Major improvements in the quality of recent pharmacologic studies of
rhinitis are evident. In many of the studies, the criteria for patient selection are being more carefully described and patients with
allergic rhinitis, nonallergic
rhinitis with
eosinophilia, and
vasomotor rhinitis are no longer grouped together. In most studies, efficacy is still being ascertained by subjective symptom scores, although in some of the challenge studies, investigators are making noble attempts to quantitate symptoms objectively, eg, amount of secretions,
sneezing, and even
itching of the nares. Although nasal congestion is only one symptom of chronic
rhinitis, the various methods of measuring nasal resistance by rhinometry are increasingly well described and standardized. General concepts that are emerging from the vast literature on pharmacologic treatment of
rhinitis are as follows: 1) The much-maligned
H1 receptor antagonists may actually be more useful than previously thought, once further information about how to use them optimally is available. Interesting new
antihistamines are being developed. Further investigations of allied drugs such as the
tricyclic antidepressants (
doxepin) are definitely in order. 2)
alpha-adrenergic agonists definitely have short-term usefulness but side effects from this class of drugs have, if anything, been underestimated. Exploration of the use of
beta-adrenergic agonists and
anti-cholinergics in the treatment of chronic
rhinitis has begun. 3)
Disodium cromoglycate is not universally effective in chronic
rhinitis, perhaps in part because compliance with a prophylactic
drug requiring insufflation four or six times daily may not be high. The degree of response and the percentage of patients having an excellent response to the
drug is lower than for the new
corticosteroids. 4) Topical
corticosteroids administered intranasally are clearly the most effective medications for treatment of chronic
rhinitis. Further study of the benefit versus the long-term risk of these drugs is mandatory, but their remarkable efficacy and safety in the treatment of chronic
rhinitis is undisputed. Some comparisons between the four major groups of drugs are now being made, and further attempts to define the relative roles and the interactions of drugs used in the pharmacologic treatment of
rhinitis are definitely needed.