Immunology and Allergic Rhinitis

1. In my article I tried to be clear and objective, describing the physiological, pathology and immunology aspects that involve a very common disease, called Allergic Rhinitis.
   INTRODUCTION — The treatment of allergic rhinitis involves the following modalities:
   
   Allergen avoidance
   Pharmacologic therapy
   Immunologic treatments, when appropriate
   
   The use of immunologic treatments in the management of allergic rhinitis will be reviewed here. Pharmacotherapy and allergen avoidance and the clinical manifestations, diagnosis, differential diagnosis, and pathogenesis of allergic rhinitis are discussed separately.
   

   WHEN TO REFER — Immunologic therapies for allergic rhinitis are usually administered by allergy specialists. Referral should be considered in the following patients:

   
   

   Children or adults whose symptoms are inadequately controlled with pharmacotherapy or have side effects from these agents

   Children or adults who wish to minimize or avoid long-term drug therapy

SUBCUTANEOUS INJECTION IMMUNOTHERAPY — Allergen injection immunotherapy, or subcutaneous allergen immunotherapy (SCIT), is mentioned briefly here and described in detail elsewhere

SCIT involves the administration of gradually increasing doses of therapeutic solutions of allergens to which a patient has demonstrated sensitivity, usually through skin testing. Over time, a dose is attained that effectively alters the patient's immune response to that allergen, resulting in fewer symptoms with natural exposure.
Allergen immunotherapy is unique among treatment modalities in its ability to alter the pathologic process that underlies allergic rhinitis in a semi-permanent manner. Thus, when administered to appropriately selected patients, this therapy represents a powerful intervention that can significantly impact patients' lives. In children with allergic rhinitis, immunotherapy can help prevent the development of allergic asthma. (
oral immunotherapy involves the application of allergen to the oral mucosa or sublingual tissues either in the form of solutions or dissolvable tablets. The solution/tablet is typically held in the mouth for a few minutes and then swallowed. Oral forms of immunotherapy for the treatment of allergic rhinitis are reviewed in detail separately.

ANTI-IGE THERAPY — Allergic inflammation appears similar in the upper and lower airway, and new antiinflammatory therapies explored in allergic asthma are potential therapies for allergic rhinitis and vice versa

WHEN TO REFER — Immunologic therapies for allergic rhinitis are usually administered by allergy specialists. Referral should be considered in the following patients:

Children or adults whose symptoms are inadequately controlled with pharmacotherapy or have side effects from these agents

Children or adults who wish to minimize or avoid long-term drug therapy