Intranasal Medications

The intranasal route is an effective means of administering sedatives and analgesics. It is a needle-free alternative to intravenous or intramuscular routes, it is not subject to first-pass metabolism, and its efficacy approaches that of intravenous administration. There is absorption through the highly vascular nasal mucosa, as well as utilization of the nose–brain pathway that bypasses systemic circulation and the blood–brain barrier and transports medications directly to the brain. Intranasal administration of sedative and analgesic medications has been shown to be safe and effective for children in a variety of settings. It provides an opportunity to avoid intravenous line placement in many situations, which may reduce the pain and anxiety associated with many diagnostic and therapeutic procedures in children. More studies are needed to compare important sedation outcomes between intranasal sedation regimens and the more common intravenous sedation regimens in order to guide best practice.

Therapeutic Advances in the Management of Allergic Rhinitis and Urticaria

Therapy for patients with allergic rhinitis and urticaria has undergone considerable change in recent years because the mechanisms of these diseases have been more clearly elucidated. Both appear to have marked inflammatory components. A review of the recent literature reveals that clinical studies of both classic and new nonsedating H1-receptor antagonists, H2-receptor antagonists, a variety of intranasal medications, and mast-cell stabilizers demonstrate variable roles in the management of these diseases. Because allergic rhinitis has early-and late-phase reactions, therapy must be directed toward control of both responses. There are a number of types of urticaria; therapy for each may vary.