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J V, Davis P, Ramanathan T, Prabu V. Prevalence of Migraine Headache among Patients with Allergic Rhinitis in a Tertiary Care Hospital, Puducherry. Indian J Otolaryngol Head Neck Surg 2024; 76:4216-4221. [PMID: 39376428 PMCID: PMC11455906 DOI: 10.1007/s12070-024-04817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/13/2024] [Indexed: 10/09/2024] Open
Abstract
Allergic rhinitis is one of the most common and undertreated diseases in the world. In recent times, there has been increased development of non-sinus headaches among patients with allergic rhinitis. Various common endogenous molecules such as nitric oxide, calcitonin gene-related peptide, and histamine have been implicated in the development of migraines, which leads to the development of migraines among allergic rhinitis patients. The study aims to determine the prevalence of migraine among allergic rhinitis patients and to find the association between the various demographic factors and the presence of migraine. This cross-sectional study was conducted in the ENT department of a tertiary care hospital in Puducherry. All patients aged more than 18 years old with the symptoms of allergic rhinitis were included in the study. The study was conducted six months, from July 2023 to December 2023. ARIA classification is used to determine the severity of the allergic rhinitis, and, per International criteria for headache, was used to diagnose migraine. A total of 282 patients with allergic rhinitis participated in the study. The mean age of the patients was found to be 38.89 ± 11.04 years. The prevalence of migraine among allergic rhinitis patients was found to be 69.1%-Economic status (39.4%). About 16.7% of the patients with diabetes were associated with migraine. The study showed a significant association between sex (p-0.006), age (p < 0.001), and socio-economic status (p-0.034) with the presence of migraine. The study also showed a significant association between the severity of allergic rhinitis and the presence of migraine (p-0.034) and the type of migraine (p-0.004). The study concludes that a significant proportion of the patients with allergic rhinitis were associated with migraine. So, clinicians should always screen for the presence of the migraine in all patients with allergic rhinitis to improve the patient's quality of life.
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Affiliation(s)
- Varunkumar J
- Department of Otorhinolaryngology, Sri Venkateswaraa Medical College Hospital and Research Insitute, Chennai, India
| | - Prem Davis
- ENT Division, Central University of TamilNadu, Thiruvarur, India
| | - T. Ramanathan
- Department of Otorhinolaryngology, SVMCH&RC, Ariyur, Puducherry, India
| | - V. Prabu
- Department of Otorhinolaryngology, SVMCH&RC, Ariyur, Puducherry, India
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John J, Savery N, Velayutham P, K M, Davis P. Evaluation of a Possible Association Between Severity of Allergic Rhinitis and the Level of Depression in Patients in a Tertiary Care Hospital in South India: A Cross-Sectional Study. Cureus 2023; 15:e39809. [PMID: 37398815 PMCID: PMC10313941 DOI: 10.7759/cureus.39809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Allergic rhinitis is one of the most common diseases in the world. It affects all people irrespective of age, sex and race. Allergic rhinitis leads to the development of social and interpersonal problems and loss of productivity which in turn causes depression. The depression was an underestimated iceberg phenomenon in allergic rhinitis patients. Objective The study evaluates the association between the severity of allergic rhinitis and the level of depression in patients attending tertiary care hospitals in south India. Methodology This cross-sectional study was conducted among 250 patients with allergic rhinitis. All the patients were subjected to the semi-structured questionnaire. And the severity of allergic rhinitis has been made based on the allergic rhinitis, and its impact on asthma classification and depression has been diagnosed and classified based on the Hamilton depression rating scale. And the association between allergic rhinitis and depression has been evaluated with the chi-square test. Results Two hundred fifty patients participated in the study, with a mean age of 33+/-2. Surprisingly the prevalence of depression among the allergic rhinitis patient was 88%. Most of them suffered from mild depression based on the Hamilton depression rating scale. A significant association was seen among allergic patients with age, gender, smoking status, locality, socioeconomic status, and co-morbidities. And the study shows the severity of allergic rhinitis is directly related to the severity of depression with a significant association. Conclusion Depression is one of the underestimated and under-treated problems in today's world. This study concludes that the severity of allergic rhinitis directly and significantly correlates with the severity of depression. The prevalence and intensity of depression should be evaluated and appropriately treated in patients with allergic rhinitis to improve the quality of life.
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Affiliation(s)
- Joemol John
- Otolaryngology - Head and Neck Surgery, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Nishanth Savery
- Otolaryngology - Head and Neck Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, IND
| | - Prabu Velayutham
- Otolaryngology - Head and Neck Surgery, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Mathan K
- Psychiatry, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Prem Davis
- Otolaryngology - Head and Neck Surgery, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
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Ralli M, Marinelli A, De-Giorgio F, Crescenzi D, Vincentiis MD, Greco A, Arcangeli A, Ercoli L. Prevalence of Otolaryngology Diseases in an Urban Homeless Population. Otolaryngol Head Neck Surg 2021; 166:1022-1027. [PMID: 34813392 DOI: 10.1177/01945998211060699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population. STUDY DESIGN Retrospective study. SETTING Primary health care facility. METHODS The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study. RESULTS A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported. CONCLUSIONS Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Primary Care Services, Eleemosynaria Apostolica, Vatican City State
| | - Alessia Marinelli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Arcangeli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Ercoli
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State.,Istituto di Medicina Solidale Onlus, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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Walanj S, Walanj A, Mohan V, Thakurdesai PA. Efficacy and safety of the topical use of intranasal cinnamon bark extract in seasonal allergic rhinitis patients: A double-blind placebo-controlled pilot study. J Herb Med 2014. [DOI: 10.1016/j.hermed.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Busse PJ, Kilaru K. Complexities of diagnosis and treatment of allergic respiratory disease in the elderly. Drugs Aging 2009; 26:1-22. [PMID: 19102511 DOI: 10.2165/0002512-200926010-00001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Atopic diseases such as rhinitis and asthma are relatively common in children and young adults. However, many patients aged >65 years are also affected by these disorders. Indeed, the literature suggests that between 3-12% and 4-13% of individuals in this age range have allergic rhinitis and asthma, respectively. However, these numbers are most likely underestimates because atopic diseases are frequently not considered in older patients. The diagnosis of both allergic rhinitis and asthma in older patients is more difficult than in younger patients because of a wide differential diagnosis of other diseases that can produce similar symptoms and must be excluded. Furthermore, treatment of these disorders is complicated by the potential for drug interactions, concern about the adverse effects of medications, in particular corticosteroids, and the lack of drug trials specifically targeting treatment of older patients with allergic rhinitis and asthma.
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Affiliation(s)
- Paula J Busse
- Division of Clinical Immunology, The Mount Sinai School of Medicine, New York, New York, USA.
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Abstract
OBJECTIVE To provide a succinct and updated discussion on common ear, nose, and throat (ENT) disorders encountered by primary care physicians. METHODS Review of recent and pertinent literature. RESULTS Recent data was identified via a PubMed search as well as commonly utilized texts in otolaryngology. DISCUSSION While it is impossible to discuss all of the ENT disorders encountered by primary care physicians, it is helpful to have a succinct resource to highlight the common disorders and their presenting signs, symptoms and initial treatments. CONCLUSION Recognizing specific signs and symptoms can help primary care physicians diagnose common ENT disorders. This review discusses these presentations and provides the initial management steps, as well as when to refer patients for further evaluation.
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Affiliation(s)
- Kevin S Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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Abstract
PURPOSE OF REVIEW The inter-relationship between allergy and nasal diseases has long been known. Failure to address when allergy is a contributing factor diminishes the possibility of a successful surgical intervention. Sublingual immunotherapy is recommended by the World Health Organization to treat allergic rhinitis and is widely used in Europe. Many clinical trials and rigorous meta-analysis support its efficacy. The criteria, however, for the integration of this treatment (with the surgical management of those allergic patients who suffer chronic nasal obstruction, severe drug-resistant hypertrophy and increase in glandular structures of the inferior turbinates) are not fully established. We review here the most recent literature on the efficacy and safety of sublingual immunotherapy. The purpose is to stimulate the use of complementary approaches by ear, nose and throat doctors and allergologists, and to improve the management of patients with persistent allergic rhinitis. RECENT FINDINGS In addition to the results of clinical trials, postmarketing surveillance has confirmed the high safety profile of sublingual immunotherapy in adults and children, its positive impact on the quality of life, and the reduction of the personal and social cost of allergy. Sublingual immunotherapy can prevent new allergic sensitizations and maintain its beneficial effect for years after its discontinuation. SUMMARY Sublingual immunotherapy is a highly efficacious and well tolerated form of immunotherapy for allergic rhinitis, and it is capable of interfering with disease progression. Sublingual immunotherapy should be integrated with surgical intervention to achieve optimal outcomes in allergic subjects with chronic nasal obstruction.
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Prenner BM, Schenkel E. Allergic rhinitis: treatment based on patient profiles. Am J Med 2006; 119:230-7. [PMID: 16490466 DOI: 10.1016/j.amjmed.2005.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 06/07/2005] [Indexed: 12/11/2022]
Abstract
Allergic rhinitis is a common medical condition characterized by nasal, throat, and ocular itching; rhinorrhea; sneezing; nasal congestion; and, less frequently, cough. The treatment of allergic rhinitis should control these symptoms without adversely affecting daily activities or cognitive performance and should prevent sequelae such as asthma exacerbation or sinusitis. This review describes a stepwise approach to treatment of allergic rhinitis derived from a synthesis of clinical trial results, patient preferences, and real-world tolerability data. Key clinical considerations include frequency and intensity of symptoms, patient age, comorbidities, compliance with treatment regimens (influenced by formulation, route and frequency of administration), and effects on quality of life. Oral second-generation antihistamines, versus first-generation agents and inhaled corticosteroids, should be considered first-line treatment because they provide rapid relief of most allergic rhinitis symptoms without safety and tolerability issues. Additional therapeutic agents can then be added or substituted based on individual symptom response.
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Affiliation(s)
- Bruce M Prenner
- Allergy Associates Medical Group, San Diego, Calif 92120, USA.
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Pleskow W, Grubbe R, Weiss S, Lutsky B. Efficacy and safety of an extended-release formulation of desloratadine and pseudoephedrine vs the individual components in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2005; 94:348-54. [PMID: 15801245 DOI: 10.1016/s1081-1206(10)60986-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antihistamine-decongestant combination products generally provide more benefit than individual components for adequately treating patients who have seasonal allergic rhinitis (SAR) with moderate-to-severe nasal congestion. OBJECTIVE To compare the effectiveness and safety of a 24-hour, extended-release formulation of desloratadine and pseudoephedrine with the individual components in patients who have SAR with moderate-to-severe nasal congestion. METHODS Patients with SAR and significant nasal congestion were enrolled in a multicenter, randomized, double-blind, double-dummy study. Patients were randomly assigned for 2 weeks to once-daily treatment with desloratadine-pseudoephedrine, 5/240-mg tablets; desloratadine, 5 mg; or pseudoephedrine, 240 mg. Primary efficacy variables for the antihistamine and decongestant components of desloratadine-pseudoephedrine were morning and evening reflective total symptom score (TSS), excluding nasal congestion, and morning and evening reflective nasal congestion score during the 2-week treatment period, respectively. Secondary variables included morning instantaneous (end-of-interval) TSS (excluding congestion), nasal congestion score, reflective morning and evening individual symptom scores, overall condition of SAR, and therapeutic response. RESULTS A total of 1121 patients were enrolled in the study, and 1047 patients completed the 2-week study. Desloratadine-pseudoephedrine was significantly more effective than desloratadine or pseudoephedrine monotherapy in reducing morning and evening reflective TSS (excluding nasal congestion) during the entire treatment period. Desloratadine-pseudoephedrine also was significantly more effective in reducing the morning and evening reflective nasal congestion score compared with desloratadine or pseudoephedrine monotherapy. Significant differences were seen between the desloratadine-pseudoephedrine and monotherapy groups for changes in morning instantaneous TSS (excluding nasal congestion) and nasal congestion scores. No unusual or unexpected adverse events were reported. CONCLUSION Desloratadine-pseudoephedrine, 5/240-mg once-daily tablets, provided additional benefit over desloratadine, 5 mg, or sustained-release pseudoephedrine, 240 mg, monotherapy in the treatment of patients with SAR and moderate-to-severe nasal congestion.
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Abstract
Perennial allergic rhinitis is an inflammatory disorder characterized by symptoms of nasal congestion, rhinorrhea, sneezing, and itching. The prevalence of allergic rhinitis is quite common and affects 20% or more of various populations. Some patients with allergic rhinitis are symptomatic only during the pollen season, while many others are allergic to multiple allergens including indoor allergens such as house dust mites, animal dander, cockroaches, and fungi, which lead to perennial symptoms. Immunoglobulin (Ig)-E is the proximate cause of perennial allergic rhinitis. Circulating IgE antibodies bind to the high affinity IgE receptor on mast cells and basophils. IgE antibodies, bound to the receptors crosslinked by allergen, initiate the secretion of inflammatory mediators including histamine, leukotrienes, and cytokines. These mediators can induce both acute and chronic changes that result in symptoms of allergy. Many therapies are approved for the treatment of allergic rhinitis including intranasal corticosteroids, antihistamines with or without decongestants, and nasal cromolyn sodium (sodium cromoglicate). Allergen avoidance is the mainstay of therapy for many patients but is not always practical. For those patients who have not responded to appropriate medications, allergen specific immunotherapy may also be effective.A number of studies with omalizumab have shown that it is effective in the treatment of seasonal allergic rhinitis induced by pollen such as ragweed and birch pollen. Omalizumab is a molecularly cloned humanized monoclonal antibody inhibiting human IgE. It binds specifically to the region of the IgE molecule that binds to the IgE receptor on the mast cell or basophils. Because omalizumab cannot bind IgE molecules that are already bound to the surface receptors on mast cells and basophils, it does not stimulate secretion of mediators from these cells. Omalizumab does not appear to stimulate an immune response against itself. It rapidly reduces free serum IgE levels by over 95% when administered at therapeutic doses and also results in the reduction of IgE receptors on mast cells and basophils. The combined effects of reduction of both free IgE in serum and the receptor density on the mast cells or basophils results in decreased allergen-stimulated mediator release. Preliminary studies in the treatment of perennial allergic rhinitis supports omalizumab's efficacy and safety. The compound has been well tolerated. Aside from urticarial reactions, adverse effects appear to be minimal. Omalizumab is the first of several new immune-based specifically targeted molecules that may prove to be extremely valuable in the treatment of perennial allergic rhinitis, as it is often unresponsive to traditional therapies.
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MESH Headings
- Antibodies, Anti-Idiotypic
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Humans
- Immunoglobulin E/physiology
- Omalizumab
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Perennial/therapy
- T-Lymphocytes/physiology
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Affiliation(s)
- Robert K Bush
- Department of Medicine, Allergy, and Immunology, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA.
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11
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Krouse JH, Stachler RJ, Shah A. Current in vivo and in vitro screens for inhalant allergy. Otolaryngol Clin North Am 2003; 36:855-68. [PMID: 14743777 DOI: 10.1016/s0030-6665(03)00061-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Screening for inhalant allergy requires the use of a rapid, accurate, cost-effective methodology for the detection of the presence or absence of allergic responsiveness. In vivo and in vitro methods have been demonstrated to be sensitive and specific in the diagnosis of inhalant allergy, even with panels as small as seven or eight antigens. There is good concurrence between skin testing techniques and various serum measures of specific IgE, and both methods can be used effectively for screening inhalant allergy, although per-test costs for in vitro methods remain higher than comparable costs for skin testing [28]. Although the rapidity of both methods is acceptable, skin testing allows immediate observation and interpretation of test results, whereas all in vitro methods involve serum processing that delays results for hours to days. In general, both in vitro methods and epicutaneous testing with a device such as the Multi-Test II offer the clinician effective techniques in screening for inhalant allergy. Each technique has benefit and can be used in both primary care practices and in specialists' offices. The choice of the primary technique to be used for screening depends on the type of practice, the practice's familiarity with skin testing, the geographic region, and the relevant payer mix. A review of the relevant research on allergy screening suggests that the number of antigens used should be in the range of 8 to 12 and should include representative allergens from all the significant classes for the specific geographic [table: see text] region. This screen would probably contain one or two grasses, weeds, and trees, two or three molds, cat allergen, and one dust mite allergen. A sample panel is demonstrated in Box 6. It is important to recognize that the diagnosis and treatment of inhalant allergy is a fluid process. In patients who have negative allergy screens but for whom suspicion of inhalant allergy remains high, additional testing with ID techniques is sometimes indicated. This procedure might be suggested in patients for whom there is a high suspicion of mold allergy or who have unusual inhalant exposures. These individuals may represent a failure of the screening process and require additional testing. In these unusual cases, the judgment of the otolaryngic allergist is critical in guiding this further diagnostic work-up. The use of screening procedures for the diagnosis of inhalant allergy provides a rapid, accurate, and cost-effective method for evaluating patients with a history suggestive of allergic disease. Research suggests that a screening panel has strong clinometric properties and has both sensitivity and specificity in excess of 95%. It is statistically unlikely that a patient with negative findings to an allergy screen will demonstrate clinically significant inhalant allergy.
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Affiliation(s)
- John H Krouse
- Department of Otolaryngology, Wayne State University, 540 East Canfield, 5E-UHC, Detroit, MI 48201, USA.
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12
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Abstract
Allergic rhinitis (AR) is a global health concern and shares a high comorbidity with asthma. Recent research suggests that different allergic diseases, such as AR, asthma, allergic conjunctivitis and chronic idiopathic urticaria (CIU), are evoked by common pathological mechanisms characterised by the release of histamine and other inflammatory mediators. Although H(1) receptor antagonists are the mainstay of therapy for allergic disease, the unacceptably high incidence of anticholinergic and CNS-related side effects of first-generation H(1) antagonists led to the search for improved second-generation H(1) antagonists. While many of these agents were largely devoid of CNS side effects, their tendency for drug-drug interactions (e.g., terfenadine and astemizole) resulted in an increased incidence of cardiotoxicity. Furthermore, second-generation H(1) antagonists exhibited weak anti-inflammatory properties and had no effect on nasal congestion. These observations emphasised the need for newer anti-allergic agents with a broader spectrum of activity and an improved safety profile. Among the newer H(1) antagonists currently in clinical development, desloratadine and mizolastine are the most widely studied. Both have a rapid onset of action, and desloratadine has demonstrated clinical efficacy in AR, CIU and seasonal asthma. Desloratadine has several advantages over other H(1) antagonists in that it has proven decongestant activity, a sparing effect on the use of bronchodilators (beta(2)-agonists) and a low potential for drug interactions. The broad anti-inflammatory properties of desloratadine and mizolastine, which distinguish these agents from other H(1) antagonists in clinical development (e.g., norastemizole and levocetirizine), suggest they may have a more profound impact on the underlying disease in patients suffering from different forms of allergy. The lack of clinical efficacy and safety data on rupatadine and HSR-609, both novel H(1) antagonists, precludes an accurate assessment of their potential for treating allergic disease. Epinastine and efletirizine are being developed exclusively for topical application and are unlikely to play a significant role in the management of allergic diseases as a whole.
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Affiliation(s)
- Luis M Salmun
- Schering-Plough Research Institute, 2000 Galloping Hill Rd., Building K-5, 2nd Floor, Mailstop B-2, Kenilworth, NJ 07033, USA.
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13
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Abstract
The prevalence of common allergic disorders such as asthma, allergic rhinitis, and atopic dermatitis has increased significantly in the past 30 years. The impact of these atopic diseases on the patient and the health care system is considerable: Allergic disorders are associated with a high degree of morbidity, which can profoundly impact patient quality of life and health care resource use. Existing strategies to treat allergic disorders beyond simple allergen avoidance focus on diminishing or eliminating the recurrent and/or persistent signs and symptoms that characterize the allergic response. A new strategy has been developed that uses antibodies directed against immunoglobulin E (IgE) to prevent it from binding to cells bearing its receptors and thus neutralizing the allergic response before it begins. These new agents reduce allergic responses in atopic individuals and improve their symptoms while reducing rescue medication and corticosteroid use in patients with allergic asthma or seasonal allergic rhinitis. Thus, anti-IgE antibodies represent proof that IgE plays a central role in allergic reactions and that anti-IgE therapy is a potentially effective treatment for allergic disease.
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Affiliation(s)
- A M Fendrick
- University of Michigan Medical Center, Division of General Medicine, Ann Arbor, MI 48109-0429, USA.
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14
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Abstract
The prevalence and differential diagnosis of rhinitis changes as we progress from birth to senescence. The heavy burden of allergic rhinitis is often overlooked in infants and disregarded in childhood and adolescence. In women, especially during pregnancy, hormonal changes can significantly affect nasal mucosal hyperreactivity and worsen ongoing syndromes. Various types of inflammatory and noninflammatory nonallergic rhinitides become more prevalent in the fifth decade and beyond. The burgeoning elderly population with irritant, atrophic, and medication-related rhinitis will constitute a greater proportion of our practices as the general population ages.
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Affiliation(s)
- J W Georgitis
- Piedmont Allergy and Asthma Associates, 1364 Westgate Center Drive, Winston-Salem, NC 27103, USA.
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Halpern LR, Martin RJ, Carter JB. Pharmacotherapeutics of Rhinosinusitis. Oral Maxillofac Surg Clin North Am 2001. [DOI: 10.1016/s1042-3699(20)30159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lane AP, Pine HS, Pillsbury HC. Allergy testing and immunotherapy in an academic otolaryngology practice: a 20-year review. Otolaryngol Head Neck Surg 2001; 124:9-15. [PMID: 11228445 DOI: 10.1067/mhn.2001.111602] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Allergic disease plays a central role in the clinical practice of otolaryngology. The purpose of this study was to review the 20-year experience of an allergy clinic integrated within an otolaryngology practice at a major academic institution. STUDY DESIGN We performed a retrospective database review of over 3300 otolaryngology patients referred for allergy skin testing between 1979 and 1999. RESULTS Approximately 80% of patients referred for allergy testing in our clinic had positive test results, of which 75.7% went on to undergo desensitization. The most common allergen was house dust, with allergies to mites, ragweed, and grass also prevalent. Among current allergy immunotherapy patients, 30.8% have undergone nasal septal, turbinate, and/or endoscopic sinus procedures in addition to allergy management. Nasal obstruction was the symptom most frequently persistent despite immunotherapy and the one most frequently reported to be improved by surgery. CONCLUSIONS The otolaryngologist-head and neck surgeon is uniquely qualified to perform comprehensive medical and surgical management for patients with complex disease processes involving a component of allergy. We believe that an integrated approach to allergy within an otolaryngology practice optimizes the treatment of such patients.
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Affiliation(s)
- A P Lane
- Division of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA
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Meltzer EO, Prenner BM, Nayak A. Efficacy and Tolerability of Once-Daily 5mg Desloratadine, an H1-Receptor Antagonist, in Patients with Seasonal Allergic Rhinitis. Clin Drug Investig 2001. [DOI: 10.2165/00044011-200121010-00004] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Simpson K, Jarvis B. Fexofenadine: a review of its use in the management of seasonal allergic rhinitis and chronic idiopathic urticaria. Drugs 2000; 59:301-21. [PMID: 10730552 DOI: 10.2165/00003495-200059020-00020] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED Fexofenadine, the active metabolite of terfenadine, is a selective histamine H1 receptor antagonist that does not cross the blood brain barrier and appears to display some anti-inflammatory properties. Fexofenadine is rapidly absorbed (onset of relief < or = 2 hours) and has a long duration of action, making it suitable for once daily administration. Clinical trials (< or = 2 weeks' duration) have shown fexofenadine 60 mg twice daily and 120 mg once daily to be as effective as loratadine 10 mg once daily, and fexofenadine 120 mg once daily to be as effective as cetirizine 10 mg once daily in the overall reduction of symptoms of seasonal allergic rhinitis. When given in combination, fexofenadine and extended release pseudoephedrine had complementary activity. Fexofenadine was effective in relieving the symptoms of sneezing, rhinorrhoea, itchy nose palate or throat, and itchy, watery, red eyes in patients with seasonal allergic rhinitis. There were often small improvements in nasal congestion that were further improved by pseudoephedrine. Fexofenadine produced greater improvements in quality of life than loratadine to an extent considered to be clinically meaningful, and enhanced patients' quality of life when added to pseudoephedrine treatment. Although no comparative data with other H1 antagonists exist, fexofenadine 180 mg once daily was effective in reducing the symptoms of chronic idiopathic urticaria for up to 6 weeks. Fexofenadine was well tolerated in clinical trials in adults and adolescents and the adverse event profile was similar to placebo in all studies. The most frequently reported adverse event during fexofenadine treatment was headache, which occurred with a similar incidence to that seen in placebo recipients. Fexofenadine does not inhibit cardiac K+ channels and is not associated with prolongation of the corrected QT interval. When given alone or in combination with erythromycin or ketoconazole, it was not associated with any adverse cardiac events in clinical trials. As it does not cross the blood brain barrier, fexofenadine is free of the sedative effects associated with first generation antihistamines, even at dosages of up to 240 mg/day. CONCLUSIONS fexofenadine is clinically effective in the treatment of seasonal allergic rhinitis and chronic idiopathic urticaria for which it is a suitable option for first-line therapy. Comparative data suggest that fexofenadine is as effective as loratadine or cetirizine in the treatment of seasonal allergic rhinitis. In those with excessive nasal congestion the combination of fexofenadine plus pseudoephedrine may be useful. In clinical trials fexofenadine is not associated with adverse cardiac or cognitive/psychomotor effects.
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Affiliation(s)
- K Simpson
- Adis International Limited, Mairangi Bay, Auckland, New Zealand.
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