PURPOSE OF REVIEW:This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines.RECENT FINDINGS:Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients.SUMMARY:This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.

慢性鼻窦炎伴鼻息肉(CRSwNP)是指病程超过12周、伴息肉形成的鼻腔鼻窦慢性炎症,是一组表型相似但内在机制存在显著差异的复杂疾病.基于其中参与的炎症因子及其病理机制的不同可将其分为1、2、3型炎症,其中2型炎症对应于嗜酸粒细胞浸润为主的CRSwNP.不同内型(endotype)的临床表现、人口学特征、治疗反应性、预后均存在差异.因此,在深入了解不同内型病理机制的基础上,可根据其临床特点建立多种间接预测模型,以优化诊断;还可在内型指导下实现症状的精准控制与治疗,以改善预后.本文就CRSwNP内型的研究进展及其指导下的精准控制与治疗作一综述.

Objective:To compare the clinical characteristics of chronic rhinosinusitis(CRS) with nasal polyps(CRSwNP) and without nasal polyps(CRSsNP), and to provide evidence for formulating rational treatment strategies.Methods:The clinical data of 225 patients suffering from CRS in Jiangsu and Anhui provinces who were hospitalized for endoscopic sinus surgery from November 2018 to December 2019, which included the preoperative blood routine, blood biochemistry, serum total IgE(tIgE), allergen specific IgE(sIgE), paranasal sinus CT, and postoperative histopathological examinations, were retrospectively analyzed for statistical analysis.Results:Of the 225 patients, 148(65.8%) were in the CRSwNP group and 77(34.2%) in the CRSsNP group. There were no significant differences in gender, age, length of hospital stay, differential leucocyte counts and biochemical indexes in peripheral blood between the two groups( P>0.05). In patients with CRSwNP and CRSsNP, the positive rate of serum sIgE against at least one of allergen was 34.5% and 40.3% respectively( P>0.05), among which dust mites were most common with a positive rate of 23.0% and 26.0% respectively( P>0.05). There were also no statistically significant differences in positive rates of serum tIgE and sIgE against 20 common allergens, as well as inhaled and ingested allergens between the CRSwNP and CRSsNP groups( P>0.05). In addition, no significant difference was found in distribution of serum allergen-sIgE concentrations between these two groups( P>0.05). However, the Lund-Mackay scores of paranasal sinus CT scans were significantly higher in the CRSwNP group than those in the CRSsNP group in terms of the sinuses, ostiomeatal complex and the total scores( P<0.05). Moreover, the positive rate of lymphocyte and plasma cell infiltration in the tissue were more than 60% in both groups, while eosinophil infiltration was significantly higher in the CRSwNP group(43.2%) than that in the CRSsNP group(22.1%; P<0.05). Conclusion:At present, lymphocyte and plasma cell inflammation is still dominant in patients with CRS in this region. However, the positive rate of eosinophil infiltration in polyp tissues was 43.2% in patients with CRSwNP, which needs to arouse our recognition and further attention. The total positive rate of allergen sensitization in CRSwNP and CRSsNP patients was 34.5% and 40.3% respectively, with no significant difference. And the major allergen is dust mites.