Allergic rhinitis is a common condition in managed care populations. The direct medical cost of
rhinitis exceeded $3 billion in 1996, and an additional cost of $4 billion resulted from the exacerbation of other concomitant conditions, such as
asthma or
otitis media. Costs continued to increase in 1999; sales of prescription
antihistamines and nasal
steroids exceeded $3 billion and $1 billion, respectively. The indirect costs of
allergic rhinitis include lost work productivity, reduced performance and learning, and increased workplace and traffic accidents.
Rhinitis treatments include
allergen avoidance, over-the-counter (OTC)
sedating antihistamines, nonsedating
antihistamines, nasal
steroids, and
immunotherapy.
Allergen avoidance strategies for patients with
asthma and
rhinitis are ineffective or are of very limited benefit. Allergists criticize the use of OTC
sedating antihistamines, which are associated with reduced learning and performance even when sedation does not occur. Evidence-based literature reviews of clinical trials have shown that nasal
steroids are more effective than nonsedating
antihistamines in the treatment of
rhinitis. The most commonly prescribed nasal
steroid,
fluticasone, has been shown to be effective in treating
rhinitis and in improving patients' quality of life. It is also more cost effective than the most commonly prescribed
antihistamine,
loratadine. Clinical trials have indicated that
immunotherapy is expensive and of limited benefit. As these evidence-based findings are used to develop managed care treatment guidelines, nasal
steroids are likely to be recommended as the first-line treatment for
rhinitis, which should result in lower treatment costs and improved outcomes for patients with
rhinitis.