Double-Blind, Placebo-Controlled Trial of Reformulated Azelastine Nasal Spray in Patients with Seasonal Allergic Rhinitis

Background

Azelastine nasal spray is a topical antihistamine with a distinctive taste that may be objectionable to some patients. The primary objectives of this clinical trial were (1) to determine if a reformulated azelastine nasal spray (Astepro) with sucralose as a taste-masking agent provides comparable efficacy to the original formulation (Astelin) and (2) to evaluate dose–response relationships between groups.

Methods

Eight hundred thirty-five patients with seasonal allergic rhinitis were randomized to six treatment groups: (1) original azelastine nasal spray, 1 spray/nostril b.i.d.; (2) reformulated azelastine, 1 spray/nostril b.i.d.; (3) placebo, 1 spray/nostril b.i.d.; (4) original azelastine nasal spray, 2 sprays/nostril b.i.d., (5) reformulated, 2 sprays/nostril b.i.d.; and (6) placebo, 2 sprays/nostril b.i.d. The primary efficacy variable was the change from baseline to day 14 in total nasal symptom score (TNSS) consisting of runny nose, sneezing, itchy nose, and nasal congestion.

Results

Original azelastine nasal spray and the reformulated spray produced comparable improvements in the TNSS at both dosages. There was a dose-related difference in TNSS comparing the 1- and 2-spray dosages. The percentage changes from baseline in the TNSS in the 2-sprays/nostril dosage groups were 27.9% (p < 0.001) with the reformulated nasal spray, 23.5% (p < 0.01) with the original formulation, and 15.4% with placebo. The incidence of bitter taste was 7% with the reformulated spray and 8% with the original at the 2-sprays/nostril dosage.

Conclusion

The results of this study showed efficacy both with original azelastine nasal spray and with the reformulated nasal spray and a clear dose–response difference between the 1- and 2-spray dosages.

Comparison of indoor fungal spore levels before and after professional home remediation

BACKGROUND

Methods for assessing and controlling fungi in the indoor environment have been well documented, but the role of fungal allergen avoidance and respiratory disease control is just beginning to be studied.

OBJECTIVE

To investigate indoor fungal spore levels to determine if remediation produced reduction of these levels.

METHODS

The study was performed on homes remediated for excessive fungal load during 2000 to 2002. Homes were included in the study if they had professional fungal remediation. Airborne spore samples were taken both before and after remediation. Slides were mounted with glycerin jelly that contained Calberla's solution. Spores were identified and counted microscopically at a magnification of X 1000. Counts were represented as the number of spores per cubic meter of air.

RESULTS

Preevaluations and postevaluations were conducted for 17 structures. There were 92 individual collections before remediation and 99 collections after remediation. Mean counts were 131,687 (median, 9461) before remediation and 1291 (median, 409) after remediation. Aspergillus and Penicillium spores (which were counted together) occurred with the highest frequency in preremediation structures (88%). Stachybotrys spores were present in 53% of structures before remediation. Cladosporium spores were found in highest frequency in postremediation collections. Preremediation houses contained at least a 1-log increase in AspergilluslPenicillium spores over outside collections. In postremediation houses, indoor spore counts averaged 18% of outdoor counts.

CONCLUSIONS

Remediation for indoor fungal spore contamination can significantly reduce spore counts. Indoor collections in preremediation buildings are generally much higher than outdoor counts for critical spore types, including Aspergillus/Penicillium and Stachybotrys. Remediation provides indoor spore levels substantially lower than outdoor counts.

Comparison of enzyme immunoassay-based assays for environmental Alternaria alternata

BACKGROUND

Alternaria alternata-derived allergenic materials are causes of human disease. Several immunoassays exist to quantify these materials.

OBJECTIVE

To compare methods for evaluating Alternaria content.

METHODS

Four methods, including 1 monoclonal antibody (MAb)-based assay specific for recombinant Alt a 1, 1 MAb-based assay for chromatographically purified Alt a 1, 1 polyclonal antibody (PAb)-based assay for chromatographically purified Alt a 1, and 1 PAb-based assay for whole Alternaria extract, were evaluated. Environmental samples collected as part of the National Survey of Lead and Allergens in Housing were examined. Alternaria spore counts were determined in dust by observation.

RESULTS

The MAb-based assay for recombinant Alt a 1 detected Alternaria in few samples (25%); the PAb-based assay for whole Alternaria proteins detected antigen in 97% of the samples. The PAb- and MAb-based assays for purified Alt a 1 detected antigen in 100% of the samples. There was a significant positive correlation between the 2 assays directed against purified Alt a 1. There was a positive correlation between the PAb-based assay for whole Alternaria and the PAb-based assay for Alt a 1. Nearly all the dust samples contained Alternaria spores, and there was a strong positive correlation between counts and all assays.

CONCLUSION

Because of the multifaceted nature of Alternaria, the disparities between methods for quantifying Alternaria, the cross-reactivity between fungal allergens, and the documented genetic promiscuity of this fungus, enzyme immunoassays using PAbs against a range of Alternaria proteins will probably produce the most reliable estimation of overall Alternaria exposure in house dust.