Pharmacotherapy For Allergic Rhinitis Research Articles

Эффективность и безопасность терапии мометазона фуроатом в сравнении с цетиризином у взрослых пациентов с сезонным аллергическим ринитом в условиях реальной клинической практики

Background: both H1-histamine blockers and intranasal corticosteroids are recommended as step 2 pharmacotherapy for allergic rhinitis (AR). Aim: to compare cetirizine and mometasone furoate (nasal spray) for AR treatment in patients requiring step 2 therapy in real-world clinical practice. Patients and Methods: this study enrolled 160 patients aged 18–75 years suffering from AR with pollen sensitization and requiring step 2 of therapy. The study was observational, open-label, comparative, and non-interventional. The patients were divided into two groups: main group (MG; n=80) who received over-the-counter medicine mometasone furoate (nasal spray) 200 μg/day regimen and comparison group (CG; n=80) who received cetirizine 10 mg/day orally for 1 month±2 days. Patients had three office visits. Each visit included a physical examination, anterior rhinoscopy, and self-assessment using the visual analog scale (VAS). Both patients and physicians completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results: treatment efficacy was excellent (0-1 VAS score) in 52 (65%) patients in the CG and in 76 patients in the MG (95%, p<0.05). Treatment efficacy was good (2-5 VAS scores) in 12 (15%) patients in the CG and in 4 (5%) patients in the MG. The study found that 5% of patients in the CG reported satisfactory results compared to 0% in the MG. Additionally, a significant difference (p<0.001) in the reduction of the RQLQ score was reported among patients who experienced an improvement in quality of life by day 14 of treatment in the CG (-80.3±19.3) and MG (-113.3±34.7). The effectiveness of mometasone furoate (200 μg/day) as a monotherapy for 4 weeks was found to be superior to cetirizine treatment (10mg/day). Additionally, it was associated with a greater improvement in quality of life and better treatment tolerability due to fewer adverse events. Conclusions: mometasone furoate (nasal spray) can be recommended as a monotherapy for adults with mild to moderate AR. KEYWORDS: seasonal allergic rhinitis, mometasone furoate, cetirizine, intranasal corticosteroids, oral antihistamines. FOR CITATION: Churyukina E.V., Gamova I.V. Efficacy and safety of mometasone furoate therapy versus cetirizine in adults with seasonal allergic rhinitis in a real-world clinical setting. Russian Medical Inquiry. 2024;8(3):132–142 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-3-3.

Allergic Rhinitis.

Allergic rhinitis (AR) affects more than 400 million people worldwide, making it 1 of the most prevalent chronic diseases. Childhood AR is increasing, and almost half of patients with AR develop symptoms before age 6 years. Although a diagnosis of AR is associated with higher socioeconomic status, underserved and urban populations have more indoor aeroallergen sensitizations and are likely underdiagnosed with AR, further exacerbating health-care disparities. AR negatively impacts quality of life, school performance, and overall health outcomes. Untreated AR in children increases the risk for poor asthma control, increased asthma severity, and exacerbations. Many patients believe that they have seasonal allergies only but in reality have both perennial and seasonal AR, which may change the approach to allergen avoidance measures and treatment recommendations. Pharmacotherapy of AR has expanded, with many intranasal corticosteroids, intranasal antihistamines, and second-generation oral antihistamines approved for pediatric use. Allergen immunotherapy, including both subcutaneous and sublingual forms, are approved for children and are disease modifying, potentially reducing further allergen sensitization and progression to asthma. Many of the currently available biological therapies indicated for pediatric asthma and/or atopic diseases reduce AR symptoms as well. Children with moderate to severe or refractory AR or those with comorbidities should be referred to allergists for diagnostic testing and expanded management options, including immunotherapy and potential biological treatment.

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique

BackgroundDiagnosis, classification, and treatment of allergic rhinitis (AR) varies considerably despite the availability of treatment guidelines. ObjectivesWe aimed to carry out a two-part modified Delphi panel study to elucidate global expert management of AR in real life. MethodsThe modified Delphi panel study was composed of two ten-minute online questionnaires sent to global AR experts, aiming to identify areas of consensus (defined as >75% respondent agreement) on aspects of their real-world daily practice related to AR diagnosis, classification, and pharmacotherapy. A workshop discussion with respondents held after the first-round questionnaire informed the development of the second-round questionnaire. ResultsEighteen experts (from 7 countries across 3 continents) completed both questionnaires in September–October 2021 and January 2022, respectively. The majority of respondents agreed that diagnosis of AR is best confirmed using a mixture of observation and testing (n = 15) and collaborating with colleagues across other specialties (n = 14). Experts agreed that severity (n = 18), upper/lower respiratory tract involvement (n = 15) and symptom frequency (n = 14) are important factors when classifying AR, however consensus was not reached on which classification tool should be used. Although there were mixed opinions on the preferred pharmacotherapy treatment in the presented case studies, respondents largely agreed on which treatments require less monitoring (intranasal corticosteroid therapies [INCS]) and when treatments should be stepped down (≤3 months). Although opinions varied across respondents, some respondents considered as-needed INCS treatment and surgery to be viable treatment options. ConclusionWe identified clear differences between real-world practice and treatment guidelines related to the management of AR. Furthermore, we recognized differences among physicians concerning their clinical practice in the pharmacological treatment of AR. These findings highlight the need for greater research into the management of AR and further indicate there is still a major gap between treatment guidelines and daily practice, even among specialists, suggesting a need for local guideline adaptation and implementation plans.

Непредсказуемый сценарий течения аллергических заболеваний респираторной системы у беременных

The article presents the analysis of literature data on the pathogenesis, course and pharmacotherapy in pregnancy during respiratory allergic diseases. The article also considers the systematized ARIA recommendations (Updated 2020) on the diagnosis and pharmacotherapy of allergic rhinitis (AR) in pregnancy, differential diagnosis concerning nasal breathing disorders of atopic and non-atopic etiology during gestation, and the developed therapeutic methods for the patient management (in particular, pregnant women) with an allergic phenotype (a combination of asthma with allergic rhinitis and/or atopic dermatitis). The association between the uncontrolled course of allergic rhinitis in pregnant women and the risk of the bronchial asthma onset has been proven. Of utmost importance, for improving perinatal outcomes is the optimization of therapy and symptom control of allergic diseases during pregnancy in the interdisciplinary practice of an obstetrician-gynecologist and allergist/immunologist. AR in pregnancy should be differentiated from the most common form of nasal breathing disorders in pregnant women — vasomotor rhinitis. Severe uncontrolled vasomotor rhinitis in pregnant women, as an individual nosological form, can worsen the existing AR and bronchial asthma course. The authors present a mathod for the AR step therapy based on pharmacological characteristics and safety profile of drugs in pregnancy. KEYWORDS: allergic rhinitis, bronchial asthma, pregnancy, vasomotor rhinitis of pregnant women, pharmacotherapy, obstetric complications. FOR CITATION: Paschenko A.A., Dobrokhotova Yu.E., Fomina D.S., Pashchenko M.G. Uncontrolled course of respiratory allergic diseases in pregnant women. Russian Journal of Woman and Child Health. 2022;5(2):122–128 (in Russ.). DOI: 10.32364/2618-8430- 2022-5-2-122-128.

Pharmacotherapy for Allergic Rhinitis

Pharmacotherapy for Allergic Rhinitis

Pharmacotherapy of allergic rhinitis

The clinical picture of allergic rhinitis includes sneezing, nasal discharge, impaired nasal breathing, and itching of the nose and roof of mouth. Depending on the duration of symptoms, allergic rhinitis is divided into intermittent and persistent forms, and depending on the severity of symptoms, it can be mild, moderate, and severe. Treatment for allergic rhinitis includes elimination of allergic contacts, allergen-specific immunotherapy, and pharmacotherapy. The choice of a treatment regimen is determined by the severity of symptoms, age of a patient and presence of concomitant diseases. The work is aimed to review the most common pharmaceuticals to treat allergic rhinitis. Saline solutions are used as monotherapy when symptoms are mild, or before use of other topical drugs to clean mucous membranes before their application. Intranasal glucocorticosteroids can be used as monotherapy, if symptoms have different levels of severity, and supplemented with other drugs, in case they are not efficient. Intranasal glucocorticosteroids do not have a systemic effect due to minimal bioavailability. The patients with moderate/severe allergic rhinitis are recommended to use them jointly with second generation antihstamines, intranasal cromones, intranasal antihistamines and leukotriene receptor antagonists. The significant side effect of antihistamines, especially of the first generation, are sedative effects on the central nervous system. The side effects of leukotriene receptor antagonists are neuropsychological disorders. Intranasal cromones have a high safety profile, which makes them popular in paediatric practice. However, the dosage regimen up to 3–4 times a day reduces patient adherence to treatment. Decongestants are not indicated as monotherapy for allergic rhinitis but can be used in combination with other drugs in short courses, taking into account the possible side effects.

Prospective areas of pharmacotherapy for allergic rhinitis

Prospective areas of pharmacotherapy for allergic rhinitis

The effectiveness of intranasal corticosteroids and antihistamines combination - mometasone furoate and azelastine hydrochloride nasal spray in adults with seasonal allergic rhinitis (The results of clinical trial)

Background. Intranasal corticosteroids and antihistamines are the basis of pharmacotherapy of allergic rhinitis (AR). The aim of this study was to evaluate the efficacy, safety and tolerability of Momat Rhino Advance (fixed combination of azelastine hydrochloride 140 mcg + mometasone furoate 50 mcg) intranasal spray in seasonal rhinitis patients. Materials and methods. Momat Rhino Advance was administered within 14 days in adults with seasonal AR in comparison with the original azelastine hydrochloride and mometasone furoate, used in combination with each other from separate devices against nasal (TNSS) and non-nasal (TNNSS) rhinitis symptoms. In total, 220 patients 18-65 years old with moderate/severe seasonal AR, were randomized in an open, parallel-group, multicenter clinical trial conducted in 16 centers in the Russian Federation during the period from April to September 2014. Results and conclusion. As a result of the study a marked decreasing of nasal symptoms using scale TNSS (in 89,6% relatively to the initial visit, p

Current trends in treatment of allergic rhinitis

Allergic rhinitis is an IgE-mediated disease, leading to inflammation of the nasal mucosa. Typical symptoms of allergic rhinitis are nasal congestion, rhinorrhea, sneezing, and/or nasal itching. Allergic rhinitis is a major health problem worldwide that causes illness and disability in daily life, affecting social life, sleep, school, and work. The economic cost of allergic rhinitis is substantial. Management of allergic rhinitis can be categorized largely into 1allergen avoidance, 1pharmacotherapy, 1immunotherapy, and 1surgical treatment. Although the general consensus is that allergen avoidance should lead to an improvement of symptoms, it is nearly impossible to completely avoid all allergens in real life. The importance of allergen avoidance is that minimizing allergen exposure can decrease medication dosage. Pharmacotherapy of allergic rhinitis may include any of histamine antagonist, topical/oral corticosteroid, leukotriene antagonist, decongestant, mast cell stabilizer, and cholinergic antagonist alone or in combination. Oral and intranasal spray of these medications are the main routes of administration. Immunotherapy is the medical procedure that uses controlled exposure to known allergens to reduce the severity of allergic disease. There are two ways of administering this treatment: subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Surgical treatment of the allergic rhinitis patient aims to resolve nasal obstruction by performing septoplasty or turbinoplasty.

The use of ectoine nasal spray in combination therapy of allergic rhinitis, the possibilities of barrier monotherapy

The work presents comparative study of the efficacy of the preparation Aqua Maris® Sens as a mono­drug in the treatment of allergic rhinitis, as well as its combination with intranasal glucocorticosteroids. We observed 90 patients with the diagnosis of allergic rhinitis in intermittent form. The use of this spray is aimed at formation of a special hydrophilic film on the surface of the nasal mucosa to prevent contact with allergens and reduce mucous trans-barrier sensibilization. Using the nasal spray Aqua Maris® Sens provides reduction of the disease symptoms, improvement of the patients’ life quality and is particularly justified in patients with counter-indication to the standard pharmacotherapy of allergic rhinitis.

The cost‐effectiveness of immunotherapy for respiratory allergy: a review

This article reviews the international literature on the cost-effectiveness of immunotherapy for respiratory allergy. Included studies conducted an economic evaluation of immunotherapy for allergic rhinoconjunctivitis, allergic conjunctivitis, allergic rhinitis, asthma or allergic rhinitis in combination with asthma. Although there were few economic evaluations and these suffered from methodological shortcomings, the evidence appears to support the cost-effectiveness of immunotherapy as compared with pharmacotherapy for allergic rhinoconjunctivitis, subcutaneous immunotherapy as compared with pharmacotherapy for allergic rhinitis and immunotherapy as compared with pharmacotherapy for allergic rhinitis and asthma. One economic evaluation suggested that immunotherapy as compared with pharmacotherapy is unlikely to be cost-effective for asthma. The questions of the cost-effectiveness of sublingual vs subcutaneous immunotherapy and of the cost-effectiveness of immunotherapy for allergic conjunctivitis have not been resolved to date. The cost-effectiveness of immunotherapy depends on the duration of the clinical benefit of immunotherapy following treatment cessation, and on the break-even point of cumulative costs between immunotherapy and pharmacotherapy. There is a need for economic evaluations based on high-quality prospective and long-term clinical studies comparing immunotherapy with pharmacotherapy in real-life practice and comparing sublingual with subcutaneous immunotherapy.

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Pharmacotherapy of allergic rhinitis: a pharmaco‐economic approach

This article reports on a systematic literature review of the costs of allergic rhinitis (AR), the economic value of pharmacotherapy of AR, and the factors affecting costs and economic value of pharmacotherapy. Included studies had carried out a cost-of-illness analysis, cost analysis, cost-effectiveness, cost-utility or cost-benefit analysis. Allergic rhinitis imposes a substantial economic burden on society, with indirect costs of productivity loss being larger than the direct healthcare costs. Cost estimates were biased because of difficulties of diagnosis; exclusion of patients who do not seek healthcare; exclusion of over-the-counter medication; difficulties in estimating productivity loss. There is limited evidence on costs of seasonal/perennial and intermittent/persistent AR. Little is known of the economic value of pharmacotherapy of AR, although levocetirizine appears to be cost-effective as compared with placebo. Economic evaluations suffered limitations from small sample sizes, short trial duration, lack of standardized effectiveness measure, restricted scope of costs. Finally, the economic value of pharmacotherapy of AR is influenced by the perspective of the economic evaluation, relative effectiveness and costs of available drugs, patient compliance with treatment.

Clinical Prescribing of Allergic Rhinitis Medication in the Preschool and Young School-Age Child

Allergic rhinitis (AR) is the most common chronic condition in children and is estimated to affect up to 40% of all children. It is usually diagnosed by the age of 6 years. The major impact in children is due to co-morbidity of sinusitis, otitis media with effusion, and bronchial asthma. AR also has profound effects on school absenteeism, performance and quality of life. Pharmacotherapy for AR should be based on the severity and duration of signs and symptoms. For mild, intermittent symptoms lasting a few hours to a few days, an oral second-generation antihistamine should be used on an as-needed basis. This is preferable to a less expensive first-generation antihistamine because of the effect of the latter on sedation and cognition. Four second-generation antihistamines are currently available for children under 12 years of age: cetirizine, loratadine, fexofenadine and azelastine nasal spray; each has been found to be well tolerated and effective. There are no clearcut advantages to distinguish these antihistamines, although for children under 5 years of age, only cetirizine and loratadine are approved. Other agents include pseudoephedrine, an oral vasoconstrictor, for nasal congestion, and the anticholinergic nasal spray ipratropium bromide for rhinorrhoea. Sodium cromoglycate, a mast cell stabiliser nasal spray, may also be useful in this population. For patients with more persistent, severe symptoms, intranasal corticosteroids are indicated, although one might consider azelastine nasal spray, which has anti- inflammatory activity in addition to its antihistamine effect. With the exception of fluticasone propionate for children aged 4 years and older, and mometasone furoate for those aged 3 years and older, the other intranasal corticosteroids including beclomethasone dipropionate, triamcinolone, flunisolide and budesonide are approved for children aged 6 years and older. All are effective, so a major consideration would be cost and safety. For short term therapy of 1 to 2 months, the first-generation intranasal corticosteroids (beclomethasone dipropionate, triamcinolone, budesonide and flunisolide) could be used, and mometasone furoate and fluticasone propionate could be considered for longer-term treatment. Although somewhat more costly, these second-generation drugs have lower bioavailability and thus would have a better safety profile. In patients not responding to the above programme or who require continuous medication, identification of specific triggers by an allergist can allow for specific avoidance measures and/or immunotherapy to decrease the allergic component and increase the effectiveness of the pharmacological regimen.

Recent advances in pharmacotherapy of allergic rhinitis

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