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J Montoro,1 J Sastre,2
I Jáuregui,3 J Bartra,4 I Dávila,5
A del Cuvillo,6 M Ferrer,7 J
Mullol,8 A Valero,4 |
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1 Allergy Unit, Hospital La Plana,
Villarreal (Castellón), Spain
2 Service of Allergy, Fundación Jiménez Díaz, Madrid,
Spain
3 Service of Allergy, Hospital de Basurto, Bilbao, Spain
4 Allergy Unit, Service of Pneumology and Respiratory
Allergy, Hospital Clínic (ICT), Barcelona, Spain
5 Service of Immunoallergy, Hospital Clínico, Salamanca,
Spain
6 Clínica Dr. Lobatón, Cádiz, Spain
7 Department of Allergology, Clínica Universitaria de
Navarra, Pamplona, Spain
8 Rhinology Unit, ENT Service (ICEMEQ), Hospital Clínic,
Barcelona, Spain |
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Abstract |
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Allergic rhinitis is
an inflammatory
disease of the nasal
mucosa, caused by an
IgE-mediated
reaction after
exposure to the
allergen to which
the patient is
sensitized.
Histamine is the
most important
preformed mediator
released in the
early stage of the
allergic reaction,
and also contributes
to the late phase of
the latter,
exhibiting
proinflammatory
effects.
Minimal persistent
infl mmation is a
physiopathological
phenomenon induced
by the presence of
an inflammatory cell
infiltrate, together
with ICAM-1
expression in the
epithelial cells of
the mucosa exposed
to the allergen to
which they are
sensitized, in the
absence of clinical
symptoms. This
molecule is
considered to be an
allergic infl
ammatory marker.
The priming effect
fi rst described by
Connell in 1968
consists of the
reduction in the
allergen
concentration
required to elicit a
nasalhyper-response
when performing a
daily nasal exposure
test. This implies
that with natural
exposure to inhaled
allergens, small
amounts of
environmental
allergen will
maintain the patient
symptoms, and thus
of course minimal
persistent infl
ammation.
Considering the
above, it is
questionable whether
antihistamines
should be
administered on a
continuous basis or
upon demand.
The antihistamines,
and fundamentally
the second-generation
drugs, have been
shown to exert an
antiinflammatory
effect, and this
effect is greater
when the drug is
administered
continuously than
when administered
upon demand.
Likewise, a
reduction in
treatment cost and
an improvement in
quality of life
among patients
treated on a
continuous basis has
been documented.
However, no studies
have been
specifically
designed to clarify
the indication of
treatment on a
continuous basis or
upon demand, as
occurs in the GINA.
As a result, the
individualization of
treatment according
to the concrete
characteristics of
each patient seems
to be the best
approach, at least
for the time being.
Key words:
Allergic rhinitis.
Antihistamines.
Minimal persistent
inflammation.
Priming effect.
Continuous Treatment.
Treatment upon
demand. |
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