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Carnovale C, Battini V, Gringeri M, Volonté M, Uboldi MC, Chiarenza A, Passalacqua G. Safety of fexofenadine and other second-generation oral antihistamines before and after the removal of the prescription requirement in Italy and other European countries: A real-world evidence study and systematic review. World Allergy Organ J 2022; 15:100658. [PMID: 35833202 PMCID: PMC9260294 DOI: 10.1016/j.waojou.2022.100658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/10/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, Università degli Studi di Milano, 20157, Italy
| | - Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, Università degli Studi di Milano, 20157, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, Università degli Studi di Milano, 20157, Italy
| | - Marina Volonté
- Scientific Affairs Department, Sanofi, Milan, Italy
- Corresponding author. Marina Volonté, Sanofi, Viale Bodio 37/B, 20158 Milan (MI), Italy,
| | | | - Andrea Chiarenza
- Pharmacovigilance and Safety Department, Sanofi Italia & Malta MCO, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
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2
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Tell me about your hay fever: a qualitative investigation of allergic rhinitis management from the perspective of the patient. NPJ Prim Care Respir Med 2018; 28:3. [PMID: 29362452 PMCID: PMC5780471 DOI: 10.1038/s41533-018-0071-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/09/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022] Open
Abstract
Allergic rhinitis (AR) is sub-optimally managed in the community and is responsible for a significant health and economic burden. Uncontrolled AR increases the risk of poorly controlled asthma and presents an increased susceptibility to thunderstorm asthma. With the availability of treatments over-the-counter, bypassing the health care professional (HCP), the role of the patient is paramount. Research on the role of the patient in AR management in the current environment is limited. This study aims to explore the patient perspective of AR management and understand why it is sub-optimally managed in the community. Patient perspectives of AR management were explored utilizing a qualitative, phenomenological approach. Adults with AR were included in the study and interviewed. Transcripts were analyzed for recurrent themes and emergent concepts. Forty-seven participants with AR were interviewed about their experiences. Patient reports of delayed diagnosis, treatment fatigue and confidence in the ability to manage their AR themselves, heavily influenced their management preferences. Patients also described barriers associated with AR management including financial expense as well as being mistaken for having an infectious disease. Patients described examples of the impact on their quality of life caused by their AR, yet they strongly believed they could manage it themselves. This belief that AR is a condition that should be entirely self-managed, contributes to its burden. It amplifies patients’ separation from HCPs and having access to guidelines aimed at optimizing their AR control. Healthcare professionals must engage fully with allergic rhinitis patients to optimize treatment and avoid issues triggered by constant self-care. Allergic rhinitis, or hay fever, can impact hugely on individuals’ health but remains poorly managed, partly because of the multiple medications available that allow people to bypass doctors and treat themselves. Biljana Cvetkovski at the University of Sydney, Australia, and co-workers, interviewed 47 adults with hay fever to analyze perceptions of the condition and its management. Many patients reported disenchantment with professional guidance for hay fever, often citing delayed diagnosis and endless tests leading to long-term ‘treatment fatigue’ and a loss of confidence in healthcare services. Patients often prefer self-treatment with limited medical help, repeatedly switching between medications and opting for ‘quick fixes’ rather than treating the chronic condition, with sometimes serious consequences.
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3
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Esteban CA, Klein RB, Kopel SJ, McQuaid EL, Fritz GK, Seifer R, York D, Golova N, Jandasek B, Koinis-Mitchell D. Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:75-81. [PMID: 24963455 DOI: 10.1089/ped.2014.0344] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/19/2014] [Indexed: 11/13/2022]
Abstract
Allergic rhinitis (AR) is a risk factor for the development of asthma, and if poorly controlled, it may exacerbate asthma. We sought to describe AR symptoms and treatment in a larger study about asthma, sleep, and school performance. We examined the proportion (1) who met criteria for AR in an urban sample of school children with persistent asthma symptoms, (2) whose caregivers stated that they were not told of their child's allergies, (3) who had AR but were not treated or were undertreated for the disease, as well as (4) caregivers and healthcare providers' perceptions of the child's allergy status compared with study assessment, and (5) associations between self-report of asthma and AR control over a 4-week monitoring period. One hundred sixty-six children with persistent asthma participated in a clinical evaluation of asthma and rhinitis, including allergy testing. Self-report of asthma control and rhinitis control using the Childhood Asthma Control Test (C-ACT) and Rhinitis Control Assessment Test (RCAT) were measured 1 month after the study clinic session. Persistent rhinitis symptoms were reported by 72% of participants; 54% of rhinitis symptoms were moderate in severity, though only 33% of the sample received adequate treatment. AR was newly diagnosed for 53% during the clinic evaluation. Only 15% reported using intranasal steroids. Participants with poorly controlled AR had poorer asthma control compared with those with well-controlled AR. This sample of urban school-aged children with persistent asthma had underdiagnosed and undertreated AR. Healthcare providers and caregivers in urban settings need additional education about the role of allergies in asthma, recognition of AR symptoms, and AR's essential function in the comanagement of asthma. Barriers to linkages with allergy specialists need to be identified.
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Affiliation(s)
- Cynthia A Esteban
- Division of Pediatric Allergy and Immunology, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Robert B Klein
- Division of Pediatric Allergy and Immunology, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Sheryl J Kopel
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Gregory K Fritz
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Ronald Seifer
- Division of Child and Adolescent Psychiatry, E.P. Bradley Hospital , Providence, Rhode Island
| | - Daniel York
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Natalie Golova
- Division of General Pediatrics and Community Health, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Barbara Jandasek
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Division of Child and Adolescent Psychiatry, Warren Alpert Medical School of Brown University , Rhode Island Hospital, Providence, Rhode Island
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4
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Gentile D, Bartholow A, Valovirta E, Scadding G, Skoner D. Current and future directions in pediatric allergic rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:214-26; quiz 227. [PMID: 24565478 DOI: 10.1016/j.jaip.2013.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/22/2013] [Accepted: 03/23/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications. OBJECTIVE The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR. METHODS Literature reviews in each of these areas were conducted, and the results were incorporated. RESULTS The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy. CONCLUSIONS In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.
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Affiliation(s)
- Deborah Gentile
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa
| | - Ashton Bartholow
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa
| | | | - Glenis Scadding
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - David Skoner
- Division of Allergy, Asthma and Immunology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pa.
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Abstract
BACKGROUND Allergy affects about 50% of the pediatric population globally. Allergic rhinitis (AR), one form of allergy, causes considerable impairment in quality of life, including disruption of sleep and, in children, interference with school attendance and performance. SCOPE Traditional formulations and delivery systems - tablets, capsules, or intranasal sprays - successfully used by adults for treatment of AR may not be as easily administered in children. Liquid oral medications are more readily taken by children but contain sugars and excipients; they can also be inconvenient with less accurate dosing and are associated with dental caries and gastrointestinal upset. METHODOLOGY This review evaluated medications for treatment of AR currently available for pediatric patients and identified the attitudes of parents and health care professionals toward these medications. Guidelines from international organizations and governmental websites were reviewed for recommendations and product labeling requirements. A Medline search was conducted using the terms dyes, excipients, palatability, prescribing habits, sugar, among others. FINDINGS In recent years, governmental regulatory agencies and professional organizations in Europe and the United States have recommended avoidance of sugar in pediatric medicines and required stricter labeling of their ingredients. Public awareness about the adverse effects of sugar and some excipients has also increased, and parents more frequently express the desire for safer and more convenient medicines for their children. In response, more sugar-free, dye-free liquid medicines and other formulations, such as granules, filmstrips, chewable tablets, fast-dissolving tablets, and drops, are becoming available for pediatric use. LIMITATIONS Data from well-designed trials conducted in children for the treatment of AR are lacking. In addition, the possibility of a social response bias may exist for parents and physicians about sugar and other ingredients in children's medications. CONCLUSION Treatment for AR is often long-term, particularly in persistent AR; therefore, safety, tolerability, convenience, and patient/parental acceptance are important considerations when deciding which medication to prescribe.
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Affiliation(s)
- Glenis Scadding
- Royal National Throat Nose & Ear Hospital, London WC1X 8DA, UK.
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6
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Abstract
UNLABELLED Allergic rhinitis is more than just sneezing and an itchy nose. Complications of this disease are numerous and can have a significant impact, both mentally and physically. That is why it is important not only to detect, investigate and treat allergic rhinitis but also to actively identify potential complications. Mental functions such as learning, sleep and activity levels can deteriorate, and the eustachian tubes, sinuses and airway functions can be affected. Otitis, sinusitis and asthma are overrepresented among individuals who suffer from allergic rhinitis. This article highlights how allergic rhinitis can affect cognitive functions, and what consequences this can have on school performance, work and quality of life. CONCLUSION Health professionals and school personnel need to increase their awareness of the ramifications of this disease and actively work to prevent deterioration in both academic achievement and workplace productivity.
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MESH Headings
- Adolescent
- Athletic Performance
- Child
- Child Behavior Disorders/etiology
- Child, Preschool
- Cognition Disorders/etiology
- Educational Status
- Efficiency
- Guidelines as Topic
- Histamine Antagonists/adverse effects
- Humans
- Medication Adherence/psychology
- Quality of Life
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/drug therapy
- Schools
- Severity of Illness Index
- Sleep Wake Disorders/etiology
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Affiliation(s)
- Magnus P Borres
- Department of Pediatrics, Sahlgrenska Academy of Göteborg University, Göteborg, Sweden.
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7
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Meltzer EO. Allergic rhinitis: the impact of discordant perspectives of patient and physician on treatment decisions. Clin Ther 2007; 29:1428-40. [PMID: 17825694 DOI: 10.1016/j.clinthera.2007.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND A wealth of literature is available that documents the effects of inadequately controlled allergic rhinitis (AR) on patients' daily activities, including impaired sleep, reduced cognitive functioning, and interference with sport and leisure activities. However, despite its high prevalence and significant impact on health-related quality of life (HRQOL) and productivity, AR may be undertreated. This might arise, in part, from the low priority given to the disease by physicians. OBJECTIVE This article aims to assess the existence of disparities between the attitudes of patients and physicians to AR, and to comment on the impact these disparities may have on treatment choices. METHODS A search was conducted of MEDLINE (1990-2006) and data presented at recent congresses (The 25th Congress of the European Academy of Allergology and Clinical Immunology, June 10-14, 2006, Vienna, Austria, and the 62nd Annual American Academy of Allergy, Asthma and Immunology Meeting, March 3-7, 2006, Miami Beach, Florida) for articles that contained combinations of the terms allergic rhinitis, patient, physician, perspective, attitude, opinion, experience, or burden. Appropriate articles were selected for review in combination with data from a recent Adelphi Group Products (New York, New York) survey. RESULTS A study of the impact of seasonal AR on HRQOL found that adolescent patients (n = 83) scored practical problems higher in terms of importance. AR was found to affect the home and social life of > or =33% of patients in a study from the United Kingdom. A European survey of 1494 patients with AR found that nasal congestion was the most common moderate or severe nasal symptom (55%) and that 44% of patients suffered moderate or severe ocular symptoms. A Danish study of adults and adolescents found that AR was undiagnosed in 32% of patients. In a study of 100 physicians in the United States, approximately 30% of physicians under-estimated the severity of AR and its impact on patients' work or school activities. Furthermore, 1 study indicated that approximately 99% of physicians did not issue adequate treatment, although no study was found that directly linked physicians' perspectives of AR and their treatment decisions to date. CONCLUSIONS In a review of the existing literature, evidence of disparities between patients' and physicians' perspectives of AR were found, although no studies linked perspectives to prescribing behavior; therefore, research into the impact on treatment decisions might be warranted. In the future, the patient-physician dialogue might be improved by a standardized questionnaire designed to identify the most bothersome symptoms of a patient's disease, so that the most appropriate treatments can be selected to maximize quality of life.
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Affiliation(s)
- Eli O Meltzer
- Allergy & Asthma Medical Group and Research Center, San Diego, California 92123, USA.
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8
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Marple BF, Fornadley JA, Patel AA, Fineman SM, Fromer L, Krouse JH, Lanier BQ, Penna P. Keys to successful management of patients with allergic rhinitis: focus on patient confidence, compliance, and satisfaction. Otolaryngol Head Neck Surg 2007; 136:S107-24. [PMID: 17512862 DOI: 10.1016/j.otohns.2007.02.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 02/20/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The American Academy of Otolaryngic Allergy (AAOA) convened an expert, multidisciplinary Working Group on Allergic Rhinitis to discuss patients' self-treatment behaviors and how health care providers approach and treat the condition. PROCEDURES AND DATA SOURCES: Co-moderators, who were chosen by the AAOA Board of Directors, were responsible for initial agenda development and selection of presenters and participants, based on their expertise in diagnosis and treatment of allergic rhinitis. Each presenter performed a literature search from which a presentation was developed, portions of which were utilized in developing this review article. SUMMARY OF FINDINGS Allergic rhinitis is a common chronic condition that has a significant negative impact on general health, co-morbid illnesses, productivity, and quality of life. Treatment of allergic rhinitis includes avoidance of allergens, immunotherapy, and/or pharmacotherapy (ie, antihistamines, decongestants, corticosteroids, mast cell stabilizers, anti-leukotriene agents, anticholinergics). Despite abundant treatment options, 60% of all allergic rhinitis patients in an Asthma and Allergy Foundation of America survey responded that they are "very interested" in finding a new medication and 25% are "constantly" trying different medications to find one that "works." Those who were dissatisfied also said their health care provider does not understand their allergy treatment needs and does not take their allergy symptoms seriously. Dissatisfaction leads to decreased compliance and an increased reliance on multiple agents and over-the-counter products. Furthermore, a lack of effective communication between health care provider and patient leads to poor disease control, noncompliance, and unhappiness in a significant portion of patients. CONCLUSIONS Health care providers must gain a greater understanding of patient expectations to increase medication compliance and patient satisfaction and confidence.
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Affiliation(s)
- Bradley F Marple
- University of Texas Southwestern Medical School, Dallas, TX 75390-7208, USA.
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9
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Abstract
OBJECTIVE Because the Sydney Olympic Games were being held in the spring, we wished to examine the prevalence of allergic disorders in the Australian Olympic and Paralympic athletes and to examine patterns of allergic reactivity and medication use for the treatment of allergic symptoms. DESIGN A survey case series of Australian Olympic and Paralympic athletes. SETTING Screening was conducted on team processing days. PARTICIPANTS Prospective members of the Australian Olympic and Paralympic teams. INTERVENTION A questionnaire seeking information on the presence of allergic disorders, symptoms, family history, and medication use was administered. Skin-prick tests (SPT) for sensitivity to common aeroallergens was performed. OUTCOME MEASURES Athletes were classified as atopic or non-atopic, and patterns of reactivity were examined according to sporting category. RESULTS Of the athletes, 56% had a positive SPT to at least 1 allergen, with 34% reacting to at least 1 seasonal allergen. There was no significant association between skin test reactivity and sporting category. Of the athletes, 37% had allergic rhinoconjunctivitis (AR/C), whereas 24% had seasonal allergic rhinoconjunctivitis (SAR/C). Approximately one-third of all those with AR/C had a history of asthma, whereas approximately one-fifth had a history of atopic dermatitis. Swimmers were most likely to have asthma, AR/C, and positive skin tests to any allergen. Very few athletes with self-reported AR/C took any medication to relieve their symptoms. CONCLUSIONS Allergic disorders are common among athletes from all sports. The known impact of AR/C on quality of life necessitates that it be screened for and managed appropriately.
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Affiliation(s)
- Constance H Katelaris
- Department of Clinical Immunology and Allergy, Westmead Hospital, Sydney, Australia.
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10
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LaForce CF, Corren J, Wheeler WJ, Berger WE. Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients who remain symptomatic after treatment with fexofenadine. Ann Allergy Asthma Immunol 2004; 93:154-9. [PMID: 15328675 DOI: 10.1016/s1081-1206(10)61468-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Currently available oral second-generation antihistamines do not provide adequate symptom relief for many allergy patients. OBJECTIVE To determine the ability of azelastine nasal spray to improve rhinitis symptoms in patients with seasonal allergic rhinitis who remained symptomatic after treatment with fexofenadine. METHODS This was a multicenter, randomized, double-blind, placebo-controlled, 2-week study in patients with moderate-to-severe seasonal allergic rhinitis. The study began with a 1-week, open-label lead-in period, during which patients received fexofenadine, 60 mg twice daily. Patients who improved less than 25% to 33% with fexofenadine were randomized to treatment with (1) azelastine nasal spray, 2 sprays per nostril twice daily; (2) azelastine nasal spray, 2 sprays per nostril twice daily, plus fexofenadine, 60 mg twice daily; or (3) placebo (saline) nasal spray and placebo capsules twice daily. The primary efficacy variable was the change from baseline to day 14 in the total nasal symptom score (TNSS), consisting of runny nose, sneezing, itchy nose, and nasal congestion symptom scores. RESULTS A total of 334 patients who remained symptomatic after treatment with fexofenadine were included in the efficacy analysis. After 2 weeks of treatment, azelastine nasal spray (P = .007) and azelastine nasal spray plus fexofenadine (P = .003) significantly improved the TNSS compared with placebo. Azelastine nasal spray monotherapy was as effective as the combination of azelastine nasal spray plus fexofenadine as measured by the TNSS and individual symptoms of the TNSS. CONCLUSIONS Azelastine nasal spray is effective monotherapy for patients who remain symptomatic after treatment with fexofenadine and should be considered in the initial management of patients with seasonal allergic rhinitis.
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Affiliation(s)
- Craig F LaForce
- Carolina Allergy and Asthma Consultants, Raleigh, North Carolina 27607, USA.
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11
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Abstract
BACKGROUND There has been a world-wide increase in the prevalence of atopic diseases. These atopic diseases, including asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis, are common in childhood and create a challenge of management for physicians and parents. METHODS MEDLINE was searched for articles related to atopy, allergy asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis. RESULTS AND CONCLUSIONS The conditions of asthma, allergic rhinoconjunctivitis and atopic eczema/dermatitis cause very significant burdens regarding the discomfort to the affected individual, management problems for the parent and physician and the economic cost to the family and the nation.
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MESH Headings
- Asthma/complications
- Asthma/economics
- Asthma/epidemiology
- Child
- Conjunctivitis, Allergic/complications
- Conjunctivitis, Allergic/economics
- Conjunctivitis, Allergic/epidemiology
- Cost of Illness
- Dermatitis, Atopic/complications
- Dermatitis, Atopic/economics
- Dermatitis, Atopic/epidemiology
- Humans
- Prevalence
- Quality of Life
- Respiratory Hypersensitivity/complications
- Respiratory Hypersensitivity/economics
- Respiratory Hypersensitivity/epidemiology
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/economics
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/economics
- Rhinitis, Allergic, Seasonal/epidemiology
- United States/epidemiology
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12
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Abstract
The majority of individuals with asthma have mild disease, often in conjunction with allergic rhinitis and exercise-induced bronchoconstriction (EIB). Although health-related quality-of-life (HRQoL) is reduced in moderate to severe asthma and allergic rhinitis, little is known about the effect of mild asthma, mild allergic rhinitis, and EIB on HRQoL outcomes. The objective of this study was to determine the effect of mild asthma, allergic rhinitis, and EIB on HRQoL. A cross-sectional study was conducted of 160 adolescent athletes participating in a screening program to detect EIB. Generic HRQoL was assessed with the teen version of the pediatric quality-of-life inventory (PedsQL). Prior diagnoses of asthma, allergic rhinitis, and EIB, and current symptoms of dyspnea during exercise and asthma, were recorded. Lung function and the presence of EIB were determined by spirometry before and after an exercise challenge test. Adolescent athletes with a prior physician diagnosis of asthma had a lower HRQoL scale summary score (P<0.01) and lower physical functioning, emotional functioning, and school functioning domain scores (P values, 0.01-0.02) in comparison to adolescent athletes with no prior diagnosis of these disorders. Athletes with a prior diagnosis of asthma reported dyspnea during exercise more frequently than did those without asthma (P<0.001). Adolescent athletes with dyspnea during exercise had a lower scale summary score, and lower physical functioning, general well-being, and emotional functioning domain scores (P values, 0.02-0.03). These data show that mild asthma and dyspnea without asthma significantly affect HRQoL. Symptoms of dyspnea during exercise are common in asthma and are associated with lower HRQoL. The clinical significance of these differences in HRQoL is unclear.
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Affiliation(s)
- Teal S Hallstrand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington 98195-6522, USA.
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13
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Berger WE, White MV. Efficacy of azelastine nasal spray in patients with an unsatisfactory response to loratadine. Ann Allergy Asthma Immunol 2003; 91:205-11. [PMID: 12952117 DOI: 10.1016/s1081-1206(10)62179-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of azelastine nasal spray, desloratadine, and the combination of azelastine nasal spray plus loratadine compared with placebo in patients with seasonal allergic rhinitis who had an unsatisfactory response to loratadine. METHODS This was a 2-week, multicenter, placebo-controlled, randomized, double-blind study in patients with moderate-to-severe symptoms of seasonal allergic rhinitis. Following a 1-week, open-label lead-in period, during which the patients received loratadine 10 mg daily, those patients who met the symptom qualification criteria (<25% to 33% improvement taking loratadine) were randomized to treatment with azelastine nasal spray 2 sprays per nostril, twice daily, azelastine nasal spray 2 sprays per nostril, twice daily, plus loratadine 10 mg daily, desloratadine 5 mg daily plus placebo (saline) nasal spray, or placebo (saline) nasal spray/placebo capsules. The primary efficacy variable was the change from baseline to day 14 in the total nasal symptom score, consisting of runny nose, sneezing, itchy nose, and nasal congestion symptom scores recorded twice daily (AM and PM) in patient diary cards. RESULTS A total of 428 patients with an unsatisfactory response to loratadine completed the double-blind treatment period. After 2 weeks of treatment, azelastine nasal spray (P < 0.001), azelastine nasal spray plus loratadine (P < 0.001), and desloratadine (P = 0.039) significantly improved the total nasal symptom score compared with placebo. CONCLUSIONS Azelastine nasal spray is an effective treatment for patients with seasonal allergic rhinitis who do not respond to loratadine and is an alternative to switching to another oral antihistamine or to using multiple antihistamines.
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Affiliation(s)
- William E Berger
- Southern California Research Center, Mission Viejo, California 92691, USA.
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14
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Borres MP, Abrahamsson G, Andersson B, Andersson B, Bråkenhielm G, Fabricius T, Hååg C, Rinné-Ljungkvist L, Foucard T. Asthma and allergies at school--a Swedish national position paper. Allergy 2002; 57:454-7. [PMID: 11972488 DOI: 10.1034/j.1398-9995.2002.13650.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The marked rise in allergies during the past decade has been increasingly perceptible for school personnel. A quarter of Swedish parents of children with allergies are unsatisfied with the school environment and how the schools are organized around their children. The Association of School Physicians has, together with six other medical, teaching and patient organizations, developed written guidelines for the management of asthma and allergies in Swedish schools. The aim was to regulate the responsibility of the school and its personnel for students with asthma and allergies, and to strengthen safety arrangements within schools. A secondary aim was to describe how the curriculum, teaching equipment, excursions, and other school activities, could be arranged appropriately and safely for students with asthma and allergies. Five-hundred copies of the document were circulated to all of Sweden's municipalities, county councils and pediatric departments. There was general agreement regarding the schools' responsibility that no child should risk becoming ill or having exacerbation of symptoms due to conditions at school. Recommendations regarding smoking on school premises and the use of perfumes were criticised. The strength of this document is that all organizations actively involved with schools have agreed upon these recommendations. This document serves to suggest a minimum level of activities thus ensuring that even students with asthma and allergies will receive appropriate schooling.
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Affiliation(s)
- M P Borres
- Department of Pediatrics, Falun Hospital, SE 791 82 Falun, Sweden
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15
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Abstract
OBJECTIVE This article presents information about the economic burden of allergic rhinitis and its effect on quality of life. After reading this article, readers should have a greater awareness of the economic impact of this disease and how important it is for both patient and society to diagnose and treat it properly. DATA SOURCES Relevant and appropriately controlled clinical studies, data compiled from surveys and patient questionnaires, and studies of direct and indirect costs associated with allergic rhinitis were used. Only literature in the English language was reviewed. STUDY SELECTION Material was taken from academic/scholarly journals and appropriate reviews. RESULTS Allergic rhinitis occurs in approximately 20% of the general population in the United States. In recent years, its economic impact has increased, with spending for direct and indirect medical costs estimated between 1.5 and $2 billion a year. In addition to its financial burden, however, allergic rhinitis exacts a considerable toll on patients' quality of life, cognitive and learning functions, decision-making, and self-perception. Low energy levels associated with allergic rhinitis can lead to impairments of both memory and decision-making abilities. CONCLUSIONS Effective treatment and greater understanding on the part of both physicians and patients can help to reduce direct and indirect costs as well as to lessen the impact of allergic rhinitis on quality of life for both patient and society.
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Affiliation(s)
- Stanley M Fineman
- Emory University School of Medicine, Atlanta Allergy and Asthma Clinic, Marietta, Georgia 30060-7290, USA.
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16
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Hesselmar B, Aberg B, Eriksson B, Aberg N. Allergic rhinoconjunctivitis, eczema, and sensitization in two areas with differing climates. Pediatr Allergy Immunol 2001; 12:208-15. [PMID: 11555318 DOI: 10.1034/j.1399-3038.2001.012004208.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this 5-year follow-up study we compared the prevalence of allergic rhinoconjunctivitis, eczema, and sensitization, in relation to several background factors, in two Swedish regions (Göteborg and Kiruna). In Göteborg, a city on the southwest coast, the climate is mild and humid. Kiruna is a town north of the Arctic Circle. Questionnaire replies and results of interviews were collected from all 412 7-8-year-old children of a population-based sample (203 in Göteborg and 209 in Kiruna); in addition, 192 children from Göteborg and 205 from Kiruna were skin-prick tested for sensitization to common aero-allergens. After 5 years, at 12-13 years of age, almost all of the initial study cohort were re-investigated. At follow-up the prevalence of allergic rhinoconjunctivitis was 17%, eczema 23%, and sensitization 32%. Allergic rhinoconjunctivitis and eczema were as common in Göteborg as in Kiruna, whereas sensitization was far more common in Kiruna. Children born during the pollen season had allergic rhinoconjunctivitis less often -- and were sensitized to pollen and animal protein less often -- than those born during the rest of the year. Sensitization to birch pollen, cat protein, and horse protein was less common in children living in Göteborg, the region with the highest frequency of cat ownership and horseback riding, and with the longest birch-pollen season. The girls were more commonly horseback riders but the boys were more often sensitized to horses. The results reinforce our previous findings: indoor climate may affect the development of sensitization and allergic diseases, to some extent independently; and if exposure to antigen is unavoidable, high doses might be better than low doses.
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Affiliation(s)
- B Hesselmar
- Department of Paediatrics, University of Göteborg, Sweden.
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17
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Nascimento Silva M, Naspitz C, Solé D. Evaluation of quality of life in children and teenagers with allergic rhinitis: adaptation and validation of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Allergol Immunopathol (Madr) 2001; 29:111-8. [PMID: 11674923 DOI: 10.1016/s0301-0546(01)79042-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND in the last decades, the study on life quality has stimulated an increasing interest among health researchers. Instruments to evaluate the chronic disease impact on patients day-by-day, have been developed and published by researchers in many countries. The objective of this study was to adapt to the Portuguese Language (Brazilian culture), the RQLQ questionnaire (Rhinoconjunctivitis Quality of Life Questionnaire), destined for life quality evaluation in teenagers with allergic rhinitis. METHODS in the beginning of the study, a list with 75 items, translated from the original article, was applied to 57 teenagers with perennial allergic rhinitis. The most frequent and troublesome items were selected to compose the modified questionnaire. The validation, reproducibility and responsiveness of the new instrument were evaluated through an interview with 52 patients before the beginning of the treatment, and of 2 and 4 weeks after the treatment. The obtained scores in these interviews were statistically analyzed to verify the questionnaire capacity to detect clinical improvement after the treatment. RESULTS a significant difference was observed between the total score and those regarding domains, obtained at the first evaluation, compared to later evaluations. A positive correlation was also observed during the treatment, between the questionnaire score and the patient grades related to nasal symptom severity. CONCLUSIONS the adapted questionnaire is reproducible, valid to be used in longitudinal studies and useful as an instrument of evaluation, but it should be submitted to other investigations to consolidate its properties.
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Affiliation(s)
- M Nascimento Silva
- Division of Allergy, Department of Pediatrics, Federal University of So Paulo-Escola Paulista de Medicina (UNIFESP-EPM) So Paulo, SP, Brazil
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18
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Abstract
OBJECTIVE This review will furnish the reader current information on the importance of quality of life evaluation in patients suffering from allergic rhinitis, the different types of quality of life instruments used, and how they can be used in judging different pharmaceutical therapies. DATA SOURCES Computer-assisted MEDLINE searches for articles assessing "quality of life" and "outcomes" in rhinitis. Also MEDLINE searches evaluating health-related quality of life in relationship to different pharmacologic treatments in allergic rhinitis. STUDY SELECTIONS Pertinent abstracts and articles in two broad areas were selected. The first groups were articles in the fields of outcomes, quality of life, allergic rhinitis, and its relationship to health-related quality of life. The second group of articles evaluated different pharmacologic agents' effect on the health-related quality of life of rhinitis patients. Both sets of articles were critically analyzed with important representative studies selected for this review. RESULTS Health-related quality of life of patients with allergic rhinitis is impaired as measured by both generic and specific health-related quality of life instruments. Use of second generation antihistamines, intranasal corticosteroids, and intranasal ipratropium bromide have been shown to improve the health-related quality of life of sufferers of allergic rhinitis. CONCLUSIONS The measuring of health-related quality of life is assuming a primary position in outcomes analysis in the patient with allergic rhinitis. Studies have documented the validity of using generic and specific health-related quality of life instruments in allergic rhinitis. Each type has its own weaknesses and strengths that the user needs to appreciate. Appraising the role of different pharmacologic agents in allergic rhinitis in improving the patient's quality of life is an important part of proving the medication's worth to the health care community.
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Affiliation(s)
- M S Blaiss
- Division of Clinical Immunology, University of Tennessee, Memphis, USA.
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