Nasal inflammation and anti-inflammatory treatment. Semantics or clinical reality.

In recent years there has been a tremendous development in molecular biology and with that an improved understanding of the immunological and inflammatory background for rhinitis. However, this progress has not yet had any influence on diagnosis or choice of treatment. Today it is emphasized that allergic rhinitis is an inflammatory disease. However, the majority of allergic rhinitis symptoms are caused by histamine, which can be released from a non-inflamed mucous membrane. Thus, the role of inflammation may be overestimated as a cause of rhinitis symptoms. It is often claimed that the 2nd generation antihistamines have non-H1 mediated anti-inflammatory effects of clinical significance. However, the large majority of published clinical data speaks against this hypothesis. Corticosteroids do not, as often believed have a general anti-inflammatory effect in the nose. They are highly effective in a disease associated with eosinophil-dominated inflammation (e.g. allergic rhinitis), but not in a disease associated with neutrophil-dominated inflammation (e.g. the common cold). It is recommended that drugs are used merely based on a thorough cost-risk-benefit-patient-compliance analysis in the single patient and disease entity with little attention being paid to the assumed mode of action of the drug, which may or may not be of clinical relevance.