Optimum treatment of rhinitis in the elderly.

With aging, multiple physiological changes occur in the connective tissue and vasculature of the nose which may predispose or contribute to chronic rhinitis. Accurate differentiation of allergic from nonallergic causes of rhinitis requires skin testing or in vitro measures of specific IgE. Empiric treatment with over-the-counter first generation antihistamines and oral decongestants frequently results in CNS, anticholinergic and cardiovascular adverse effects. While newer second generation histamine antagonists do not cause these problems, selected drugs in this class may cause electrocardiographic QT prolongation and, in rare cases, ventricular arrhythmias. Topical therapies including sodium cromoglycate (cromolyn sodium), corticosteroids and ipratropium bromide are all well-tolerated with minimal adverse effects. Avoidance of allergens and/or irritants is an important adjunct in treating patients with allergic and vasomotor rhinitis. If all other therapies fail in patients with confirmed allergic rhinitis, immunotherapy can be safely instituted in most older patients.