A contemporary view of the treatment of allergic rhinitis patients: When standard therapy isn’t enough

Allergic rhinitis (AR) is one of the most common chronic diseases of the upper respiratory tract, in which a focus of inflammation forms in the mucous membrane of the nasal cavity. Pathogenetically, inflammation in the nasal cavity is caused by the development of immediate-type hypersensitivity involving IgE, the so-called T2 inflammation. The diagnosis of AR is a multidisciplinary task. The treatment of AR is a complex of measures, including elimination therapy, drug treatment and allergen-specific immunotherapy. An important aspect of the management of such patients is their training in order to manage the disease. Currently, one of the most modern areas of therapy for AR patients is the use of biological therapy, namely monoclonal antibodies. Monoclonal antibodies have proven their safety and effectiveness in the treatment of various diseases based on the results of numerous studies. The clinical recommendations of the Ministry of Health of the Russian Federation recommend the use of omalizumab for the treatment of patients with severe persistent rhinitis or severe exacerbation. The results of clinical studies have demonstrated that the addition of omalizumab to standard therapy for patients with AR is well tolerated and more effective than traditional treatment. There was a marked reduction in nasal and ophthalmological symptoms, a clinically significant improvement in quality of life and a decrease in the impact of the disease on daily activities and labor productivity. An observation of a patient presenting with AR, allergic conjunctivitis, and bronchial asthma revealed a positive clinical and functional response to genetically engineered biological therapy. This improvement was documented through validated questionnaires, detailed patient history, and comprehensive otorhinolaryngological examination.

1. Астафьева НГ, Баранов АА, Вишнева ЕА, Дайхес НА, Жестков АВ, Ильина НИ и др. Аллергический ринит: клинические рекомендации. М.; 2024. 88 с. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/261_2.

2. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108–352. https://doi.org/10.1002/alr.22073.

3. Хаитов РМ, Ильина НИ (ред.). Аллергология и иммунология. М.: ГЭОТАРМедиа; 2009. 656 с. Режим доступа: https://drive.google.com/file/d/1kX5q9fWzkYFpYXh4lyFnuWCeDLVGSH4g/view.

4. Tosca MA, Trincianti C, Naso M, Nosratian V, Ciprandi G. Treatment of Allergic Rhinitis in Clinical Practice. Curr Pediatr Rev. 2024;20(3):271–277. https://doi.org/10.2174/1573396320666230912103108.

5. Nappi E, Paoletti G, Malvezzi L, Ferri S, Racca F, Messina MR et al. Comorbid allergic rhinitis and asthma: important clinical considerations. Expert Rev Clin Immunol. 2022;18(7):747–758. https://doi.org/10.1080/1744666X.2022.2089654.

6. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008. Allergy. 2008;63(S86):8–160. https://doi.org/10.1111/j.1398-9995.2007.01620.x.

7. Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic Rhinitis: A Review. JAMA. 2024;331(10):866–877. https://doi.org/10.1001/jama.2024.0530.

8. Siddiqui ZA, Walker A, Pirwani MM, Tahiri M, Syed I. Allergic rhinitis: diagnosis and management. Br J Hosp Med. 2022;83(2):1–9. https://doi.org/10.12968/hmed.2021.0570.

9. Ilina NI. Allergy in Russia today: problems and solutions. Russian Journal of Allergy. 2022;19(3):285–288. (In Russ.) https://doi.org/10.36691/RJA1566.

10. Vardouniotis A, Doulaptsi M, Aoi N, Karatzanis A, Kawauchi H, Prokopakis E. Local Allergic Rhinitis Revisited. Curr Allergy Asthma Rep. 2020;20(7):22. https://doi.org/10.1007/s11882-020-00925-5.

11. Campo P, Eguiluz-Gracia I, Bogas G, Salas M, Plaza Serón C, Pérez N et al. Local allergic rhinitis: Implications for management. Clin Exp Allergy. 2019;49(1):6–16. https://doi.org/10.1111/cea.13192.

12. Pagel JML, Mattos JL. Allergic Rhinitis and Its Effect on Sleep. Otolaryngol Clin North Am. 2024;57(2):319–328. https://doi.org/10.1016/j.otc.2023.09.003.

13. Badhwar AK, Druce HM. Allergic rhinitis. Med Clin North Am. 1992;76(4):789–803. https://doi.org/10.1016/s0025-7125(16)30326-1.