible for causal therapy. Prior to this, proof of the clinical relevance of sensitization detected in the allergy test is required!
- Stage I (mild, intermittent symptoms):
- Antihistamines (oral or intranasal) and sympathomimetics (symptomatic)/decreasing nasal drops (oxymetazoline, xylometazoline* ); use because of rebound hyperemia/obstruction (reactive accumulation of blood with swelling of the nasal mucosa)/obstruction (“occlusion”) only for a maximum of seven days
- If necessary, leukotriene receptor antagonists (LTRA): montelukast; in combination with inhaled glucocorticoids; indication: for allergic rhinitis with concomitant bronchial asthma
- If persistent rhinitis after two to three weeks no improvement occurs, the specifications for stage II apply.
- Stage II (intermittent symptomatology moderate to severe or exist mild persistent symptoms); subsequent agents added to the agents of stage I:
- Intranasal glucocorticoids (see also “Further notes” below) and cromones.
- For persistent moderate to severe symptoms:
- Increase intranasal glucocorticoid dose.
- Itching and sneezing: H1 antihistamines in
- Rhinorrhea (runny nose): ipratropium bromide (parasympathetic); for inhalation 3-4/day.
- Decongestants (drugs with decongestant effect; mostly sympathomimetics (see above)).
- In severe cases, short-term oral glucocorticoids against obstruction (short-term therapy for ≤ 1 week).
- If necessary, eye and nose ointment containing dexpanthenol to relieve symptoms.
- Cromoglicic acid (mast cell stabilizer) for prophylaxis.
- Specific immunotherapy (SIT), i.e. allergen-specific immunotherapy; indications:
- Moderate to severe symptomatology
- Insufficient effect of symptomatic pharmacotherapy
- Signs of allergy progression, such as floor change to asthma and expansion of the spectrum of sensitization
- See also under “Further therapy“.
* Contraindicated in infants under one year of age.
Further notes
- There is no evidence that antihistamines improve olfactory function.
- There is limited evidence that topical glucocorticoids improve olfaction (especially in seasonal allergic rhinitis).
- In a meta-analysis, no association between therapy and increased intraocular pressure or cataract (cataract) could be detected in adults with allergic rhinitis receiving intranasal corticosteroid therapy. Neither condition occurred after systemic steroid use within one year.
- The FDA (U. S. Food and Drug Administration; United States Food and Drug Administration) warns of neuropsychiatric complications of montelukast and advises against prescribing the drug in patients with mild symptoms, especially those with allergic rhinitis.
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Vitamins (C, E, D3)
- Minerals (calcium, magnesium)
- Fatty acids (omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
- Other vital substances (curcumin, probiotics).
Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.
