Mediator antagonists in the treatment of allergic disease.

New approaches to allergic inflammation include specific cytokine antagonists and monoclonal antibodies against IgE, against chemokines, and against adhesion molecules. Currently available therapies, such as leukotriene antagonists, may soon be approved for allergic rhinitis. New generation antihistamines such as desloratadine have wide-ranging anti-allergic, anti-inflammatory profiles, including suppression of cytokine, chemokine, and adhesion molecule expression. Recent desloratadine studies have demonstrated that this highly potent H1 receptor antagonist consistently provides relief of nasal congestion and may provide benefits similar to montelukast in mild asthma patients. New generation intra-nasal corticosteroids such as fluticasone and mometasone provide high corticosteroid potency while being minimally bioavailable when administered as intranasal preparations. Future advances in allergy therapy also include improved T-cell selective formats of immunotherapy. The range of therapies for allergic rhinitis is likely to substantially increase in the coming years.