Allergic Rhinitis Medication Research Articles

An Overview of Adherence—What It Is and Why It Is Important

Asthma, allergic rhinitis, and food allergy are common allergic diseases, yet adherence to many management options remains poor, leading to worse health outcomes and financial implications for society and health systems. The underlying causes of non-adherence are numerous, ranging from patient specific factors to broader socioeconomic and systems-based factors. In this review, we aim to discuss the definition of adherence, which can be divided into 3 components: initiation, implementation, and persistence, as well as to review various methods of measuring adherence. Subsequently, we will review the epidemiology of adherence to asthma and allergic rhinitis medications, allergen immunotherapy, and oral immunotherapy. Finally, we will discuss the multifaceted etiology of poor adherence and its subsequent impact on patients and society.

The Significance of Intercurrent Remedy in Management of Allergic Rhinitis: A Case Report

Allergic Rhinitis is a very common disorder that affects people of all ages. It affects quality of life and productivity at work or school. Medication for Allergic Rhinitis are histamines and topical steroids, which suppresses the body immune response to allergens. Homoeopathy offers a mode of therapy that is individualized to the patient without compromising immunity of patient.

The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis

Drug repurposing is a major field of value-added medicine. It involves investigating and evaluating existing drugs for new therapeutic purposes that address unmet healthcare needs. Several unmet needs in allergic rhinitis could be improved by drug repurposing. This could be game-changing for disease management. Current medications for allergic rhinitis are centered on continuous long-term treatment, and medication registration is based on randomized controlled trials carried out for a minimum of 14 days with adherence of 70% or greater. A new way of treating allergic rhinitis is to propose as-needed treatment depending on symptoms, rather than classical continuous treatment. This rostrum will discuss existing clinical trials on as-needed treatment for allergic rhinitis and real-world data obtained by the mobile health app MASK-air, which focuses on digitally-enabled, patient-centered care pathways.

Demographic Disparities in the Federal Drug Approval Process for Allergic Rhinitis Medications.

Demographic minorities are underrepresented in clinical trials. For the approval of new drug applications (NDAs), the Food and Drug Administration (FDA) has asserted that clinical trial enrollment should represent the demographics of patients likely to receive the trial drug. The aim of this study is to assess the demographics of clinical trials included in NDAs and biologics license applications (BLAs) approved by the FDA since 1990 for allergic rhinitis (AR), a condition whose demographic prevalence mirrors the US population. Federal Freedom of Information Act requests were submitted to the US government to obtain documents related to all relevant NDAs and BLAs. The Drugs@FDA database was queried for all clinical trial documentation. Demographic data were extracted from clinical trials used to inform FDA approval for AR pharmacotherapies. Demographics were analyzed relative to national US Census data. Since 1990, 22 drugs have been approved for AR. The racial, ethnic, and sex composition of all included study populations differed significantly (p < 0.05) from the demographics of AR and from US Census data. Most NDAs and BLAs included overrepresentation of White participants and underrepresentation of Black, Asian, Pacific Island, Native American, and Hispanic participants. The patients enrolled in clinical trials used to inform FDA approval for AR pharmacotherapeutics do not represent the demographics of the United States or the demographics of AR. The clinical significance of unrepresentative demography between study and treatment populations has been examined for several medical disorders, but has not been studied for AR. 4 Laryngoscope, 133:755-763, 2023.

Behavioural patterns in allergic rhinitis medication in Europe: A study using MASK-air® real-world data.

Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. We analysed 2015-2020MASK-air® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1year. We analysed 222,024days (13,122 users), including 63,887days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p<.001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.

Intranasal fluticasone furoate in pediatric allergic rhinitis: randomized controlled study

BackgroundIntranasal corticosteroids are the most efficacious anti-inflammatory medications for allergic rhinitis (AR). However, the efficacy and safety of intranasal corticosteroids in children have not yet been subject to specific research in China. The aim of this study was to investigate the efficacy and safety of fluticasone furoate nasal spray (FFNS) in a Chinese pediatric population.MethodsIn this phase 4 randomized, double-blind, placebo-controlled, multicenter study, pediatric AR patients aged 2–12 years were randomized 1:1:1, receiving either FFNS 55 µg or 110 µg or placebo. Electronic diary cards were completed to record symptoms, rescue medication use, and treatment compliance. Anterior rhinoscopy and overall response to therapy were evaluated and recorded.ResultsPatients treated with FFNS at either dose experienced a significantly greater reduction in daily reflective total nasal symptom score compared with placebo. This was maintained in a younger subset of patients (2–6 years). Drug-related adverse events occurred in <20% of patients in all groups. FFNS was well tolerated at both doses.ConclusionsThis study demonstrates favorable efficacy and safety profiles for FFNS 55 µg or 110 µg in Chinese pediatric populations (2–12 years), supporting its use in clinical treatment for AR children, including younger children aged 2–6 years.ImpactThe aim of this study was to investigate the efficacy and safety of intranasal fluticasone furoate in Chinese pediatric allergic rhinitis.This research not only addresses the deficiency in efficacy and safety data for intranasal corticosteroids in very young patients (aged 2–6 years) worldwide but also demonstrates that fluticasone furoate nasal spray shows a favorable benefit/risk profile at different dose levels.Our data will be of interest to the broad readership of Pediatric Research and will positively contribute to the dialog regarding the treatment of allergic rhinitis in children aged 2–6 years.

Professor LAI Xin-sheng's experience of acupuncture and medication for allergic rhinitis

Professor LAI Xin-sheng believes that allergic rhinitis is mainly caused by deficiency of lung-spleen-kidney, combined with the attack of external pathogens, especially wind pathogens, which invade nasal orifices. Thus, three principles are established: syndrome differentiation and treatment, internal and external coherence, strengthening the root to eliminate pathogenic factors. For clinical practice, professor LAI proposes the original tongyuan acupuncture which takes the conception vessel and governor vessel as the general principles, takes zangfu syndrome differentiation as core, and takes regulating yin and yang as the major method. This acupuncture method integrates spirit and yuan, bases on verified method and acupoint, combines acupuncture and medication, and achieves satisfactory results.

Interaction between air pollution and pollen seasons on allergic rhinitis control

A few studies have suggested an interaction between air pollution and pollen exposure on allergy symptoms but more research is needed. As part of the POLLAR (Impact of Air Pollution in Asthma and Rhinitis) project, we investigated the associations between major air pollutants (ozone and PM2.5) and allergic rhinitis control, during grass and birch pollen seasons, using the Allergy Diary app (a validated mHealth tool for allergic rhinitis management). The daily impact of allergic symptoms was recorded, using visual analogue scale (VAS), by 3,328 geolocated app users in 2017 and 2018 in Northern Europe, representing 36,523 VAS days. Uncontrolled allergic rhinitis was defined either as 1) VAS≥50, 2) VAS≥35 with intra-nasal corticosteroids or azelastine-fluticasone propionate use or 3) VAS≥20 and use of ≥3 allergic rhinitis medications. For each VAS recorded with geolocation, pollutants levels were assessed using the SILAM (System for integrated modelling of atmospheric composition) database, and pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Positive associations were found between ozone and uncontrolled allergic rhinitis during the grass pollen season only (ORs=1.25 [1.11-1.41] and 1.14 [1.04-1.25], per interquartile range increase in ozone, for 2017 and 2018 respectively). A similar trend was found for PM2.5 levels in 2017 while results for 2018 did not suggest any effect modification by pollen seasons. These results show the importance of air pollution and allergen concentrations, and their interaction, as predictors of allergic rhinitis control.

Add-on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial.

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add-on probiotics on symptoms and QoL of patients. In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8-week washout. The primary outcome was the change of the Short Form 36-Item Health Survey (SF-36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test-22 (SNOT-22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires. A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF-36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF-36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT-22 and CARAT. This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended. 1b Laryngoscope, 129:1744-1750, 2019.

Allergic Rhinitis Causes Loss of Smell in Children: The OLFAPEDRIAL Study

C Langdon, JM Guilemany, M Valls. Pediatr Allergy Immunol. 2016;27(8):867–870 To evaluate the impact of allergic rhinitis on olfaction in children and characterize it using the ARIA (Allergic Rhinitis and Its Impact on Asthma) criteria for severity and duration. This study included 1260 children who were 6–12 years of age with allergic rhinitis diagnosed by an allergist from 271 centers in Spain between May and July 2008. This was an observational, cross-sectional, multicenter study. Inclusion criteria included symptoms of rhinoconjunctivitis for >1 year, sensitization to 1 or more aeroallergens by skin or specific immunoglobulin E testing, and discontinuation of maintenance medications for allergic rhinitis at …

A Network Meta-analysis of Randomized Controlled Trials Focusing on Different Allergic Rhinitis Medications.

This study is aimed to investigate the effectiveness of 4 allergic rhinitis (AR) drugs (loratadine, cetirizine, montelukast, and desloratadine) in reducing functional problems in patients, as indicated by rhinoconjunctivitis quality of life questionnaire scores. After an exhaustive search of electronic databases containing published scientific literature, high-quality randomized controlled trials relevant to our study were selected based on a stringent predefined inclusion and exclusion criteria. Statistical analyses were conducted using STATA 12.0 and comprehensive meta-analysis (CMA 2.0) software. The literature search broadly identified 386 studies, and after a multistep screening and elimination process, a total of 13 randomized controlled trials contributed to this network meta-analysis. These 13 high-quality studies contained a combined total of 6867 patients with AR on 4 different medications. The results of network meta-analysis revealed that, compared with placebo, all 4 mediations treated AR effectively [cetirizine: mean: -0.62, 95% confidence intervals (95% CI) = -0.90 to -0.34, P < 0.001; loratadine: mean: -0.32, 95% CI = -0.55 to -0.097, P = 0.005; montelukast: mean: -0.28, 95% CI = -0.54 to -0.023, P = 0.033; desloratadine: mean: -0.39, 95% CI = -0.60 to -0.18, P < 0.001]. A comparison of surface under the cumulative ranking curve values of these 4 interventions clearly showed that cetirizine is the most optimal medication for AR treatment. In conclusion, this network meta-analysis provides the first evidence that cetirizine is the most efficacious treatment for AR compared with loratadine, montelukast, and desloratadine, significantly reducing the functional problems in patients with AR.

Medications for Allergic Rhinitis.

Objectives Adherence to the allergic rhinitis clinical practice guideline is being considered as a potential focus for national performance metrics. To help inform this discussion, we assessed patient- and clinician-reported medication administration among nationally representative populations of patients with allergic rhinitis. Study Design Cross-sectional analyses. Setting and Subjects Home health assessments, ambulatory visits. Methods Participants in the National Health and Nutrition Examination Survey and the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey were assessed. The primary outcomes were the percentage of patients reporting receipt of antihistamines and/or nasal steroids among those with allergy-related symptoms and the percentage for whom a clinician administered these medications when diagnosing allergic rhinitis. Secondary outcomes included assessments of those with worse quality of life, confirmatory allergy testing, and leukotriene receptor antagonist use. Results Within the National Health and Nutrition Examination Survey, an estimated 29.2 million patients were diagnosed with "hay fever," while 92.2 million were diagnosed with "allergies." Patients with symptoms of allergic rhinitis reported that antihistamines or nasal steroids were prescribed in 21.1% to 24.0% of cases. Leukotriene receptor antagonists were given to 1.7% of those without asthma or use of other allergy medications. Within the National Ambulatory Medical Care Survey / National Hospital Ambulatory Medical Care Survey, observations representing 149.5 million visits for allergic rhinitis demonstrated that nasal steroids were administered in 29.6% of cases, while nonsedating and sedating antihistamines were given in 22.4% and 17.2%, respectively. Conclusions Despite a high prevalence of allergic rhinitis, per patient report and clinician entry, a substantial number of affected patients do not receive antihistamines and nasal steroids.

Association between medication prescription for atopic diseases and attention-deficit/hyperactivity disorder

BackgroundData on the association between atopic diseases and attention-deficit/hyperactivity disorder (ADHD) have been inconclusive. ObjectiveTo assess whether children with drug-treated ADHD are more likely to receive treatment for asthma, allergic rhinitis, or eczema before the start of ADHD medication use compared with controls and to examine the effect of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring. MethodsWe conducted a retrospective nested case-control study among children (6-12 years of age) using the Groningen University prescription database. Cases were defined as children with at least 2 prescriptions of methylphenidate within 12 months. For each case, 4 controls were matched on age, sex, and regional area code. Parental prescription data were linked to cases and controls to assess the influence of parents receiving medication for ADHD and atopic diseases on ADHD medication use in their offspring. ResultsWe identified 4257 cases and 17,028 matched controls. Drug treatment for asthma, allergic rhinitis, and eczema was more common in cases than controls (adjusted odds ratios [aORs], 1.4 [95% confidence interval (CI), 1.3-1.6], 1.4 [95% CI, 1.1-1.8], and 1.3 [95% CI, 1.1-1.5], respectively). Medication for allergic rhinitis and asthma among parents was associated with ADHD treatment in their children (aORs, 1.3 [95% CI, 1.1-1.5] and 1.2 [95% CI, 1.1-1.3], respectively). ConclusionThis study provides further evidence to support the hypothesis that atopic diseases are associated with ADHD. The parental-offspring association suggests a possible genetic and/or environmental component.

Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring

Maternal supplementation with long-chain n-3 polyunsaturated fatty acids can have immunologic effects on the developing fetus through several anti-inflammatory pathways. However, there is limited knowledge of the long-term programming effects. In a randomized controlled trial from 1990 with 24years of follow-up, our aim was to determine whether supplementation with 2.7g of long-chain n-3 polyunsaturated fatty acids in pregnancy can reduce the risk of asthma in offspring and allergic respiratory disease. The randomized controlled trial included 533 women who were randomly assigned to receive fish oil during the third trimester of pregnancy, olive oil, or no oil in the ratio 2:1:1. The offspring were followed in a mandatory national prescription register, with complete follow-up for prescriptions related to the treatment of asthma and allergic rhinitis as primary outcomes. Furthermore, the offspring were invited to complete a questionnaire (74% participated) and attend a clinical examination (47% participated) at age 18 to 19years. In intention-to-treat analyses the probability of having had asthma medication prescribed was significantly reduced in the fish oil group compared with the olive oil group (hazard ratio, 0.54, 95% CI, 0.32-0.90; P=.02). The probability of having had allergic rhinitis medication prescribed was also reduced in the fish oil group compared with the olive oil group (hazard ratio, 0.70, 95% CI, 0.47-1.05; P=.09), but the difference was not statistically significant. Self-reported information collected at age 18 to 19years supported these findings. No associations were detected with respect to lung function outcomes or allergic sensitization at 18 to 19years of age. Maternal supplementation with fish oil might have prophylactic potential for long-term prevention of asthma in offspring.

Allergic rhinitis in children: medication therapy options

This article provides a review of contemporary views of allergic rhinitis in children. The role of various agents of allergic rhinitis medication therapy is evaluated based on the review data. Detailed assessment of antihistamine class in allergic rhinitis therapy is provided.

Allergic Rhinitis Medications

C l i n M e d International Library Citation: Shirasaki H (2015) Allergic Rhinitis Medications. Int J Aller Medcations 1:002e Received: February 16, 2015: Accepted: February 20, 2015: Published: February 23, 2015 Copyright: © 2015 Shirasaki H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Shirasaki. Int J Aller Medcations 2015, 1:1

Youtube Videos for Patient Education on How to Use Nasal Sprays Associated with Insufficient Reliability

Nasal sprays are extremely important for delivery of intranasal medications for allergic rhinitis, however their effectiveness is dependent on proper technique. We hypothesized that there is a paucity of YouTube videos that effectively educate viewers on how to use nasal sprays. The website YouTube.com was queried for the phrase “how to use nasal spray”. The resulting videos were assessed whether they discussed the following 9 steps of nasal spray use: blowing the nose, removing cap, shaking device, priming, properly holding device, tilting head forward, spraying away from septum, gently inhaling or sniffing, exhaling through mouth. Videos were excluded if they lacked English words or text, contained repeated segments of previous videos, addressed non-allergic conditions, were non-educational advertisements, or did not address how to use nasal sprays. Search phrase returned 7480 videos. The 60 videos on the first three pages of results were analyzed since prior studies have shown that patients are most likely to view these videos. Thirty-four videos were excluded based on criteria above. The remaining 26 videos averaged 133 seconds duration with 10,862 views. Only 2 videos (7.7%) discussed all 9 steps of nasal spray use. On average, most steps were discussed by videos from non-clinical healthcare groups (7.7 steps), followed by clinics and hospitals (3.5 steps), individual healthcare professionals (3.2 steps), and non-healthcare persons (2.5 steps). Only 7.7% of videos discussed all steps of correct nasal spray use. Videos from non-clinical healthcare groups were most comprehensive. Creation of patient education videos authored by allergists should be encouraged.

Reasons for prescribing second generation antihistamines to treat allergic rhinitis in real-life conditions and patient response.

BackgroundSecond generation H1 antihistamines (H1A) are currently recommended as first choice medications for allergic rhinitis and rhinoconjunctivitis. However, little is known about what influences the choice of prescription of one second generation (H1A) as opposed to another in real-life conditions.ObjectiveThe aim of the study was to identify the main criteria determining the choice of a second generation H1A by allergy specialists in mainland France.MethodsConsecutive patients suffering from allergic rhinitis or rhinoconjunctivitis were included and followed prospectively for 30 days from the prescription of a second generation H1A in monotherapy. Patients were asked to fill in auto-questionnaires at baseline, daily during the first 10 days of the new treatment, and at the end of follow-up. Data on efficacy, tolerance, safety, rate and type of response to treatment, as well as patient satisfaction were recorded and analyzed.Results1,080 patients were included between March 2011 and October 2012, mostly suffering from moderate to severe rhinitis (82.0%). The most frequently cited reason for choosing a specific H1A was the expected efficacy (85.3%). The mean time to nasal and ocular recovery was 6 days and 78.2% of patients responded to treatment within this interval. The presence of conjunctivitis was significantly associated with a more rapid response. At the end of follow-up, the satisfaction rate was higher for patients who were switched from a previous treatment (87.5%), compared to those receiving their first treatment (78.8%).Conclusion and clinical relevanceThe main reason for choosing a specific second generation H1A was its expected efficacy. Concomitant conjunctivitis is associated with a more rapid response to treatment. Symptom recovery necessitates a mean of 6 days.

Evaluation of allergic rhinitis and asthma control in a Portuguese community pharmacy setting.

Allergic rhinitis and asthma (ARA) are frequent respiratory diseases that often coexist, causing a high social and economic impact. It is important to maintain ARA disease control to reduce the disease burden. To assess control in patients with 1 or both pathologies through the application of validated questionnaires at community pharmacies. A cross-sectional study was conducted in the pharmacies of the Portuguese county of Covilhã (located in the central region of Portugal with about 53,000 inhabitants). Subjects aged between 18 and 70 years who presented a prescription for an asthma and/or allergic rhinitis medication were invited to participate in the study by responding to a questionnaire that included the Control of Allergic Rhinitis and Asthma Test (CARAT). The CARAT is a validated tool to simultaneously assess the control of ARA with scores that range from 0 to 30 points, 0 meaning the worst and 30 meaning the best possible control of disease. Of the 224 participants, 58% were female and the median age was 48.5 years. The median CARAT score was 19 (mean = 17.8 ± 6.4), and 87% of participants had a score < 25, indicating noncontrolled disease. Female participants, the elderly, and those with less school education responded with scores that demonstrated significantly less disease control. Using a simple self-assessment questionnaire, such as the CARAT, pharmacists can help identify patients with uncontrolled ARA disease, which is an important first step to change patients' knowledge about their disease, with an ultimate goal of improving ARA outcomes.

Sensitisation patterns and association with age, gender, and clinical symptoms in children with allergic rhinitis in primary care: a cross-sectional study

Background:Polysensitisation is a frequent phenomenon in patients with allergic rhinitis. However, few studies have investigated the characteristics of polysensitised children, especially in primary care.Objectives:This analysis describes the patterns of sensitisation to common allergens and the association with age, gender, and clinical symptoms in children in primary care diagnosed with allergic rhinitis.Methods:Cross-sectional data from two randomised double-blind placebo-controlled studies were used to select children aged 6–18 years (n=784) with a doctor's diagnosis of allergic rhinitis or use of relevant medication for allergic rhinitis in primary care. They were assessed for age, gender, specific IgE (type and number of sensitisations), nasal and eye symptom scores.Results:In 699 of the 784 children (89%) with a doctor's diagnosis or relevant medication use, a positive IgE test for one or more allergens was found. Polysensitisation (≥2 sensitisations) was found in 69% of all children. Sensitisation was more common in children aged 9–13 than in younger children aged 5–8 years (p=0.03). Monosensitisation and polysensitisation were not significantly different in girls and boys. The severity of clinical symptoms did not differ between polysensitised and monosensitised children, but symptoms were significantly lower in non-sensitised children.Conclusions:Polysensitisation to multiple allergens occurs frequently in children with allergic rhinitis in general practice. Overall, clinical symptoms are equally severe in polysensitised and monosensitised children. Treatment decisions for allergic rhinitis should be made on the basis of a clinical history and allergy testing.