Department of Otolaryngology, Sapporo Medical University, Japan

Keywords

Cysteinyl leukotrienes, Allergic rhinitis, PAF, Thromboxane, Glucocorticoids

The nasal allergic response is a complex process involving the interaction of many mediators. The current therapeutic strategy is mainly based on drugs (antihistamines, nasal corticosteroids, etc.) and allergen immunotherapy. The most effective medication in persistent rhinitis is topical corticosteroid, which decreases all symptoms [1]. Antihistamines reduce nasal itch, sneeze and rhinorrhea [2]. Cysteinyl Leukotrienes (CysLTs) play an important role in allergic rhinitis because CysLT1 receptor antagonists relieve the symptoms of allergic rhinitis [3]. CysLT1 receptor antagonists provide a new opportunity for simultaneous management of allergic diseases of the upper and lower respiratory tract. The combination therapy is more effective and acts more rapidly than either drug used alone. Ramatroban, a thromboxane A2 receptor antagonist with clinical efficacy in allergic rhinitis, was shown to also antagonize the prostaglandin D2 receptor CRTH2 [4,5]. In addition to other inflammatory mediators, PAF have a relevant participation in allergic inflammation [6]. Rupatadine is a dual inhibitor of histamine H1 and PAF receptors, which has been shown to be an effective and generally well-tolerated treatment for allergic rhinitis and chronic urticaria. These medications for allergic rhinitis offer numerous options that are effective, and readily available to target specific nasal symptoms.

References

1. Shirasaki H, Watanabe K, Kanaizumi E, Konno N, Sato J, et al. (2004) Expression and localization of steroid receptors in human nasal mucosa. Acta Otolaryngol 124: 958-963.
   


2. Shirasaki H, Kanaizumi E, Seki N, Himi T (2012) Localization and upregulation of the nasal histamine H receptor in perennial allergic rhinitis. Mediators Inflamm 2012: 951316.
   


3. Shirasaki H (2008) Cysteinyl leukotriene receptor CysLT1 as a novel therapeutic target for allergic rhinitis treatment. Expert Opin Ther Targets 12: 415-423.
   


4. Shirasaki H, Kikuchi M, Seki N, Kanaizumi E, Watanabe K, et al. (2007) Expression and localization of the thromboxane A2 receptor in human nasal mucosa. Prostaglandins Leukot Essent Fatty Acids 76: 315-320.
   


5. Shirasaki H, Kikuchi M, Kanaizumi E, Himi T (2009) Accumulation of CRTH2-positive leukocytes in human allergic nasal mucosa. Ann Allergy Asthma Immunol 102: 110-115.
   


6. Shirasaki H, Seki N, Kikuchi M, Kanaizumi E, Watanabe K, et al. (2005) Expression and localization of platelet-activating factor receptor in human nasal mucosa. Ann Allergy Asthma Immunol 95: 190-196.