Hematoxylin  current rec-ommendations for nasal antihistamines as first-line therapy for allergic rhinitis. We searched published articles in the peer-reviewed medical literature for clinical trials that fo-cused on the effica safe and rmended uses of the currently approved nasal antihistamines in the United States: azelastine nasal spr , and olopatadine nasal spr . NASAL ANTIHISTAMINES IN THE MANAGEMENT OF AR AR can be seasonal or perennial and should be differentiated by histo physical examinati and skin testing from non-allergic rhinopathy . Seasonal AR typically occurs in response to exposure to pollen and can occur in the spri late sum-m and fall.

Although the symptoms of AR and NAR overl the former is triggered by allerge whereas  Dexrazoxane  the latter results from a variety of nonspecific environmental stimu including strong smel airborne irritan changes in environmental condition strong emotio and changes in hormone leve among others. The management of AR includes avoidance of allerge consideration for immunothera and pharmacotherapy. Oral and intranasal medications are available to treat AR; the latter medication has the advantage of limiting systemic ex-posure to medications directed primarily at the nose. The short-term goal for pharmacotherapy is symptom control with minimal impact on daily functioni including little or no sedation and associated cognitive impairment.

A stepwise treatment approach based on symptom severity is r-mend with second-generation antihistamines among the first-line choices. These agents do not cross the  purchase EPO906 blood-brain barrier and are usually preferred over first-generation antihis-tamines to minimize sedati performance impairme and anticholinergic effects. The topical administration of antihistamines directly to the nasal passages has several advantages over oral administra-tion. The potential for systemic adverse effects is lowered with delivery of the drug directly to the target and higher concentrations of drug can be used. Current treatment and is indicated for the relief of symptoms of SAR in patients years and older. AZELASTINE Azelasti a phthalazinone derivati is a uniq pharma-cologically distin second-generation antihistamine with high affinity for H receptors and some affinity for H recep-tors. Its binding affinity is approximately times that of chlorpheniramine at the H receptor site. Azelastine also inhibits the synthesis and/or expression of a wide range of chemical mediators of the allergic respon including  order Genistein leuko-trien kini cytokines and chemokin superoxide free radica and neuropeptides.

Azelastine nasal spray has a rapid onset of action. The initial studies used for labeling in the United States included a relatively small number of patients per treatment gro and assessments were made at hourly intervals. In these studi the onset of action of azelastine was determined to be within to hourspared with placebo. Recent tria howev have suggested that the onset of action is more rap on the order of minutes not hours. Significant reduction of nasal SAR symptoms has been documented within minutes in  oxidation  individuals exposed to allergen in an environmental exposure chamber pared with placebo. Efficacy in SAR Several multicent randomiz double-bli placebo-con-trolled trials have documented that azelastine.