THE JOURNAL OF

AND

VOLUME 90

NUMBER 4. PART 2

IWediators of allergic rhinitis Martha V. White, MD, and Michael A. Kaliner, MD Berhesh,

Md.

Although histaminc~ is the principal tnediator aj the immediutr ullergic reuction. other ittjfumtnuto~ tnediatars us well us neurapeptides also contribute to rhinorrheu and nasa/ congestion. Within minutes of exposure to ullergen. mast cells produce hi.stumine, leukotrirtw C,,. and prostu~lat~din 17,. A cotzcotnitunt increuse occurs in twuropeptidrs und hrudykinin. In \,itro mast cell uctivution ulso lends to the release oJ’tutnor necrosis ,fuctor-a, seiwul interleukins, and grunulocyte-macr[~phnge colony-.stimulrttitt~ j&tar. Because trll these variorr.~ mediutors und neurapeptides tnq play u role in producing rhinorrhea and congestion, antihistamines ulone cannot control ull of the .symptotns of ullergic rhinitis. However. thr comhinution a/‘ antihistamines with topical corticosteroids can inhibit the generation, rr4ea.w. card trcti~*it~ of‘ mast if not all of the mediutors potentiall? itz\wlwd in the>nllergic response?, I J AI.I.tx