General Medical Information

Advances In Allergic Rhinosinusitis

Richard L. Mabry

Diagnosis

New developments are making the diagnosis of allergic rhinosinusitis easier, but proper physician judgment remains critical. Although computer-assisted history taking can save time and ensure that no important questions are omitted, ongoing evaluation of symptoms and response to treatment is the responsibility of the allergy team. In vitro testing methods are being improved to provide accurate results rapidly, but a knowledge of skin test mechanisms and interpretation remains essential.

Treatment

Second- and third-generation antihistamines relieve symptoms without many of the side effects of older preparations; however, the cost is greater. The role of leukotriene modifiers in the management of allergic rhinosinusitis is currently under vigorous investigation, especially in combination with nonsedating antihistamines. A new emphasis is being placed on topical therapy, including topical antihistamines, allergy-blocking agents such as human IgE pentapeptide (HEPP), improved topical nonsteroidal agents such as nedocromil, and new nasal glucocorticoids. The most promising therapeutic advance under consideration is anti-IgE for systemic administration. Standardization of extracts used in immunotherapy, so that one allergy unit of any pollen is biologically equivalent to one allergy unit of dust mite or mold, promises to contribute to the safety of the procedure. The ability to measure mediator substances in nasal secretions has provided a giant stride in studies of the allergic reaction and its proper therapy.