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Ellis AK, Cook V, Keith PK, Mace SR, Moote W, O'Keefe A, Quirt J, Rosenfield L, Small P, Watson W. Focused allergic rhinitis practice parameter for Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:45. [PMID: 39118164 PMCID: PMC11311964 DOI: 10.1186/s13223-024-00899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/21/2024] [Indexed: 08/10/2024]
Abstract
Allergic rhinitis (AR) is a prevalent disease in Canada that affects both children and adults. Several guidelines for the management of AR have been published by professional allergy societies worldwide. However, there are regional differences in the clinical management of AR, and regulatory approval of some AR pharmacotherapies varies among countries. Thus, six research questions specific to the treatment of AR in Canada were identified for this focused practice parameter. Reviews of the literature published since 2016 were conducted to obtain evidence-based support for the responses of the Work Group to each research question. In response to research question 1 "In patients with symptoms indicative of AR, is serum-specific IgE sufficient to identify candidates for immunotherapy or is a skin prick test mandatory?" the Work Group concluded that either sIgE testing or skin prick test are acceptable for diagnosing AR and guiding immunotherapy. In response to research question 2 "When taking into account the preferences of the patient and the prescriber (stakeholder engagement) should second-generation oral antihistamine (OAH) or intranasal corticosteroid (INCS) be first line?" the Work Group concluded that existing guidelines generally agree on the use of INCS as a first-line therapy used for AR, however, patient and provider preferences and considerations can easily shift the first choice to a second-generation OAH. In response to research question 3 "Is a combination intranasal antihistamine (INAH)/INCS formulation superior to INCS plus OAH? Do they become equivalent after prolonged use?" the Work Group concluded that that the combination INAH/INCS is superior to an INCS plus OAH. However, there was insufficient evidence to answer the second question. In response to research question 4 "Do leukotriene receptor antagonists (LTRA) have a greater benefit than OAH in AR for some symptoms to justify a therapeutic trial in those who cannot tolerate INCS?" the Work Group concluded that LTRAs have inferior, or at best equivalent, daytime or overall symptom control compared with OAH, but LTRAs may improve nighttime symptom control and provide benefits in patients with AR and concomitant asthma. In response to research question 5 "Should sublingual immunotherapy (SLIT) tablets be considered first-line immunotherapeutic options over subcutaneous immunotherapy (SCIT) based on the evidence of efficacy?" the Work Group concluded that the choice of SLIT or SCIT cannot be made on efficacy alone, and differences in other factors outweigh any differences in efficacy. In response to research question 6 "Based on efficacy data, should ALL patients seen by an allergist be offered SLIT or SCIT as a treatment option?" the Work Group concluded that the efficacy data suggests that SLIT or SCIT should be used broadly in patients with AR, but other clinical concerns also need to be taken into consideration.
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Affiliation(s)
- Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Victoria Cook
- Community Allergy Clinic, Victoria, BC, and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Paul K Keith
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sean R Mace
- Mace Allergy and Clinical Immunology, Toronto, ON, Canada
| | | | - Andrew O'Keefe
- Department of Pediatrics, Memorial University, St. John's, NL, Canada
| | - Jaclyn Quirt
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lana Rosenfield
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Small
- Jewish General Hospital, Montreal, QC, Canada
| | - Wade Watson
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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Tantilipikorn P, Kirtsreesakul V, Bunnag C, Vangveeravong M, Thanaviratananich S, Chusakul S. The Use of Azelastine Hydrochloride/Fluticasone Propionate in the Management of Allergic Rhinitis in Asia: A Review. J Asthma Allergy 2024; 17:667-679. [PMID: 39045291 PMCID: PMC11264124 DOI: 10.2147/jaa.s451733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/13/2024] [Indexed: 07/25/2024] Open
Abstract
The incidence of allergic rhinitis (AR) in Asia and the world is steadily rising. Patients experience incomplete symptom relief despite existing treatment options, which warrants the need for new therapeutic regimes. Azelastine hydrochloride/fluticasone propionate (MP-AzeFlu), a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate has been indicated in the treatment of AR. The current review discusses the effects of MP-AzeFlu versus conventional therapies in achieving superior clinical improvement with a very rapid onset of action (5 minutes). The superiority of MP-AzeFlu in offering complete symptom control with sustained relief in patients with AR compared to the existing therapeutic options is also discussed. MP-AzeFlu has been shown to improve the quality of life for patients with AR, thereby enhancing patient adherence to therapy and establishing its preference for the treatment of AR. Currently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommend the use of a combination of intranasal corticosteroids and intranasal antihistamines as first-line treatment in patients with persistent AR with visual analog scores ≥5 or when prior treatment with single agents has been ineffective. Widely published data on the efficacy and safety of its prolonged use in adults and children have validated that effective treatment of AR can be achieved with MP-AzeFlu.
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Affiliation(s)
- Pongsakorn Tantilipikorn
- Center of Research Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chaweewan Bunnag
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Supinda Chusakul
- Department of Otolaryngology, Chulalongkorn University, Bangkok, Thailand
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Trincianti C, Tosca MA, Ciprandi G. Updates in the diagnosis and practical management of allergic rhinitis. Expert Rev Clin Pharmacol 2023; 16:669-676. [PMID: 37314373 DOI: 10.1080/17512433.2023.2225770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a widespread disease that can be associated with other conditions, including conjunctivitis, rhinosinusitis, asthma, food allergy, and atopic dermatitis. Diagnosis is based on the history and documentation of sensitization, such as the production of allergen-specific IgE, preferably using molecular diagnostics. Treatments are based on patient education, non-pharmacological and pharmacological remedies, allergen-specific immunotherapy (AIT), and surgery. Symptomatic treatments mainly concern intranasal/oral antihistamines and/or nasal corticosteroids. AREAS COVERED This review discusses current and emerging management strategies for AR, covering pharmacological and non-pharmacological remedies, AIT, and biologics in selected cases with associated severe asthma. However, AIT presently remains the unique causal treatment for AR. EXPERT OPINION The management of allergic rhinitis could include new strategies. In this regard, particular interest should be considered in the fixed association between intranasal antihistamines and corticosteroids, probiotics and other natural substances, and new formulations (tablets) of AIT.
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Starostina SV, Toldanov AV. Intranasal corticosteroid use in patients with allergic rhinitis. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Allergic rhinitis (AR) is one of the most common diseases in the world, which is based on IgE-mediated inflammation that develops after exposure to various allergens. About 40% of people suffer from the same or other allergic diseases, every third inhabitant of the Earth has symptoms of AR and every tenth has bronchial asthma. According to the ARIA classification, ARs are divided: by the nature of the flow, by the severity of the flow and by the stage of the flow; for symptoms, the proposed therapy, consisting of sequential steps. Groups of drugs include: systemic or topical blockers of histamine H1 receptors, intranasal and systemic corticosteroids, mast cell stabilizers (intranasal cromones), M-antagonists, antagonists of leukotriene receptors. Medicines do not give a lasting effect after their cancellation, therefore, with persistent AR, treatment should be prolonged; methods of application more often oral or intranasal. The advantages of the pharmacological antiallergic effect of InHCS are the simultaneous inhibition of both the early and late phases of the allergic response and the inhibition of all AR symptoms. The advantage of InHCS over oral administration is the minimal risk of developing systemic side effects against the background of the creation of adequate concentrations of the substance in the nasal mucosa, which allows to control the symptoms of AR. Based on data from a number of studies, the advantages of intrasal corticosteroids for AR, in particular fluticasone propionate, are used.
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Linton S, Burrows AG, Hossenbaccus L, Ellis AK. Future of allergic rhinitis management. Ann Allergy Asthma Immunol 2021; 127:183-190. [PMID: 33971355 DOI: 10.1016/j.anai.2021.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To present a comprehensive, clinically focused scoping review of therapeutic agents and practices comprising the future of allergic rhinitis (AR) management. DATA SOURCES A review of the published literature was performed using the PubMed database, published abstracts, and virtual presentations from scientific meetings and posted results on ClinicalTrials.gov. STUDY SELECTIONS Primary manuscripts with trial results, case reports, case series, and clinical trial data from ClinicalTrials.gov, PubMed, and articles highlighting expert perspectives on management of AR were selected. RESULTS Telemedicine, social media, and mHealth facilitate integrated care for AR management. Pharmacotherapy remains the standard of care for AR management; however, treatment combinations are recommended. Intralymphatic immunotherapy and peptide immunotherapy are the most promising new allergen immunotherapy options. Studies of targeted biologics for AR are ongoing. Probiotics may be beneficial for AR management, particularly Bifidobacterium spp, and as an add-on to allergen immunotherapy. CONCLUSION AR is a chronic and often comorbid condition that requires integrated care for optimal management. New formulations and combinations of existing AR therapies are the most promising and merit future research.
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Affiliation(s)
- Sophia Linton
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alyssa G Burrows
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Lubnaa Hossenbaccus
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anne K Ellis
- Allergy Research Unit, Kingston Health Sciences Center-Kingston General Hospital Site, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
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Klimek L, Casper I, Bergmann KC, Biedermann T, Bousquet J, Hellings P, Jung K, Merk H, Olze H, Mösges R, Schlenter W, Gröger M, Ring J, Chaker A, Pfaar O, Wehrmann W, Zuberbier T, Becker S. Die Therapie der allergischen Rhinitis in der Routineversorgung: evidenzbasierte Nutzenbewertung der kombinierten Anwendung mehrerer Wirkstoffe. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-2551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kennedy DW. Pain management in sinonasal surgery: are opioids required? Int Forum Allergy Rhinol 2019; 9:337-338. [PMID: 30848872 DOI: 10.1002/alr.22325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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