How is allergic rhinitis with asthma treated?

The treatment of allergic rhinitis and allergic asthma shares certain similarities but also exhibits important differences. So, how should comorbid allergic rhinitis and asthma be managed?

Management of Allergic Rhinitis with Comorbid Asthma

The treatment of asthma triggered by allergic rhinitis requires a comprehensive, multimodal approach.

First, management of allergic rhinitis may include intranasal corticosteroid sprays, as well as antiallergic medications such as ketotifen, loratadine, and montelukast. In select cases, otolaryngologic thermal ablation of the nasopharynx may also be considered. In contrast, asthma management primarily focuses on anti-inflammatory therapy: patients with mild-to-moderate disease typically receive inhaled or nebulized topical anti-inflammatory agents, whereas those with severe disease often require systemic corticosteroid therapy.

Second, bronchodilator therapy is essential for asthma patients to relieve bronchospasm and alleviate wheezing. This includes short-acting β₂-adrenergic agonists (e.g., salbutamol) and anticholinergic agents (e.g., ipratropium bromide, an M-receptor antagonist).

Third, antiallergic therapy remains critical for patients whose asthma is driven by allergic rhinitis. Appropriate and effective antiallergic agents—such as montelukast—should be administered.

Fourth, symptomatic supportive care and fluid replacement therapy are indicated as needed.

Fifth, oxygen therapy should be provided; in critically ill patients exhibiting overt respiratory failure, mechanical ventilation support may be required.

Sixth, adjunctive traditional Chinese medicine (TCM) therapies may be considered for selected patients.

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