Резюме
Трищук Н.М. Особливості фармакотерапії алергічного риниту.
Алергічні риніти представляють глобальну проблему охорони здоров’я. Алергічний риніт визначається клінічно як симптоматичний розлад в порожнині носа, який індуцирується після експозиції алергену та опосредкує IgE-залежним запаленням оболонок носа. У статті визначені основні групи препаратів, які необхідні для терапії алергічного риніту згідно з міжнародними рекомендаціями.
Ключові слова: фармакотерапія, алергічний риніт.
Резюме
Трищук Н.М. Особенности фармакотерапии аллергического ринита.
Аллергические риниты представляют глобальную проблему здравоохранения. Аллергический ринит определяется клинически как симптоматическое расстройство в полости носа, которое индуцируется после экспозиции аллергена и опосредуется IgE-зависимым воспалением оболочек носа. В статье определены основные группы препаратов, которые необходимы для терапии аллергического ринита согласно международным рекомендациям.
Ключевые слова: фармакотерапия, аллергический ринит.
Summary
Tryshchuk N.М. Features pharmacotherapy of allergic rhinitis.
Allergic rhinitis are a global health problem. Аllergic rhinitis is defined as a symptomatic disorder of the nose, induced after allergen exposure due to an immunoglobulin (Ig) E-mediated inflammation of the membranes lining the nose. Article defines the main groups of drugs that are needed for the treatment of allergic rhinitis according to the international recommendations.
Key words: pharmacotherapy, allergic rhinitis.
Рецензент: д.мед.н. І.В. Киреєв

УДК 616.2

Национальный фармацевтический университет (Харьков)

National University of Pharmacy (Kharkov)

nadezhdatr@mail.ru

Nearly a quarter of the global population suffers this disorder which represents a world health problem, because it affects the quality of life, the sleep, the work and the learning. According to the ARIA document, allergic rhinitis is defined as a symptomatic disorder of the nose, induced after allergen exposure due to an immunoglobulin (Ig) E-mediated inflammation of the membranes lining the nose. Rhinitis is the most frequent respiratory disease in the world and the most frequent manifestation of allergic disease in humans. It is often linked to other atopic diseases such as food allergy, atopic dermatitis or asthma. Depending on the sensitization pattern, patients may develop seasonal- or perennial symptoms: seasonal rhinitis is caused by aeroallergens such as pollens while the perennial form is mostly induced by mites, mold, and dander. Treatment of allergic rhinitis (AR) should be based on three basic steps: control of the environment, drug therapy and immuno­modulating therapy. Efforts to avoid exposure to allergens are in­tended to prevent the development of symptoms in sensitive patient. It is particularly effective in reactions mediated by food, medicine, dander and mites. In the case of pollen allergies air specific measures are controversial.

The most common agents to treat AR include antihistamines, decongestants, steroids, mast cell stabilizers, anticholinergic agents, antileukotrienes and mucolytics: topical corticosteroids are the preferred method of treatment for both seasonal and perennial allergic rhinitis.

Nasal glucocorticoids (NGC) remain the cornerstone in the treat­ment of AR. Gluco­corticoids inhibits the functions of infiltrating inflammatory cells and their recruitment into the nasal mucosa. Antihistamines are considered as second-line therapeutic agents in the control of RA. First-generation antihistamines, tend to reduce itching, sneezing and rhinorrhea, with less impact on nasal congestion. They cause significant sedation. New antihista­minic are effective in relieving the nasal congestion associated with AR .The use of antihistamines is approved by international consen­sus, although the effect is lower than nasal steroids, but greater than an­tileukotrienes and cromones. Azelastine is better for nasal congestion, and time of action is faster compared with oral antihistamines. The advantages of such therapy in­clude attaining higher concentrations of active drug directly to the tar­get tissue with the added benefit of reduced systemic side effects.

Membrane stabilizers such as cromolyn sodium and nedocromil inhibit the release of mediators such as histamine libelous by inhibition of chloride channels in the membrane of mast cells. Cromolyn sodium is effective in the treatment of seasonal allergic rhinitis when evaluated against placebo, however, most studies show that it is less effective than INGCs or second-generation antihistamines. Nasal decongestants are not recommended in the treatment of chron­ic allergic rhinitis. Their administration may be useful in specific cases in patients with severe nasal obstruction. Receptor antagonists of leukotrienes as montelukast inhibits the development of nasal symptoms by preventing the binding of LTC4 and LTD4 receptor CysLT1 in its improvement through questionnaires assessed value as the rhinitis severity score has shown its impact in al­leviating nasal congestion and the clinical improvement experienced by patients is comparable with the use of antihistaminics without clutch. These effects are outweighed by the intranasal glucocorticoids. Omalizumab is a ‘‘humanized’’ monoclonal antibody which binds the IgE molecule at its IgE receptor-binding portion, preventing IgE’s interaction with the high-affinity IgE receptor present on mast cells, basophils, and dendritic cells. Specific allergen immunotherapy should be considered when there is a poor response to pharmacotherapy, particularly as it is effective and modifies the course of the disease. A clear advantage of SIT over pharmacotherapy, the benefits of which last as long as it is continued, is a long-lasting relief of allergic symptoms after treatment discontinuation.

As a result of this review for the treatment of AR can draw the following conclusions: first, it is necessary to use drugs for the treatment of AR safe, convenient to use, and accessible to patients and, of course, the most effective, which have confirmed the evidence base.

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