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Address correspondence to Sandra K. Willsie, DO, FACP, FCCP, Professor of Medicine, Vice President of Academic Affairs, and Dean, University of Health Sciences College of Osteopathic Medicine, 1750 Independence Ave,Kansas City, MO 64106-1453. E-mail: swillsie{at}uhs.edu

This supplement to JAOA—The Journal of the American Osteopathic Association addresses new developments in the understanding of the pathophysiology, diagnosis, and management of allergic rhinitis (AR), a disease process with profound impact on the lives of patients and their families as well as on the United States' economy. Contributing to morbidity in an estimated 20% of adults and 40% of children,^1,2 AR remains both frustrating to treat and fascinating from the standpoint of developing immunologic principles.

Since publication of the state-of-the-art review in 2002 in the JAOA,^3,4 significant developments have occurred in AR. In this issue of the JAOA, Gailen D. Marshall, MD, PhD, provides a thorough overview of the normal immune system as well as changes manifested in allergic diseases, including AR.⁵ Given new levels of understanding about the role of an individual's genetic makeup in expression of disease, the future promises to afford unique, specific modes of therapy targeted at individuals with AR.

Sadeq A. Quraishi, MHA; Michael J. Davies, MD; and Timothy J. Craig, DO, provide a complete review of traditional modes of therapy for AR, including avoidance and environmental controls, antihistamines, corticosteroids, topical anticholinergic preparations (particularly effective when rhinorrhea is the primary symptom of AR), mast cell stabilizers, and allergen immunotherapy. Therapeutic modalities newly approved (since 2002) by the Food and Drug Administration (FDA) for AR include montelukast, which, in prospective, double-blind, placebo-controlled trials, demonstrated significant improvement in both daytime and nighttime symptoms and led to a reduction in circulating eosinophils.⁶ Other leukotriene inhibitors have been studied in AR but are not yet FDA approved for this condition.

In summary, this supplement of the JAOA promises to provide an up-to-date review for the busy primary care physician. Take the time to read this supplement and absorb the state-of-the-art science and recommended modes of therapy for AR. You, your patients, and society stand to benefit!

References
1. Dykewicz MS, Fineman S, Skroner DP, Nicklas R, Lee R, Blessing-Moore J, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81:478 -518.[Medline]

2. Fineman S. The burden of allergic rhinitis: beyond dollars and cents. Ann Allergy Asthma Immunol.2002;88:S2 -S7.

3. D'Alonzo GE. Scope and impact of allergic rhinitis. J Am Osteopath Assoc. 2002;102(6 suppl): S2-S6.[Free Full Text]

4. Willsie SK. Improved strategies and new treatment options for allergic rhinitis. J Am Osteopath Assoc. 2002;102(6 suppl):S7 -S14.[Abstract]

5. Marshall GD. New advances in understanding allergic disease. J Am Osteopath Assoc. 2004;104(suppl 5):S1 -S6.[Abstract]

6. Quraishi SA, Davies MJ, Craig TJ. Inflammatory responses in allergic rhinitis: traditional approaches and novel treatment strategies. J Am Osteopath Assoc. 2004;104(suppl 5):S7 -S15.

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