Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa impacting up to 25% of Canadians. The standard of care for AR includes a treatment plan that takes into account patient preferences, the severity of the disease, and most essentially involves a shared decision-making process between patient and provider. Since their introduction in the 1940s, antihistamines (AHs) have been the most utilized class of medications for the treatment of AR. First-generation AHs are associated with adverse central nervous system (CNS) and anticholinergic side effects. On the market in the 1980s, newer generation AHs have improved safety and efficacy. Compared to antihistamines, intranasal corticosteroids (INCS) have significantly greater efficacy but longer onset of action. Intranasal AH and INCS combinations offer a single medication option that offers broader disease coverage and faster symptom control. However, cost and twice-per-day dosing remain a major limitation. Allergen immunotherapy (AIT) is the only disease-modifying option and can be provided through subcutaneous (SCIT) or sublingual (SLIT) routes. While SCIT has been the definitive management option for many years, SLIT tablets (SLIT-T) have also been proven to be safe and efficacious. There is a range of available treatment options for AR that reflect the varying disease length and severity. For mild to moderate AR, newer generation AHs should be the first-line treatment, while INCS are mainstay treatments for moderate to severe AR. In patients who do not respond to INCS, a combination of intranasal AH/INCS (AZE/FP) should be considered, assuming that cost is not a limiting factor. While SCIT remains the option with the most available allergens that can be targeted, it has the potential for severe systemic adverse effects and requires weekly visits for administration during the first 4 to 6 months. SLIT-T is a newer approach that provides the ease of being self-administered and presents a reduced risk for systemic reactions. In any case, standard care for AR includes a treatment plan that takes into account disease severity and patient preferences.

中文翻译：

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实现过敏性鼻炎的明确治疗：最佳使用新疗法和既定疗法。

过敏性鼻炎 (AR) 是一种鼻粘膜炎症性疾病，影响高达 25% 的加拿大人。AR 的护理标准包括考虑患者偏好、疾病严重程度的治疗计划，最重要的是涉及患者和提供者之间的共同决策过程。自 20 世纪 40 年代推出以来，抗组胺药 (AH) 一直是治疗 AR 时最常用的一类药物。第一代 AH 与不良中枢神经系统 (CNS) 和抗胆碱能副作用有关。在 20 世纪 80 年代的市场上，新一代 AH 提高了安全性和有效性。与抗组胺药相比，鼻内皮质类固醇（INCS）的疗效明显更高，但起效时间更长。鼻内 AH 和 INCS 组合提供单一药物选择，可提供更广泛的疾病覆盖范围和更快的症状控制。然而，成本和每天两次给药仍然是主要限制。过敏原免疫疗法（AIT）是唯一的缓解疾病的选择，可以通过皮下（SCIT）或舌下（SLIT）途径提供。虽然 SCIT 多年来一直是最终的治疗选择，但 SLIT 片剂 (SLIT-T) 也已被证明是安全有效的。AR 有一系列可用的治疗方案，反映了不同的疾病持续时间和严重程度。对于轻中度 AR，新一代 AH 应是一线治疗，而 INCS 是中重度 AR 的主要治疗方法。对于对 INCS 无反应的患者，假设成本不是限制因素，应考虑鼻内 AH/INCS (AZE/FP) 组合。虽然 SCIT 仍然是最有针对性的过敏原的选择，但它有可能产生严重的全身不良反应，并且需要在前 4 至 6 个月内每周就诊一次。SLIT-T 是一种较新的方法，可以轻松自我管理，并降低全身反应的风险。无论如何，AR 的标准护理包括考虑疾病严重程度和患者偏好的治疗计划。