Management of allergic rhinitis in the era of effective over-the-counter treatments

Allergic rhinitis (AR) may be regarded as a trivial issue unworthy of the doctor’s time, and with the availability of many different over-the-counter (OTC) treatments, up to two thirds of patients self-manage AR before seeking medical care. Yet, AR can have a significant impact on health-related quality of life and is associated with a greater detriment to work productivity than other chronic diseases such as diabetes and hypertension. For many patients, the impact on quality of life is greater than suggested by reported symptoms and should also be a focus of treatment.
Although many patients can effectively manage AR symptoms independently, a significant percentage will need direction from a physician to obtain optimal results. The availability of several different classes of treatment – including decongestants, sedating and non-sedating antihistamines, and more recently intranasal corticosteroids (INS) – has increased the complexity of self-management, leaving patients confused about the best approach to treatment. Treatment guidelines universally classify INS as the most effective medical agents available for use in the OTC and primary care settings. Many patients are unaware that INS are available OTC and that they are more effective than other therapies. Patients may have negative perceptions about the safety of INS and may have experienced unpleasant taste, scent, and feel with nasal sprays. Unless a patient volunteers the information, healthcare professionals (HCPs) may be unaware that the patient has significant AR and is using one or more OTC AR therapies. To address this gap in communication, HCPs must be proactive in identifying, assessing, and advising patients with AR, including best strategies to assess allergen trigger symptoms, which treatments are appropriate, and when and how to use them. Proper use of delivery devices is especially important. This article reviews the primary care management of AR in the context of the availability of effective OTC medicines.

过敏性鼻炎（Allergic rhinitis, AR）常被视作无需医师耗费精力的轻症问题，随着多种非处方（over-the-counter, OTC）治疗手段的普及，多达三分之二的患者会在就医前自行处理过敏性鼻炎。然而，过敏性鼻炎对健康相关生活质量可产生显著影响，且相较于糖尿病、高血压等其他慢性病，对工作生产力的损害更为严重。对于多数患者而言，其对生活质量的影响远超主诉症状所体现的程度，因此也应作为治疗的重点关注对象。
尽管不少患者可自行有效控制过敏性鼻炎症状，但仍有相当比例的患者需要医师指导才能获得最佳治疗效果。目前已有多种分类的治疗手段可供选择，包括减充血剂、镇静与非镇静类抗组胺药，以及近年推出的鼻用糖皮质激素（intranasal corticosteroids, INS），这使得患者的自我管理复杂度提升，令其对最佳治疗方案感到困惑。各类治疗指南均将鼻用糖皮质激素列为非处方及基层医疗场景中最为有效的临床用药。许多患者并不知晓鼻用糖皮质激素可通过非处方渠道获取，且其疗效优于其他治疗手段。患者可能对鼻用糖皮质激素的安全性存在顾虑，且曾因鼻喷剂出现味觉异常、异味及不适体感。若患者未主动告知，医疗保健专业人员（healthcare professionals, HCPs）可能无从得知患者罹患重度过敏性鼻炎且正在使用一种或多种非处方过敏性鼻炎治疗药物。为填补这一沟通缺口，医疗保健专业人员需主动识别、评估过敏性鼻炎患者并提供诊疗建议，包括评估过敏原诱发症状的最优策略、适宜的治疗方案，以及用药的时机与方法。正确使用给药装置尤为关键。本文结合高效非处方药物的可及性现状，综述了过敏性鼻炎的基层医疗管理方案。