Treatment Option For Allergic Rhinitis Research Articles

CircRNA_0008668 Sponges miR-1301-3p to Promote the Inflammatory Response in Allergic Rhinitis by Upregulating GATA6 Expression.

We aim to explore GATA6 modulation in allergic rhinitis (AR). Circular RNAs (circRNAs) and microRNAs (miRNAs) are involved in inflammatory responses; GATA6 is also known to regulate multiple inflammatory pathways. However, the mechanism of regulation of AR between them is unclear. We expect that this study will provide new treatment options for AR from a GATA6 perspective. In vitro, AR models were employed to examine the efficacy of our study, where we utilized monoclonal anti-2,4,6-dinitrophenyl immunoglobulin (Ig) E/human serum albumin (DNP-IgE/HSA) to induce rat basophilic leukemia cells (RBL-2H3 cells). Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) was performed to measure the expression of circ_0008668, miR-1301-3p, GATA6, and cellular inflammatory markers. Enzyme-linked immunosorbent assay (ELISA) was used to measure concentrations of beta-hexosaminidase, histamine, and cellular inflammatory factors including TNF-α, IL-1β, IL-4, and IL-5. In addition, western blot, RNA pull-down, and luciferase assays were performed to validate the molecular mechanism by which circ_ 0008668 and miR-1301-3p interactions promote GATA6 to ameliorate the inflammatory state of RBL-2H3 cells. In the in vitro model of AR, the expression levels of circ_0008668 and GATA6 were elevated, whereas that of miR-1301-3p was decreased. Pull-down assays confirmed that circ_0008668 efficiently binds miR-1301-3p and its overexpression leads to upregulation of the levels of GATA6, cellular inflammatory factors (IL-4, IL-5, TNF-α, and IL-1β), and markers associated with inflammatory signaling pathways (NLRP3, ERK1/2, and P65 protein phosphorylation). In addition, miR-inhibitor with circRNA enhanced GATA6 and NLPR3 expression and activated inflammatory pathway activity. In particular, miR-mimic was effective in reversing the onset of this inflammatory state. Our results indicate that circ_0008668 promotes the inflammatory state of mast cells by sponging miR-1301-3p to target GATA6, which in turn affects the allergic response to AR. This process could improve the current diagnosis of AR patients and clinical treatment.

A Review on Novel Therapeutic Modalities and Evidence-based Drug Treatments against Allergic Rhinitis.

Allergic rhinitis (AR) is an IgE-mediated atopic disease that occurs due to inhaled antigens in the immediate phase. Misdiagnosis, insufficient treatment, or no treatment at all are frequent problems associated with the widespread condition known as chronic allergic rhinitis. AR symptoms include runny, itchy, stuffy, and sneezing noses. Asthma and nasal polyps, for example, sometimes occur simultaneously in patients. In order for people living with AR to be as comfortable and productive as possible, treatment should center on reducing their symptoms. The online sources and literature, such as Pubmed, ScienceDirect, and Medline, were reviewed to gather information regarding therapeutic modalities of AR and evidence-based treatments for the disease as the objectives of the present study. An increasing number of people are suffering from AR, resulting in a heavy financial and medical burden on healthcare systems around the world. Undertreating AR frequently results in a decline in quality of life. Treatment compliance is a critical challenge in the administration of AR. Innovative therapies are needed for RA to provide patients with symptom alleviation that is less expensive, more effective, and longer duration of action. Evidence-based guidelines are helpful for managing AR illness. Treating AR according to evidence-based standards can help in disease management. AR treatment includes allergen avoidance, drug therapy, immunotherapy, patient education, and follow-up. However, AR treatment with intranasal corticosteroids is more popular. Hence, in this review article, treatment options for AR are discussed in depth. We also discussed the incidence, causes, and new treatments for this clinical condition.

Efficacy and safety of the combination nasal spray olopatadine hydrochloride-mometasone furoate in the treatment of allergic rhinitis

Abstract Introduction Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis. Methods In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account. Results Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy. Conclusion In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.

Anafilaktički šok izazvan subkutanom imunoterapijom alergenom Ambrosia elatior - prikaz slučaja

Introduction: Sensitization to ragweed pollen can lead to symptoms of allergic rhinitis, conjunctivitis, and allergic asthma. Allergen immunotherapy (AIT) is an immunomodulatory therapeutic procedure that, in addition to short-term curative effect (reduction of disease symptoms), also has a long-term preventive effect (preventing the progression of allergic rhinitis into allergic asthma and/or preventing the development of a more severe form of the disease). The two main AIT administration modalities used in clinical practice are subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT). Both modalities are equally effective in reducing disease symptoms, but the use of SCIT is associated with a higher risk of local and systemic adverse reactions. Case report: A patient who developed a clinical picture of anaphylactic shock during the induction phase of SCIT with Ambrosia elatior pollen extract is presented in this article. The clinical course is described as well as the quick and effective therapeutic management of this life-threatening condition. Conclusion: When properly dosed, in a medical facility and under medical supervision, SCIT with Ambrosia elatior is a very safe and well-tolerated treatment option for allergic rhinitis. Local reactions at the site of subcutaneous administration occur more often than systemic adverse reactions. Anaphylactic shock is the most severe form of a systemic allergic reaction that affects multiple organ systems and can end in death, usually due to airway obstruction and cardiovascular collapse. It is necessary to educate the medical staff as well as the patients regarding the proper treatment of this difficult condition. Based on the assessment of risk factors in each patient, severe reactions to SCIT can be predicted and avoided with appropriate precautions and prophylactic measures. Future innovations in AIT are expected to further improve the efficacy and safety of this form of treatment for allergic diseases.

Phototherapy in allergic rhinitis

Allergic rhinitis, commonly known as hay fever, is a condition characterized by the inflammation of the nasal passages caused by allergens such as pollen, dust mites, animal dander, and mold. It affects approximately 10-30% of the global population, and its symptoms include sneezing, runny nose, nasal congestion, itchy eyes, and throat irritation. One of the treatment options for allergic rhinitis is phototherapy, a non-invasive and drug-free approach that has shown promising results in managing the condition. Objectives. The main objective is to study phototherapy in the treatment of allergic rhinitis compared with placebo therapy. We want to apply an effective therapeutic method, a safe one, without notable side effects, cheaper, which improve the health of our patients, and the quality of their life. Methods. It is randomized study, investigating the effect of placebo controlled rhinophototherapy, for a total of 187 patients who met the criteria for inclusion/exclusion. Rhinophototherapy effect was investigated measuring the nasal flow (rhinomanometry) and individual scores for subjective and objective symptoms. Results. Patients treated with phototherapy = 65, placebo = 32 patients treated. Evolution lot phototherapy: very good - 67% improvement, good improvement - 28%, 5%-unfavorable evolution. Analyzing the placebo treated group: good results-10%, 43% moderate-improvement, evolution-47% unfavorable. Conclusions. Phototherapy is an effective therapeutic method to treat patients with allergic rhinitis, is a well tolerated therapy, with minor side effects, easy to implement and monitor.

House dust mite sublingual immunotherapy tablet safety in adolescents with allergic rhinoconjunctivitis: Worldwide clinical trial results

BackgroundThe house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet is a treatment option for allergic rhinitis with/without conjunctivitis (AR/C) approved in adults worldwide and in adolescents in some countries. ObjectiveTo supplement existing adolescent HDM SLIT-tablet safety data by conducting the MT-18 trial in adolescents. MethodsMT-18 (EudraCT:2020-000446-34) was a phase 3, open-label, single-arm, 28-day safety trial of daily HDM SLIT-tablet (12 SQ-HDM dose) in European adolescents (12-17 years) with HDM AR/C, with or without asthma. The primary end point was at least 1 treatment-emergent adverse event (TEAE). MT-18 results were compared with 12 SQ-HDM adolescent subpopulation data from previously described 1-year phase 3 trials conducted in North America (P001; clinicaltrials.gov:NCT01700192) or Japan (TO-203-3-2; JapicCTI:121848). ResultsNo treatment-related anaphylaxis, epinephrine administrations, severe local swellings, severe mouth or throat edema, or eosinophilic esophagitis occurred in the trials. For MT-18 (N = 253), P001 (N adolescents = 189), and TO-203-3-2 (N adolescents = 206), the percentage of adolescents treated with 12 SQ-HDM reporting any TEAE was 88%, 95%, and 93%, respectively, and the percentage reporting any treatment-related AE (TRAE) was 86%, 93%, and 66%, respectively. The most common TRAEs were local application site reactions. Most TRAEs were mild in intensity and were typically experienced the first 1 to 2 days of treatment. There were no asthma-related TEAEs with the HDM SLIT-tablet. The safety profile appears similar between adolescents with or without asthma at baseline. ConclusionThe HDM SLIT-tablet was well tolerated in European, North American, and Japanese adolescents with HDM AR/C, indicating safety of the HDM SLIT-tablet is insensitive to age or geographic region. Trial registrationClinicalTrials.gov Identifier: (P001: NCT01700192); EudraCT: (MT-18; 2020-000446-34); JapicCTI: (TO-203-3-2; 121848)

Patient Satisfaction and Sensory Attributes of Nasal Spray Treatments of Olopatadine Hydrochloride/Mometasone Furoate Monohydrate and Azelastine Hydrochloride/Fluticasone Propionate for Allergic Rhinitis in Australia - An Observational Real-World Clinical Study.

Combination intranasal corticosteroid and antihistamine sprays are a first-line treatment option for allergic rhinitis (AR), of which Azelastine Hydrochloride and Fluticasone Propionate nasal spray (AZE/FLU; Dymista®), and Olopatadine Hydrochloride and Mometasone Furoate Monohydrate nasal spray (OLO/MOM; Ryaltris®) are currently registered in Australia. As it is not known how patients value treatment attributes of current combination nasal sprays, this observational, real-world clinical study aimed to understand patients' satisfaction with, and importance of, treatment attributes of OLO/MOM and AZE/FLU using an Anchored Best-Worst Scaling (ABWS) exercise. Four hundred and twenty-six adults in Australia with moderate to severe AR using either OLO/MOM or AZE/FLU completed an online survey incorporating an ABWS with 11 domains: 7 sensory (immediate taste of medication, aftertaste of medication, smell of medication, irritation to your nose, urge to sneeze, dripping out your nose/down your throat, dryness of your nose/throat) and 4 treatment-related (convenience, fast acting, duration of effect, and AR symptom control). The ABWS involved rescaling individual BWS scores using anchored ratings (0-10) for most and least satisfied/important domains to create a total satisfaction index (TSI) (0-100) to be compared across groups. Statistical comparisons were completed using ANOVA (TSI) and MANOVA (individual domains). Participants using OLO/MOM (M = 68.26, SE = 1.39) had significantly higher TSI than participants using AZE/FLU (M=62.78, SE = 0.70) (p < 0.001), significantly higher satisfaction on 7 of 11 domains and regarded 8 of 11 domains as significantly more important compared to participants using AZE/FLU (all p < 0.05). Preferred domains were predominantly sensory attributes. Current findings showed that participants using OLO/MOM were more satisfied with their overall treatment compared to participants using AZE/FLU, particularly with sensory attributes, thus highlighting the suitability of OLO/MOM for people with AR who value sensory attributes. Prescribers of AR treatments are encouraged to discuss treatment attributes with patients to facilitate shared decision-making.

Allergen immunotherapy in the polyallergic adolescent

Allergen immunotherapy is the only disease-modifying treatment option for allergic rhinitis, with adherence being its major limitation. We report a case of an adolescent with rhinitis, proven allergy to multiple non-homologous pollens, and troublesome symptoms despite maximal symptomatic therapy during the late spring and early summer months. Allergen immunotherapy to the most clinically relevant allergen was initiated under the supervision of a pediatrician. Shortly before her second year of treatment, she transferred to adult care and maintained a high degree of adherence and a favourable response to immunotherapy. In conclusion, allergen immunotherapy is effective in polyallergic adolescents with good adherence.

ONSET OF ACTION OF AZELASTINE HCL NASAL SPRAY 0.15% EVALUATED IN AN ENVIRONMENTAL EXPOSURE CHAMBER

<h3>Introduction</h3> Azelastine nasal spray is an effective treatment in managing seasonal allergic rhinitis (SAR). The objective of this single center, double-blinded, placebo-controlled study was to evaluate the time to onset of efficacy of azelastine HCl 0.15% in the relief of nasal symptoms of SAR in an environmental exposure chamber (EEC). <h3>Methods</h3> 110 participants aged 18 to 65 years were randomized to receive azelastine HCl 0.15% or placebo nasal spray after being continuously exposed to ragweed pollen in an EEC. The primary efficacy parameter was the time to onset of efficacy of azelastine as measured by the change from baseline in total nasal symptom score (TNSS) versus placebo. <h3>Results</h3> Azelastine HCl 0.15% demonstrated a statistically significant improvement in TNSS compared with placebo starting from 30 minutes post-dose (p=0.0002), and the effect was sustainable at all time points throughout the end of the EEC session at 240 minutes post dose (p= <0.0001). Adverse events observed was consistent with known safety profile. No serious adverse events or other significant AEs were reported. <h3>Conclusions</h3> This is the first study assessing the onset of action of azelastine HCl 0.15% in an EEC, demonstrating a fast onset in 30 minutes. Azelastine HCl 0.15% nasal spray was well tolerated and there were no safety concerns raised during this SAR study. The rapid onset of action for the relief of allergy symptoms combined with a safe side effect profile indicate azelastine HCl 0.15% is a valuable treatment option for allergic rhinitis.

OPEN-LABEL SAFETY TRIAL OF HOUSE DUST MITE SUBLINGUAL IMMUNOTHERAPY TABLET IN ADOLESCENTS WITH ALLERGIC RHINITIS/RHINOCONJUNCTIVITIS

<h3>Introduction</h3> The HDM sublingual immunotherapy (SLIT) tablet is a treatment option for allergic rhinitis with/without conjunctivitis (AR/C) approved in adults worldwide and in adolescents in some countries. The MT-18 trial was conducted specifically in adolescents per FDA request to supplement existing adolescent safety data of the HDM SLIT tablet. <h3>Methods</h3> MT-18 (EudraCT:2020-000446-34) was a phase 3, open-label, single-arm, multi-center, 28-day safety trial of daily HDM SLIT tablet (12 SQ-HDM dose) conducted in European adolescents (12-17 y; N=253) with HDM-associated AR/C, with or without asthma. The primary endpoint was at least 1 treatment-emergent adverse event (TEAE). Secondary endpoints were at least 1 solicited TEAE, at least 1 treatment-related adverse event (TRAE), and at least 1 serious TEAE. <h3>Results</h3> The percentage of adolescents reporting any TEAE was 88%, the percentage reporting any TRAE was 86%, and there were no serious TEAEs. Two subjects (1%) discontinued due to AEs. The most common TRAEs were local application site reactions. Most TRAEs were mild in severity and were typically experienced during the first 1-2 days of treatment. The most common TRAEs recurred for <10 days in MT-18. No treatment-related anaphylaxis, epinephrine administrations, severe local swellings, severe mouth or throat edema, or eosinophilic esophagitis occurred in the trial. <h3>Conclusions</h3> There were no new or unexpected safety findings in MT-18 compared with previous safety data. The HDM SLIT tablet was well tolerated in European adolescents with HDM AR/C, similar to previous data in North American adolescents.

Adverse Drug Reactions of Intranasal Corticosteroids in the Netherlands: An Analysis from the Netherlands Pharmacovigilance Center.

BackgroundIntranasal corticosteroids are one of the cornerstone treatment options for allergic rhinitis and chronic sinusitis complaints. Safety information in the summary of product characteristics may not be representative for observations in daily clinical practice. The Netherlands Pharmacovigilance Center (Lareb) collects post-marketing safety information, using spontaneous reporting systems.ObjectiveOur objective was to analyse reports of adverse drug reactions associated with intranasal corticosteroids reported in the Dutch spontaneous reporting database of the Netherlands Pharmacovigilance Center Lareb to obtain insight into real-world safety data.MethodsWe retrospectively examined all adverse drug reactions of intranasal corticosteroids reported to the Netherlands Pharmacovigilance Center Lareb, entered into the database from 1991 until 1 July, 2020.ResultsIn total, 2263 adverse drug reactions after intranasal corticosteroid use were reported in 1258 individuals. Headache (n = 143), epistaxis (n = 124) and anosmia (n = 57) were reported most frequently. Nasal septum perforation (reporting odds ratio 463.2; 95% confidence interval: 186.7–1149.7) had the highest reporting odds ratio, followed by nasal mucosal disorder (reporting odds ratio 104.5; 95% confidence interval 36.3–301.3) and hyposmia (reporting odds ratio 90.8; 95% confidence interval 45.1–182.7). Moreover, 101 (4.5%) reports were classified as serious by Lareb, including reports of Cushing’s syndrome, adrenal cortical hypofunction and growth retardation.ConclusionsMany side effects are consistent with the safety information in the summary of product characteristics of intranasal corticosteroids. Several serious (systemic) side effects are reported and it is important to realise that intranasal corticosteroids may contribute to the development. Healthcare providers and patients should be aware of the potential (individual) adverse drug reactions of intranasal corticosteroids. This information could help in discussing treatment options.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00301-x.

Nasal administration of a probiotic assemblage in allergic rhinitis: A randomised placebo-controlled crossover trial.

BackgroundTopical probiotics have been suggested as a treatment option for allergic rhinitis, as they may skew the immune response towards a beneficial type‐1 non‐allergic profile. So far observations in man have exclusively involved oral intake. The aim of this study was to examine whether a topical/nasal administration of a probiotic assemblage (PA) affects quality of life, symptoms and signs of allergic rhinitis in a nasal allergen challenge (NAC) model.MethodsIn a placebo‐controlled and crossover design, 24 patients with seasonal allergic rhinitis were randomised to topical/nasal administration with a PA of Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A or placebo for 3 weeks. Participants and investigators were blind to treatment allocation. The last week of each treatment period was combined with a NAC series. Efficacy variables were “Mini‐Rhinoconjunctivitis Quality of Life Questionnaire” (Mini‐RQLQ), “Total Nasal Symptom Score” (TNSS), “Peak Nasal Inspiratory Flow” (PNIF) and “Fractional Exhaled Nitric Oxide” (FeNO). In addition, to assess whether or not the PA produced any pro‐inflammatory effect per se, soluble analytes were monitored in nasal lavage fluids. Finally, bacterial cultures, sampled using swabs from the middle nasal meatus, were assessed for the presence of the PA by MALDI‐TOF analysis.ResultsAdministration of the PA did not produce any nasal symptoms (cf. placebo). An innate immune response was discerned within the PA run (cf. baseline), but no change in nasal lavage fluid levels of cytokines/mediators was observed cf. placebo except for IL‐17/IL‐17A (a minor increase in the PA run). Administration of the PA did neither affect Mini‐RQLQ, TNSS, PNIF nor FeNO. No evidence of persistent colonization was observed.ConclusionsTopical/nasal administration of a PA comprising Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A, while likely evoking a minor innate immune response yet being safe, does not affect quality of life, symptoms or signs of allergic rhinitis. Trial registration: not registered.

Features of the modern antihistamines use in the treatment of allergic rhinitis

Allergic rhinitis remains one of the most relevant problems of modern otorhinolaryngology. The widespread prevalence, late diagnosis, underestimation of the possible risks of disease progression, the development of complications (including asthma) prompts the development and improvement of new treatment options for allergic rhinitis. Allergic rhinitis is a heterogeneous disease that presents with various clinical phenotypes, and therefore the severity of nasal symptoms can vary from mild malaise to severe disease.. Today, pharmacotherapy remains the most frequently used treatment tactic for patients with allergic rhinitis. While prescribing therapy the doctor develops an individual treatment plan based on the principles of personalized medicine, considering: the dominant symptoms, anamnesis data on previous therapy and the effect of treatment, the type of inflammation (Th2-type, mixed inflammation), concomitant diseases (conjunctivitis, asthma, etc.) etc.) and patient preferences. The tissue effects of the histamine mediator lead to the development of symptoms during the course of the disease, which determines the wide-spread use of antihistamines in the treatment of rhinitis. Antihistamines of the second generation are devoid of sedative effects, have a long-lasting effect and a good safety profile. One of the modern II generation antihistamines is bilastine. The research results proved the high antihistaminic activity of bilastine 20 mg in vitro and in vivo, the absence of cardiac and sedative side effects on the central nervous system, the ability to eliminate the nasal and ocular symptoms of disease and improve the quality of life of patients with allergic rhinitis. Thus, bilastine fully complies with current EAACI / WAO ARIA requirements for drugs used to treat AR. The paper presents a clinical case of a patient with chronic persistent allergic rhinitis, household sensitization with a slight uncontrolled course. The oral antihistamine bilastine was added to intranasal glucocorticosteroids, which help to relieve symptoms of the disease, stabilize the condition and prepare the patient for subsequent allergen-specific immunotherapy.

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

Intranasal corticosteroid (INCS) therapy is the preferred treatment option for allergic rhinitis (AR). Although all INCSs for the treatment of AR are considered safe and effective, differences in potency, molecular structure features and physicochemical and pharmacokinetic properties could result in differences in clinical efficacy and safety. Higher glucocorticoid receptor (GR) binding affinity of INCS is associated with higher lipophilicity, nasal tissue retention and topical potency. Higher topical potency is also accompanied by low oral bioavailability and high systemic clearance conferring low systemic exposure, reduced potential for systemic adverse effects and an improved therapeutic index. It has been shown that adverse events related to systemic exposure of INCSs in children are low. Although INCSs mostly produce low systemic effects, use of an INCS with low systemic exposure in patients on multiple corticosteroid (CS) therapies could help reduce the total systemic burden of CS therapy. Despite differences in topical potency, physicochemical and pharmacokinetic properties between INCSs, clinical studies of INCSs in the treatment of AR generally show no clinically important differences between these compounds, and poor correlation between INCS topical potency and clinical response. However, the lack of head-to-head comparisons of INCSs in clinical studies conducted in more severe AR patients should be noted. This narrative review provides an assessment of the therapeutic relevance of topical potency and the physicochemical and pharmacokinetic properties of INCSs and describes for the first time the relationship between topical potency and therapeutic index using pharmacological features of INCSs. It concludes that higher GR binding affinity and topical potency can potentially improve the therapeutic index of an INCS. Therefore, both efficacy and systemic exposure profiles should be considered when comparing INCS regimens in terms of therapeutic equivalence, to aid clinical decision-making and avoid the assumption that all INCS formulations are the same when considering treatment options.

Efficacy and safety of intralymphatic immunotherapy in allergic rhinitis: A systematic review and meta-analysis.

BackgroundIntralymphatic immunotherapy (ILIT) is a potential treatment option for allergic rhinitis (AR). We aimed to determine the efficacy (primary outcomes) and safety (secondary outcomes) of ILIT in treating patients with AR.MethodsAn electronic literature search was performed using MEDLINE and Cochrane Central Register of Controlled Trials CENTRAL (from their inception to December 2020). A random‐effects model was used to estimate the pooled prevalence with 95% confidence intervals. This study is registered with PROSPERO (CRD42019126271).ResultsWe retrieved a total of 285 articles, of which 11 satisfied our inclusion criteria. There were 452 participants with age ranged from 15 to 58 years old. Intralymphatic immunotherapy was given in three doses with intervals of four weeks between doses in 10 trials. One trial gave three and six doses with an interval of two weeks. Both primary and secondary outcomes showed no difference between ILIT and placebo for all trials. There was no difference in the combined symptoms and medication score (SMD ‐0.51, 95% CI −1.31 to 0.28), symptoms score (SMD −0.27, 95% CI −0.91 to 0.38), medication score (SMD −6.56, 95% CI −21.48 to 8.37), rescue medication (RR 12.32, 95% CI 0.72–211.79) and the overall improvement score (MD −0.07, 95% CI −2.28 to 2.14) between ILIT and placebo. No major adverse events noted.ConclusionsIntralymphatic immunotherapy possibly has a role in the treatment of AR patients. This review found it is safe but not effective, which could be contributed by the high variation amongst the trials. Future trials should involve larger numbers of participants and report standardized administration of ILIT and outcome measures.

The use of nasal allergen vs allergen exposure chambers to evaluate allergen immunotherapy

ABSTRACT Introduction Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment option for allergic rhinitis (AR) patients with persistent moderate-severe AR for whom traditional pharmacotherapies are ineffective. The nasal allergen challenge (NAC) and allergen exposure chamber (AEC) are two translational models of AR that can be used to investigate the properties, safety, and efficacy of AIT. Areas Covered Peer-reviewed, human-centered articles utilizing AEC or NAC models to investigate AIT between 2010 and 2020 were curated from PubMed, EMBASE, and OVID Medline databases. AECs have been used to evaluate traditional subcutaneous and sublingual administrations of AIT, including cross-protective effects and different dosing regimens. More recently, the effectiveness of novel AIT formulations has been evaluated. NACs are another model used to study AIT, including using novel intralymphatic routes of administration. It is an especially powerful and versatile tool to determine if basic science and animal model findings are clinically translatable. Expert opinion The AEC and NAC models both produce clinically relevant and reproducible results. AECs are more effective for studying many participants but are limited because they require a specialized facility. As more AIT therapies and new formulations are developed over time, the versatility of the NAC will be especially useful.

Budesonide vs Saline Nasal Irrigation in Allergic Rhinitis: A Randomized Placebo‐Controlled Trial

Budesonide nasal irrigation is currently widely used in the treatment of chronic sinusitis typically following endoscopic sinus surgery to improve inflammatory control. Its application in treatment of allergic rhinitis has not been previously studied. This study assesses the subjective and clinical response to budesonide buffered hypertonic saline nasal irrigation and hypertonic saline nasal irrigation in patients with allergic rhinitis. This is a prospective, single-center, double-blind, randomized placebo-controlled trial. Tertiary care hospital. Fifty-two patients diagnosed with allergic rhinitis were randomized into 2 groups to receive either buffered hypertonic saline nasal irrigation with a placebo respule or buffered hypertonic saline nasal irrigation with a budesonide respule. Patients were assessed at baseline and 4 weeks subjectively using the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire and visual analog scale (VAS). Clinical assessment was done using the modified Lund-Kennedy score. The average SNOT-22, VAS, and modified Lund-Kennedy scores improved in both groups (P < .001). The budesonide irrigation group was found to have significantly better improvement than the saline nasal irrigation group with the SNOT-22 scores (P = .012) and VAS scores (P = .007). However, the difference in the clinical response between the 2 groups was not significant (P = .268). This study adds evidence to the use of saline nasal irrigation in allergic rhinitis but also demonstrates efficacy of the addition of budesonide to irrigations. Budesonide nasal irrigation thus appears to be a viable treatment option for allergic rhinitis.

Effects of a Novel Barley-Based Formulation on Allergic Rhinitis: A Randomized Controlled Trial.

Current treatment options for Allergic Rhinitis (AR) may have their own limitations and side effects. This study aimed to investigate the effects of Ma-al-Shaeer (MS), a novel natural formulation based on Hordeum vulgare, in the treatment of AR compared with Fexofenadine (FX). A total of 77 patients with AR were divided into two groups: MS group (n=38) and FX group (n=39). The first group received 15 g of dried MS powder, and the second group received 60 mg of FX twice daily for 14 days. At baseline (week zero) and after the 14-day treatment period (week two), both groups were evaluated for sneezing, rhinorrhea, nasal congestion, nasal itching, post nasal drip, eye, throat, or ear symptoms, headache, cough, mental function, quality of life scores, blood eosinophil count and total IgE levels. Rhinitis control assessment tests were conducted at week zero and again at one week after cessation of treatment (week three) in both groups. All symptoms of AR except cough were significantly reduced in both groups; for nasal congestion, post nasal drip, and headache, the MS treatment was found to be superior. Rhinitis control was significantly increased after treatment in both groups (p value < 0.001). Both drugs significantly reduced total IgE levels. There was no significant change in eosinophil count in either group. MS formulation based on H. vulgare may be an effective treatment for AR. Further studies are needed to confirm the effect of MS as an alternative treatment in AR.

A comparative study to assess the efficacy and safety of bepotastine and cetirizine in allergic rhinitis

Background: Pharmacotherapy is the mainstay of allergic rhinitis and many caregivers use over-the-counter antihistamines. Bepotastine is a novel oral second generation non-sedative antihistamine and an effective treatment option for allergic rhinitis. The objectives of the present study were to evaluate the efficacy and safety of bepotastine versus cetirizine an over the counter drug.Methods: A prospective, randomized, open-label, parallel-group study was conducted among 60 patients fulfilling the inclusion and exclusion criteria. Group A (n=30) received tablet cetirizine 10 mg once daily and Group B (n=30) received tablet bepotastine 10 mg once daily. Efficacy was assessed by mean change in total symptom score (TSS) which is the sum of total nasal symptom score and total ocular symptom score at the end of two weeks from baseline.Results: At the end of two weeks of treatment, both groups showed statistically significant (p&lt;0.005) improvements from their baseline TSS. Mean TSS was reduced from12.36±2.12 to 4.2±1.66 in group A and from 13.33±3.039 to 3.033±1.40 in Group B. Significant statistical difference in TSS was seen more in Group B than Group A (p&lt;0.005).Conclusions: Both the groups showed a substantial therapeutic benefit in patients with allergic rhinitis, however bepotastine is more effective.

Conventional and Alternative Treatment Options for Allergic Rhinitis

Conventional and Alternative Treatment Options for Allergic Rhinitis