1
|
Li H, Di C, Xie Y, Bai Y, Liu Y. Therapeutic potential of the topical recombinant human interleukin-1 receptor antagonist in guinea pigs with allergic rhinitis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:36. [PMID: 38835041 DOI: 10.1186/s13223-024-00893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/20/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Recombinant human Interleukin receptor antagonist (rhIL-Ra) can bind to the IL-1 receptor on the cell membrane and reversibly blocks the proinflammatory signaling pathway. However, its effect on allergic rhinitis (AR) and the underlying mechanism remains unknown. This study aims to investigate the efficacy of recombinant human interleukin-1 receptor antagonist (rhIL-1Ra) on AR guinea pigs. METHODS Guinea pigs were systemically sensitized by intraperitoneal injection and topical intranasal instillation with ovalbumin within 21 days. Animals administrated with saline served as the normal control. The AR animals were randomly divided into the model group and distinct concentrations of rhIL-1Ra and budesonide treatment groups. IL-1β and ovalbumin specific IgE levels were detected by ELISA kits. Nasal mucosa tissues were stained with hematoxylin & eosin (HE) for histological examination. RESULTS It was found that the numbers of sneezing and nose rubbing were remarkably reduced in rhIL-1Ra and budesonide-treated guinea pigs. Besides, rhIL-1Ra distinctly alleviated IgE levels in serum and IL-1β levels in nasal mucus, together with decreased exfoliation of epithelial cells, eosinophilic infiltration, tissue edema and vascular dilatation. CONCLUSIONS rhIL-1Ra is effective in AR guinea pigs and may provide a novel potential choice for AR treatments.
Collapse
Affiliation(s)
- Haibing Li
- Department of Pharmacy, Yingtan 184 Hospital, Yingtan, 335000, Jiangxi, China
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, No. 27, Taiping Rd., Haidian District, Beijing, 100850, China
| | - Chanjuan Di
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, No. 27, Taiping Rd., Haidian District, Beijing, 100850, China
| | - Yanbing Xie
- Department of Pharmacy, Yingtan 184 Hospital, Yingtan, 335000, Jiangxi, China
| | - Yuexia Bai
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, No. 27, Taiping Rd., Haidian District, Beijing, 100850, China
- Department of Pathology, Qilu Children's Hospital of Shandong University, Shandong, 250022, China
| | - Yongxue Liu
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, No. 27, Taiping Rd., Haidian District, Beijing, 100850, China.
| |
Collapse
|
2
|
Wu FM, Ulloa R, Badash I, Hur K. Geographic Variation in Otolaryngologist Intranasal Steroid Prescribing Patterns Among Medicare Beneficiaries. Ann Otol Rhinol Laryngol 2023; 132:126-132. [PMID: 35176893 DOI: 10.1177/00034894221079094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intranasal corticosteroids (INCS) are a commonly prescribed medication to treat various rhinological conditions. However, no prior studies have looked at factors and patterns that influence the rates of INCS prescriptions among Medicare beneficiaries in the United States. OBJECTIVE This study aims to describe the patterns of INCS prescriptions by otolaryngologists for Medicare beneficiaries in the United States between 2013 and 2017. METHODS Data on the most common INCS prescriptions by otolaryngologists for Medicare beneficiaries were obtained from the 2013 to 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) and the Part D Public Use Files from the Centers for Medicare and Medicaid Services (CMS). INCS prescriptions were analyzed by cost, state, provider, and regional temperature. State temperature data was collected through the National Centers for Environmental Information. RESULTS From 2013 to 2017, the total claims per beneficiary for fluticasone, mometasone, and triamcinolone combined increased from 2.31 to 2.39. Combined cost/beneficiary was similar for mometasone and triamcinolone at 102.47 and 103.60 respectively, while it was much lower for fluticasone at 39.12. There was a strong correlation between otolaryngology providers per beneficiary in each state and total claims per state with a correlation coefficient of .79. Additionally, comparing the average state temperature to the claims/beneficiary yielded a moderately strong correlation coefficient of .44, suggesting that temperature was a possible factor for INCS prescription patterns. CONCLUSIONS INCS prescriptions by otolaryngologists and the number of INCS beneficiaries have increased between 2013 and 2017. Over the same time period, the costs of fluticasone and triamcinolone have decreased while the cost of mometasone increased. Total providers by state correlated with claims per state. Additionally, average annual temperature was positively correlated with INCS claims per beneficiary in each state.
Collapse
Affiliation(s)
- Franklin M Wu
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ruben Ulloa
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ido Badash
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
3
|
Ramot Y, Rottenberg Y, Domb AJ, Kubek MJ, Williams KD, Nyska A. Preclinical In-Vivo Safety of a Novel Thyrotropin-Releasing Hormone-Loaded Biodegradable Nanoparticles After Intranasal Administration in Rats and Primates. Int J Toxicol 2023:10915818231152613. [PMID: 36634266 DOI: 10.1177/10915818231152613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thyrotropin-releasing hormone (TRH) and TRH-like peptides carry a therapeutic potential for neurological conditions. Nanoparticles (NP) made of the biodegradable polymer, Poly(Sebacic Anhydride) (PSA), have been developed to carry TRH, intended for intranasal administration to patients. There is limited information on the safety of biodegradable polymers when given intranasally, and therefore, we have performed two preclinical safety and toxicity studies in cynomolgus monkeys and rats using TRH-PSA nanoparticles. The rats and monkeys were dosed intranasally for 42 days or 28 days, respectively, and several animals were followed for additional 14 days. Animals received either placebo, vehicle (PSA), or different concentrations of TRH-PSA. No systemic adverse effects were seen. Changes in T3 or T4 concentrations were observed in some TRH-PSA-treated animals, which did not have clinical or microscopic correlates. No effect was seen on TSH or prolactin concentrations. In the monkey study, microscopic changes in the nasal turbinates were observed, which were attributed to incidental mechanical trauma caused during administration. Taken together, the TRH-loaded PSA NPs have proven to be safe, with no local or systemic adverse effects attributed to the drug loaded nanoparticles. These findings provide additional support to the growing evidence of the safety of peptide-loaded NPs for intranasal delivery and pave the way for future clinical trials in humans.
Collapse
Affiliation(s)
- Yuval Ramot
- Faculty of Medicine, 54621Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Dermatology, 58884Hadassah Medical Center, Jerusalem, Israel
| | - Yakir Rottenberg
- Faculty of Medicine, 54621Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Oncology, Hadassah Medical Organization, Jerusalem, Israel
| | - Abraham J Domb
- School of Pharmacy-Faculty of Medicine, 54621The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael J Kubek
- 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin D Williams
- Consultant in Toxicology, WKM Consulting, LLC, Waunakee, WI, USA
| | - Abraham Nyska
- Consultant in Toxicologic Pathology, 26745Tel Aviv and Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Rollema C, van Roon EN, van Boven JFM, Hagedoorn P, Klemmeier T, Kocks JH, Metting EI, Oude Elberink HNG, Peters TTA, San Giorgi MRM, de Vries TW. Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis. Clin Exp Allergy 2022; 52:1247-1263. [PMID: 35947495 DOI: 10.1111/cea.14212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/26/2023]
Abstract
This review presents an overview of the available literature regarding intranasal corticosteroids (INCs) for the treatment of allergic rhinitis (AR). Various treatment options exist for AR including INCs, antihistamines and leucotriene antagonists. INCs are considered to be the most effective therapy for moderate-to-severe AR, as they are effective against nasal and ocular symptoms and improve quality of life. Their safety has been widely observed. INCs are effective and safe for short-term use. Local adverse events are observed but generally well-tolerated. The occurrence of (serious) systemic adverse events is unlikely but cannot be ruled out. There is a lack of long-term safety data. INC may cause serious eye complications. The risk of INCs on the hypothalamic-pituitary-adrenal axis, on bone mineral density reduction or osteoporosis and on growth in children, should be considered during treatment. Pharmacological characteristics of INCs (e.g. the mode of action and pharmacokinetics) are well known and described. We sought to gain insight into whether specific properties affect the efficacy and safety of INCs, including nasal particle deposition, which the administration technique affects. However, advances are lacking regarding the improved understanding of the effect of particle deposition on efficacy and safety and the effect of the administration technique. This review emphasizes the gaps in knowledge regarding this subject. Advances in research and health care are necessary to improve care for patients with AR.
Collapse
Affiliation(s)
- Corine Rollema
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Eric N van Roon
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.,Department PharmacoTherapy, Epidemiology and Economy, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Titia Klemmeier
- Department of Pulmonology, Martini Hospital Groningen, Groningen, The Netherlands
| | - Janwillem H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,General Practitioners Research Institute (GRIP), Groningen, The Netherlands.,Observational and Pragmatic Research Institute, Singapore City, Singapore.,Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther I Metting
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Hanneke N G Oude Elberink
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Allergology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas T A Peters
- Department of Otorhinolaryngology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Michel R M San Giorgi
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Tjalling W de Vries
- Department of Paediatrics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| |
Collapse
|
5
|
Türkoğlu Babakurban S, Vural Ö, Korkmaz Kasap Y, Hızal E, Yurtcu E, Büyüklü AF. The Genotoxic Effect of Nasal Steroids on Human Nasal Septal Mucosa and Cartilage Cells In Vitro. Ann Otol Rhinol Laryngol 2022; 132:497-503. [PMID: 35695134 DOI: 10.1177/00034894221099355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether budesonide (Bud) and triamcinolone acetate (TA) cause DNA fractures in the nasal mucosa and septal cartilage cells through examinations using the comet assay technique. STUDY DESIGN Prospective, controlled experimental study. SETTING University hospital. METHODS Septal mucosal epithelial and cartilage tissue samples were taken from 9 patients. Cell cultures were prepared from these samples. Then, budesonide and triamcinolone acetate active ingredients at 2 different doses of 0.2 and 10 µM were separately applied to the cell cultures formed from both tissues of each patient, except the control cell culture, for 7 days in one group and 14 days in one group. After the applications, genotoxic damage was scored with the comet assay technique and the groups were compared. RESULTS In both the budesonide and triamcinolone acetate groups, the comet scores at low and high doses, on the 7th and 14th days were found to be significantly higher in both cartilage and epithelial tissue than in the control group. CONCLUSION The study results showed that budesonide and triamcinolone acetate lead to a significantly high rate of genotoxic damage in both epithelial tissue and cartilage tissue.
Collapse
Affiliation(s)
| | - Ömer Vural
- Department of Otolaryngology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Yeşim Korkmaz Kasap
- Department of Medical Biology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Evren Hızal
- Department of Audiology, Gulhane Faculty of Health Sciences, and Department of Otorhinolaryngology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Erkan Yurtcu
- Department of Medical Biology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Adnan Fuat Büyüklü
- Department of Otolaryngology, Faculty of Medicine, Baskent University, Ankara, Turkey
| |
Collapse
|
6
|
Zare F, Aalaei E, Zare F, Faramarzi M, Kamali R. Targeted drug delivery to the inferior meatus cavity of the nasal airway using a nasal spray device with angled tip. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106864. [PMID: 35580527 DOI: 10.1016/j.cmpb.2022.106864] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/09/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Nowadays, by advancement in computational tools, Computational Fluid and Particle Dynamics (CFPD) technique can be used more than ever. The main aim of this study is using a nasal spray device with angled tip to deliver drug particles to the inferior meatus cavity for treatment purposes. In the present study, the drug delivery to the lower regions of the nasal cavity will be improved that has been considered less in the literature. METHODS For this purpose, a spray with an angled tip was used, and the deposition of sprayed particles was compared with a spray with a straight tip. Based on the objectives presented above, a realistic model of the nasal route, including facial geometry, and paranasal sinuses obtained from a series of Computed tomography (CT) scan images, as well as the geometry of a nasal spray with two types of tip were developed. RESULTS It is observed that by using the spray with the straight tip, particles were mainly deposited in the middle and superior regions of the nasal cavity and no particles entered the inferior meatus airway. The results proved that the spray with the angled tip improved the regional deposition percentage in the inferior meatus cavity up to 2.4% of the total sprayed particles and 1 mg drug mass delivered to this region. The majority of these particles had a diameter between 15-55 µm and that could be considered by spray designers to produce more compatible sprays with the targeted region. Also, most particles were deposited near the inferior meatus cavity and so there is a strong chance to be absorbed and delivered to this region. CONCLUSION The deposition pattern and particle size contour due to the spray with the angled tip can give sight to the designers and producers of nasal sprays to build more efficient types for better targeted drug delivery purposes. With this spray type, deposited particles were observed in the inferior meatus that never happened with the straight type. Also, the angled tip of the nasal spray shows the benefit of the ease of use for the user.
Collapse
Affiliation(s)
- Farhad Zare
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Ehsan Aalaei
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran.
| | - Farzad Zare
- Aliebne-Abitaleb School of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran
| | - Mohammad Faramarzi
- Department of Otolaryngology-Head & Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Kamali
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran.
| |
Collapse
|
7
|
ENT education in the pandemic, nasal adenocarcinoma in High Wycombe, topical rhinitis treatment, and coronavirus disease 2019 in otolaryngologists. The Journal of Laryngology & Otology 2022; 136:1-2. [DOI: 10.1017/s0022215122000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
8
|
Chen J, Martin AR, Finlay WH. Recent In Vitro and In Silico Advances in the Understanding of Intranasal Drug Delivery. Curr Pharm Des 2021; 27:1482-1497. [PMID: 33183191 DOI: 10.2174/1381612826666201112143230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many drugs are delivered intranasally for local or systemic effect, typically in the form of droplets or aerosols. Due to the high cost of in vivo studies, drug developers and researchers often turn to in vitro or in silico testing when first evaluating the behavior and properties of intranasal drug delivery devices and formulations. Recent advances in manufacturing and computer technologies have allowed for increasingly realistic and sophisticated in vitro and in silico reconstructions of the human nasal airways. OBJECTIVE The study aims to perform a summary of advances in the understanding of intranasal drug delivery based on recent in vitro and in silico studies. CONCLUSION The turbinates are a common target for local drug delivery applications, and while nasal sprays are able to reach this region, there is currently no broad consensus across the in vitro and in silico literature concerning optimal parameters for device design, formulation properties and patient technique which would maximize turbinate deposition. Nebulizers can more easily target the turbinates, but come with the disadvantage of significant lung deposition. Targeting of the olfactory region of the nasal cavity has been explored for the potential treatment of central nervous system conditions. Conventional intranasal devices, such as nasal sprays and nebulizers, deliver very little dose to the olfactory region. Recent progress in our understanding of intranasal delivery will be useful in the development of the next generation of intranasal drug delivery devices.
Collapse
Affiliation(s)
- John Chen
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| |
Collapse
|
9
|
Lauriello M, di Marco GP, Necozione S, Tucci C, Pasqua M, Rizzo G, Eibenstein A. Effects of liposomal nasal spray with vitamins A and E on allergic rhinitis. ACTA ACUST UNITED AC 2021; 40:217-223. [PMID: 32773784 PMCID: PMC7416366 DOI: 10.14639/0392-100x-n0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/27/2019] [Indexed: 12/13/2022]
Abstract
The aim of this study was to investigate the relationship between nasal obstruction and nasal cytology in patients with allergic rhinitis (AR) treated with a liposomal based nasal spray containing vitamins A and E. This is a prospective double-blind, controlled study. A total of 106 patients with AR, who rejected anti-allergic therapy, were randomly divided into two groups: G (study group, n = 53) received liposomal nasal spray and C (control group, n = 53) received 0.9% sodium chloride solution nasal spray. Both nasal sprays were applied two times a day, in the morning and at night, in both nasal cavities. The study lasted for 30 days. The first ENT evaluation was performed the first day (T0) and the second evaluation was performed at the end of the study (T1). Symptoms (SNOT-22 test with VAS) and signs (nasal cytology) of both groups were recorded at T0 and T1. Liposomal nasal spray was effective in improving both nasal symptoms and cytology in patients suffering from perennial AR. Treatment with liposomal nasal spray with vitamins A and E was followed by a significant improvement of VAS scale (p < 0.0001), a significant decrease in SNOT-22 (p < 0.0001) and a significant decrease in inflammatory cell count (p < 0.0001). In conclusion, our study provides evidence that liposomal nasal spray improves the nasal symptoms of AR. The patients were compliant to this therapy because of limited side effects. The reduction in inflammatory cells count was remarkable and confirmed the close association between eosinophil infiltration and nasal airflow impairment. These results may have implications for clinical practice.
Collapse
Affiliation(s)
- Maria Lauriello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | | | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Cinzia Tucci
- Speciality School of ENT, University of Tor Vergata, Roma, Italy
| | - Marina Pasqua
- Speciality School of ENT, University of Tor Vergata, Roma, Italy
| | | | - Alberto Eibenstein
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| |
Collapse
|
10
|
Ahsanuddin S, Povolotskiy R, Tayyab R, Nasser W, Barinsky GL, Grube JG, Paskhover B. Adverse Events Associated with Intranasal Sprays: An Analysis of the Food and Drug Administration Database and Literature Review. Ann Otol Rhinol Laryngol 2021; 130:1292-1301. [PMID: 33813873 DOI: 10.1177/00034894211007222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intranasal sprays (INSs) are commonly used medications for the treatment of many rhinologic conditions. Despite their popularity, an analysis of a nationwide reporting database and comparison to the available literature has never been performed. METHODS The Food and Drug Administration Adverse Event Reporting System (FAERS) database was accessed to obtain adverse event (AE) records from 2014 to 2019 for varying INSs, including: 10 corticosteroids, 1 alpha adrenergic, and 3 antihistamines. The Proportional Reporting Ratios (PRR) and Reporting Odds Ratios (ROR) were calculated for dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache. A PRR ≥ 2 or ROR ≥ 1 was considered significant. RESULTS Corticosteroids had 98 864 total reported AEs to the database, followed by antihistamines (7011) and alpha adrenergics (2071). In total, dyspnea was reported 5843 times, followed by headache (4230), epistaxis (1205), ageusia/dysgeusia (920), and anosmia (312). Overall, PRR and ROR values for dyspnea ranged from 0.51 to 4.25 and 0.51 to 4.49; for dysgeusia/ageusia from 0.56 to 6.09 and 0.56 to 6.12; and for epistaxis from 1.03 to 27.24 and 1.03 to 30.76, respectively. All medications which listed anosmia within the top AEs had PRR and ROR values exceeding 2 and 1, respectively. The PRR for headache exceeded 2 for 1 medication and the ROR exceeded 1 in 7 medications. CONCLUSION The AEs of dyspnea, anosmia, ageusia/dysgeusia, epistaxis, and headache are reported within the FAERS database for commonly prescribed INSs. When compared against the existing scientific literature, the clinical significance of this reporting tool from the FDA for these classes of medications remains unvalidated.
Collapse
Affiliation(s)
- Salma Ahsanuddin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rahma Tayyab
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wissam Nasser
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordon G Grube
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, Albany Medical Center, Albany, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Facial Plastics and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
11
|
Lee CJ, Seak CJ, Liao PC, Chang CH, Tzen IS, Hou PJ, Lin CC. Evaluation of the Relationship Between Blood Pressure Control and Epistaxis Recurrence After Achieving Effective Hemostasis in the Emergency Department. J Acute Med 2020; 10:27-39. [PMID: 32995152 PMCID: PMC7517968 DOI: 10.6705/j.jacme.202003_10(1).0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/22/2019] [Accepted: 10/19/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Epistaxis is the most common cause of otorhinolaryngologic emergencies. There is a longstanding controversy regarding the relationship between epistaxis and hypertension (HTN), in terms of blood pressure (BP) control in the emergency department (ED) setting. The objective of this study is to evaluate the association between HTN, BP control, and recurrent epistaxis among patients initially admitted to the ED for epistaxis. METHODS This retrospective cohort study was conducted in the EDs of three different hospitals in Taiwan and included a total of 739 patients admitted for epistaxis. RESULTS Among ED patients with epistaxis, older age was significantly associated with a history of HTN, and a statistically significant difference in age was noted between groups classified according to the systolic BP/diastolic BP (SBP/DBP) at triage. Patients with a history of HTN had higher BP values at triage than did patients without a history of HTN (SBP: 175.68 ± 32.30 mmHg vs. 148.00 ± 26.26 mmHg, DBP: 95.04 ± 20.98 mmHg vs. 83.30 ± 16.65 mmHg; p < 0.0001). Antihypertensive medications were more commonly administered to patients with a history of HTN (p < 0.0001) and in those patients with SBP/DBP: ≥ 140/≥ 90 mmHg at triage (p < 0.0001). Among patients receiving antihypertensive medications, reductions in SBP by the time of discharge were significantly greater in patients with a history of HTN and in patients with SBP/DBP: ≥ 160/≥ 100 mmHg at triage. ED revisits due to recurrent epistaxis within 72 hours were significantly associated with male sex, a positive history of HTN, level of GOT, observation for recurrent epistaxis at ED, and duration of recurrent bleeding. CONCLUSIONS A positive history of HTN is related to recurrent epistaxis among ED patients. The effectiveness of administering antihypertensive agents before achieving hemostasis in patients admitted to the ED for epistaxis warrants further study.
Collapse
Affiliation(s)
- Cheng-Jung Lee
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chen-June Seak
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
- Chang Gung University College of Medicine Taoyuan Taiwan
| | - Pin-Chieh Liao
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chia-Hsun Chang
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - I-Shiang Tzen
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Po-Jen Hou
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Chih-Chuan Lin
- Linkou Medical Center, Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
- Chang Gung University College of Medicine Taoyuan Taiwan
| |
Collapse
|
12
|
Wu EL, Harris WC, Babcock CM, Alexander BH, Riley CA, McCoul ED. Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161:18-27. [DOI: 10.1177/0194599819832277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs. Data Sources Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases. Review Methods Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS. Results Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity. Conclusions While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.
Collapse
Affiliation(s)
- Eric L. Wu
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - William C. Harris
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Casey M. Babcock
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Bailin H. Alexander
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Charles A. Riley
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Edward D. McCoul
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
- Ochsner Clinical School, School of Medicine, University of Queensland, New Orleans, Louisiana, USA
| |
Collapse
|
13
|
Morse E, Fujiwara RJT, Mehra S. The Association of Industry Payments to Physicians with Prescription of Brand-Name Intranasal Corticosteroids. Otolaryngol Head Neck Surg 2018; 159:442-448. [PMID: 29865931 DOI: 10.1177/0194599818774739] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To examine the association of industry payments for brand-name intranasal corticosteroids with prescribing patterns. Study Design Cross-sectional retrospective analysis. Setting Nationwide. Subjects and Methods We identified physicians prescribing intranasal corticosteroids to Medicare beneficiaries 2014-2015 and physicians receiving payment for the brand-name intranasal corticosteroids Dymista and Nasonex. Prescription and payment data were linked by physician, and we compared the proportion of prescriptions written for brand-name intranasal corticosteroids in industry-compensated vs non-industry-compensated physicians. We associated the number and dollar amount of industry payments with the relative frequency of brand-name prescriptions. Results In total, 164,587 physicians prescribing intranasal corticosteroids were identified, including 7937 (5%) otolaryngologists; 10,800 and 3886 physicians received industry compensation for Dymista and Nasonex, respectively. Physicians receiving industry payment for Dymista prescribed more Dymista as a proportion of total intranasal corticosteroid prescriptions than noncompensated physicians (3.1% [SD = 9.6%] vs 0.2% [SD = 2.5%], respectively, P < .001). Similar trends were seen for Nasonex (12.0% [SD = 16.8%] vs 4.8% [SD = 13.6%], P < .001). The number and dollar amount of payment were significantly correlated to the relative frequency of Dymista (ρ = 0.26, P < .001 and ρ = 0.20, P < .001, respectively) and Nasonex prescriptions (ρ = 0.09, P < .001 and ρ = 0.15, P < .001, respectively). For Dymista, this association was stronger in otolaryngologists than general practitioners ( P < .001). There was a stronger correlation between the percentage of prescriptions and the number and dollar amount of payments for Dymista than for Nasonex ( P = .014 and P < .001). Conclusions Industry compensation for brand-name intranasal corticosteroids is significantly associated with prescribing patterns. The magnitude of association may depend on physician specialty and the drug's time on the market.
Collapse
Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,2 Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
14
|
Masoudian P, McDonald JT, Lasso A, Kilty SJ. Socioeconomic status and anterior epistaxis in adult population. World J Otorhinolaryngol Head Neck Surg 2017; 4:263-267. [PMID: 30564789 PMCID: PMC6284191 DOI: 10.1016/j.wjorl.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 11/09/2022] Open
Abstract
Objective Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population. The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population. Methods Retrospective review of emergency department visits from January 2012 to May 2014. The setting is in an emergency department of a Canadian tertiary care centre. Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study. The main outcome was emergency department visits for anterior epistaxis visits. Results A total of 351 cases of anterior epistaxis were included. The mean age was 70 years and 51% of patients were male. The patients were stratified into two groups based on whether their age was equal to and above, or below 75 years. Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles (P < 0.05). This association did not hold true for those younger than 75 years or for all age groups combined. Conclusion There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.
Collapse
Affiliation(s)
| | - J Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, NB, Canada
| | - Andrea Lasso
- The Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Shaun J Kilty
- The Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
15
|
Karatzanis A, Chatzidakis A, Milioni A, Vlaminck S, Kawauchi H, Velegrakis S, Prokopakis E. Contemporary Use of Corticosteroids in Rhinology. Curr Allergy Asthma Rep 2017; 17:11. [PMID: 28233155 DOI: 10.1007/s11882-017-0679-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Exogenously administered corticosteroids are widely used today in the field of rhinology. Allergic rhinitis (AR), non-allergic rhinitis (NAR), acute rhinosinusitis (ARS), chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps, and autoimmune disorders with nasal manifestations are common diseases treated effectively with intranasal and oral glucocorticoids. We focus on physiological pathways, therapeutic benefits, indications, contra-indications, and side effects of glucocorticoid utilization in the treatment of rhinologic disorders such as AR, NAR, ARS, CRSsNP, and CRSwNP. RECENT FINDINGS Second-generation intranasal steroid (INS) agents have pharmacokinetic characteristics that minimize their systemic bioavailability, resulting in minimum risk for systemic adverse events. Several studies have demonstrated the symptomatic efficacy of both intranasal and oral corticosteroids in ARS. Moreover, intranasal and systemic steroid administration has been repeatedly proven beneficial in the conservative and perioperative management of CRSwNP. For patients with AR, there is no need for oral steroids, with the exception of severe cases, as there is lack of superiority to INS. SCUAD patients challenge currently available treatment schemes, underlining the importance of research in the field. Corticosteroids' effectiveness in the treatment of various rhinologic disorders is indisputable. However, their characteristics, and potential side effects, make a clear consensus for utilization difficult.
Collapse
Affiliation(s)
- Alexander Karatzanis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Alkiviadis Chatzidakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Athanasia Milioni
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stephan Vlaminck
- Department of Otorhinolaryngology, St. Jan General Hospital, Bruges, Belgium
| | - Hideyuki Kawauchi
- Department of Otorhinolaryngology, School of Medicine, University of Shimane, Shimane, Japan
| | - Stylianos Velegrakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece. .,Department of Otorhinolaryngology, University Hospital of Crete, University avenue, A Building 3rd Floor, 71110, Heraklion, Crete, Greece.
| |
Collapse
|
16
|
Nasal Drug Delivery. Drug Deliv 2016. [DOI: 10.1201/9781315382579-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
17
|
Passali D, Spinosi MC, Crisanti A, Bellussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med 2016; 11:18. [PMID: 27141307 PMCID: PMC4852427 DOI: 10.1186/s40248-016-0054-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/16/2016] [Indexed: 01/24/2023] Open
Abstract
The inflammatory diseases of the nose, rhino-pharynx and paranasal sinuses (allergic and non allergic rhinitis, NARES; rhinosinusitis with/without nasal polyposis, adenoidal hypertrophy with/without middle ear involvement) clinically manifest themselves with symptoms and complications severely affecting quality of life and health care expenditure. Intranasal administration of corticosteroids, being fast, simple, and not requiring cooperation, is the preferred way to treat the patients, to optimize their quality of life, at the same time minimizing the risk of exacerbations and complications. Among the different topical steroids available on the market, we performed a comparative analysis in terms of effectiveness and safety between mometasone furoate (MF) and its main competitors. Searching through Pub Med and Google Scholar and using as entries “mometasone furoate”, “rhinitis”, “sinusitis”, “asthma”, “polyposis”, “otitis media with effusion”, and “adenoid hypertrophy” we found 344 articles, 300 of which met the eligibility criteria. Taking into account relevance and date of publication, a sample of 40 articles was considered for the review. MF effectiveness for treatment and/or prophylaxis of nasal symptoms in seasonal and perennial allergic rhinitis has been fully established with a level of evidence Ia. Even though it has not been assessed for MF in particular, topical steroids are the most appropriate treatment in mixed rhinitis and NARES. In acute rhinosinusitis (ARS) evidences support their use as mono-therapy or as adjuvant to antibiotics for reducing the recurrence rate, and decrease the usage of related prescriptions and medical consultations. In chronic rhinosinusitis (CRS) with Nasal polyposis, MF reduces polyps size, nasal congestion, improves quality of life and sense of smell and it is also effective in the treatment of daytime cough. The topical use of MF has great efficacy in the management of adenoidal hypertrophy and otitis media of atopic children. As regards the safety, MF has demonstrated an excellent safety profile: pregnant women can safely use it; no systemic effects on growth velocity and adrenal suppression have been shown; no changes in epithelial thickness or atrophy have been observed after long term administration of the drug. Conclusions: MF has been demonstrated to be effective in the treatment of the inflammatory diseases of the nose and paranasal sinuses; when compared to its competitors it shows a greater symptom control; it is a reliable treatment in the long term thanks not only to its proven efficacy, but also to its safety being on the market since more than 17 years.
Collapse
Affiliation(s)
| | | | - Anna Crisanti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | |
Collapse
|
18
|
The nasal approach to delivering treatment for brain diseases: an anatomic, physiologic, and delivery technology overview. Ther Deliv 2014; 5:709-33. [PMID: 25090283 DOI: 10.4155/tde.14.41] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The intricate pathophysiology of brain disorders, difficult access to the brain, and the complexity and high risks and costs of drug development represent major hurdles for improving therapies. Nose-to-brain drug transport offers an attractive alternative or addition to formulation-only strategies attempting to enhance drug penetration into the CNS. Although still a matter of controversy, many studies in animals claim direct nose-to-brain transport along the olfactory and trigeminal nerves, circumventing the traditional barriers to CNS entry. Some clinical trials in man also suggest nose-to-brain drug delivery, although definitive proof in man is lacking. This review focuses on new nasal delivery technologies designed to overcome inherent anatomical and physiological challenges and facilitate more efficient and targeted drug delivery for CNS disorders.
Collapse
|
19
|
Thennati R, Khanna A, Khanna M, Sonaiya T, Mehta T, Mehta K, Shahi P, Patel J. Safety, tolerability, pharmacokinetics, and pharmacodynamics of compound SFDAC by intranasal administration of multiple escalating dose in healthy male subjects. Clin Pharmacol Drug Dev 2014; 3:428-38. [DOI: 10.1002/cpdd.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 06/09/2014] [Indexed: 01/02/2023]
Affiliation(s)
| | - Aman Khanna
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Mallika Khanna
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Tushar Sonaiya
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Tejas Mehta
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Kalpana Mehta
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Pradeep Shahi
- Pharmacokinetic Department; Sun Pharmaceutical Industries Ltd.; Vadodara India
| | - Jigneshkumar Patel
- Clinical Pharmacology Unit; Sun Pharmaceutical Industries Ltd.; Vadodara India
| |
Collapse
|
20
|
Shirtcliff EA, Peres JC, Dismukes AR, Lee Y, Phan JM. Hormones: commentary. Riding the physiological roller coaster: adaptive significance of cortisol stress reactivity to social contexts. J Pers Disord 2014; 28:40-51. [PMID: 24344886 DOI: 10.1521/pedi.2014.28.1.40] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The authors conjecture that to understand normal stress regulation, including cortisol stress reactivity, it is important to understand why these biomarkers are released and what they function to accomplish within the individual. This perspective holds that high (or rising) cortisol has advantages and disadvantages that must be understood within a context to understand how individual differences unfold. This perspective is juxtaposed with a popular vantage point of this stress hormone or of stress exposure that emphasizes the deleterious consequences or problems of this hormone. While the costs and benefits of cortisol are emphasized for normal stress regulation, this dynamic context-dependent purpose of stress hormones should extend to the development of psychopathology as well. This functional and dynamic view of cortisol is helpful for interpreting why Tackett and colleagues (2014) appear to observe advantageous cortisol recovery from stress in individuals with elevated personality disorder symptoms.
Collapse
|
21
|
A V R. Inhalational Steroids and Iatrogenic Cushing's Syndrome. Open Respir Med J 2014; 8:74-84. [PMID: 25674177 PMCID: PMC4319196 DOI: 10.2174/1874306401408010074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
Bronchial asthma (BA) and Allergic rhinitis (AR) are common clinical problems encountered in day to day practice, where inhalational corticosteroids (ICS) or intranasal steroids (INS) are the mainstay of treatment. Iatrogenic Cushing syndrome (CS) is a well known complication of systemic steroid administration. ICS /INS were earlier thought to be safe, but now more and more number of case reports of Iatrogenic Cushing syndrome have been reported, especially in those who are taking cytochrome P450 (CYP 450) inhibitors. Comparing to the classical clinical features of spontaneous Cushing syndrome, iatrogenic Cushing syndrome is more commonly associated with osteoporosis, increase in intra-ocular pressure, benign intracranial hypertension, aseptic necrosis of femoral head and pancreatitis, where as hypertension, hirsuitisum and menstrual irregularities are less common. Endocrine work up shows low serum cortisol level with evidence of HPA (hypothalamo-pituitary-adrenal) axis suppression. In all patients with features of Cushing syndrome with evidence of adrenal suppression always suspect iatrogenic CS. Since concomitant administration of cytochrome P450 inhibitors in patients on ICS/INS can precipitate iatrogenic CS, avoidance of CYP450 inhibitors, its dose reduction or substitution of ICS are the available options. Along with those, measures to prevent the precipitation of adrenal crisis has to be taken. An update on ICS-/INS- associated iatrogenic CS and its management is presented here.
Collapse
Affiliation(s)
- Raveendran A V
- Department of Internal Medicine, Government Medical College & Hospitals, Kottayam, Kerala-686008, India
| |
Collapse
|
22
|
Carr WW. New therapeutic options for allergic rhinitis: back to the future with intranasal corticosteroid aerosols. Am J Rhinol Allergy 2013; 27:309-13. [PMID: 23816748 DOI: 10.2500/ajra.2013.27.3946] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Under current guidelines, intranasal corticosteroids (INSs) are considered the most effective first-line therapy to improve allergic rhinitis (AR) symptoms and burden of disease. In the late 1980s-1990s, chlorofluorocarbon (CFC)-propelled corticosteroid aerosol nasal sprays formed the standard of care for the treatment of AR. Because of environmental concerns, CFC aerosols were gradually phased out, and aqueous INS formulations of nasal sprays became the standard of care. Although many aqueous INS sprays are available, specific product-related factors can reduce patient adherence to an INS and subsequently reduce treatment efficacy. The purpose of this paper was to review the evolution of AR therapeutics and drug devices and how it may have an effect on patient adherence/compliance and patient satisfaction with current available therapies and show the unmet need to improve INS delivery systems. METHODS Although aqueous INSs are effective and well tolerated, use in some patients may be compromised because of patient sensory perception and device preference. A historical review of the evolution of intranasal delivery of INSs was undertaken to provide further insight into improving treatment options for patients with AR. RESULTS Although the various approved INSs appear to be equivalent in terms of reducing AR disease burden, the method in which an INS is delivered to a patient has significant bearing on the overall success of each specific drug product. CONCLUSION Hydrofluoroalkane-propelled INS drug products offer a back-to-the-future delivery approach that may be further tailored to the individual patient's needs. Past experiences and the development of new devices are paving the way toward further therapy choices, ultimately affording health care providers access to the most effective treatments for patients with AR.
Collapse
Affiliation(s)
- Warner W Carr
- Allergy & Asthma Associates of Southern California, 27800 Medical Center Road, Mission Viejo, CA 92691, USA.
| |
Collapse
|
23
|
Djupesland PG. Nasal drug delivery devices: characteristics and performance in a clinical perspective-a review. Drug Deliv Transl Res 2013; 3:42-62. [PMID: 23316447 PMCID: PMC3539067 DOI: 10.1007/s13346-012-0108-9] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nasal delivery is the logical choice for topical treatment of local diseases in the nose and paranasal sinuses such as allergic and non-allergic rhinitis and sinusitis. The nose is also considered an attractive route for needle-free vaccination and for systemic drug delivery, especially when rapid absorption and effect are desired. In addition, nasal delivery may help address issues related to poor bioavailability, slow absorption, drug degradation, and adverse events in the gastrointestinal tract and avoids the first-pass metabolism in the liver. However, when considering nasal delivery devices and mechanisms, it is important to keep in mind that the prime purpose of the nasal airway is to protect the delicate lungs from hazardous exposures, not to serve as a delivery route for drugs and vaccines. The narrow nasal valve and the complex convoluted nasal geometry with its dynamic cyclic physiological changes provide efficient filtration and conditioning of the inspired air, enhance olfaction, and optimize gas exchange and fluid retention during exhalation. However, the potential hurdles these functional features impose on efficient nasal drug delivery are often ignored. With this background, the advantages and limitations of existing and emerging nasal delivery devices and dispersion technologies are reviewed with focus on their clinical performance. The role and limitations of the in vitro testing in the FDA guidance for nasal spray pumps and pressurized aerosols (pressurized metered-dose inhalers) with local action are discussed. Moreover, the predictive value and clinical utility of nasal cast studies and computer simulations of nasal airflow and deposition with computer fluid dynamics software are briefly discussed. New and emerging delivery technologies and devices with emphasis on Bi-Directional™ delivery, a novel concept for nasal delivery that can be adapted to a variety of dispersion technologies, are described in more depth.
Collapse
|
24
|
Ku SK, Kim JW, Cho HR, Kim KY, Min YH, Park JH, Kim JS, Park JH, Seo BI, Roh SS. Effect of β-glucan originated from Aureobasidium pullulans on asthma induced by ovalbumin in mouse. Arch Pharm Res 2012; 35:1073-81. [PMID: 22870817 DOI: 10.1007/s12272-012-0615-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 01/06/2012] [Accepted: 01/09/2012] [Indexed: 12/22/2022]
Abstract
The objective of this study is to detect the effect of beta-glucan derived from Aureobasidium pullulans SM-2001, a UV induced mutant of A. pullulans on the ovalbumin (OVA) induced allergic asthma. The test articles were orally administered to OVA-inducing asthmatic mice 4 days after sensitization for 13 days at 31.25, 62.5 or 125 mg/kg levels. Three days after the OVA sensitization, ten mice were selected per group based on body weight and were sacrificed three days after the OVA aerosol challenge. The changes on the body weight, lung weight, total leukocytes in peripheral blood and total cells in bronchoalveolar lavage fluid (BALF) were observed with changes on the lung histopathology and histomorphometry. The results were compared with dexamethasone (DEXA) 3 mg/kg intraperitoneally treated mice. The results showed increases of body weight after the OVA aerosol challenge, lung weight, total leukocytes and eosinophils in peripheral blood, total cell numbers, neutrophil and eosinophils in BALF were detected in the OVA control compared to sham control (non-OVA). However, these changes from asthmatic responses were significantly or dose-dependently decreased in the beta-glucan-dosing groups compared to those of the OVA control. Therefore, it is concluded that beta-glucan has favorable effects on asthmatic response induced by OVA. It was found that beta-glucan 125 mg/kg showed similar or slightly lower efficacy compared with DEXA 3 mg/kg.
Collapse
Affiliation(s)
- Sae Kwang Ku
- Department of Histology and Anatomy, College of Oriental Medicine, Daegu Haany University, Gyeongsan 712-715, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Kapucu B, Cekin E, Erkul BE, Cincik H, Gungor A, Berber U. The effects of systemic, topical, and intralesional steroid treatments on apoptosis level of nasal polyps. Otolaryngol Head Neck Surg 2012; 147:563-7. [PMID: 22555894 DOI: 10.1177/0194599812446678] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the apoptotic responses to systemic, topical, and intrapolyp injection of glucocorticoid with no treatment in nasal polyps. STUDY DESIGN Prospective, randomized controlled study. SETTING Tertiary training hospital. SUBJECTS AND METHODS The study was performed on 48 patients with nasal polyposis in the Department of Otorhinolaryngology between 2008 and 2009. Patients were assigned to 1 of 4 groups of 12 patients. Group A was treated with oral methylprednisolone 1 mg/kg/d, and the dose was tapered gradually. Group B received 0.3 mL triamcinolone acetonide (40 mg/mL), which was injected into polyp tissue. Group C was treated with topical 55 µg triamcinolone acetonide 2 times daily for 1 month. Group D received no medication. Samples were collected endoscopically after the seventh day for groups A and B, the first month for group C, and the first visit for group D. Apoptotic indexes were determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method. RESULTS Statistically significant differences in apoptotic index were found between each steroid-medicated group and the control group (P (D-A) = .0001; P (D-B) = .003; P (D-C) = .026) and between groups A and C (P (A-C) = .012). Group B did not differ significantly from either group A or C (P (A-B) = .11; P (B-C) = .75). CONCLUSIONS The apoptotic index in nasal polyps treated with systemic, topical, and intrapolyp injection forms of glucocorticoids was higher than that in the control group. Systemic steroid treatment induced the most apoptosis.
Collapse
Affiliation(s)
- Burak Kapucu
- Department of Otorhinolaryngology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
26
|
Byrro RMD, César IC, de Santana e Silva Cardoso FF, Mundim IM, Teixeira LDS, Bonfim RR, Gomes SA, Pianetti GA. A rapid and sensitive HPLC–APCI-MS/MS method determination of fluticasone in human plasma: Application for a bioequivalency study in nasal spray formulations. J Pharm Biomed Anal 2012; 61:38-43. [DOI: 10.1016/j.jpba.2011.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/07/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
|
27
|
Chaaban M, Corey JP. Pharmacotherapy of Rhinitis and Rhinosinusitis. Facial Plast Surg Clin North Am 2012; 20:61-71. [DOI: 10.1016/j.fsc.2011.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
28
|
Meltzer EO. The role of nasal corticosteroids in the treatment of rhinitis. Immunol Allergy Clin North Am 2011; 31:545-60. [PMID: 21737042 DOI: 10.1016/j.iac.2011.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intranasal corticosteroids (INSs) are the first choice for rhinitis pharmacotherapy. This preference is because of their broad range of actions that result in reductions of proinflammatory mediators, cytokines, and cells. Over the past 30 years, INSs have been modified to improve their pharmacodynamic, pharmacokinetic, and delivery system properties, with attention to improving characteristics such as receptor binding affinity, lipophilicity, low systemic bioavailability, and patient preference. Clinically, they have been shown to be the most effective class of nasal medications for treating allergic rhinitis and nonallergic rhinopathy, with no clear evidence that any specific INS is superior to others.
Collapse
Affiliation(s)
- Eli O Meltzer
- Allergy & Asthma Medical Group & Research Center, 5776 Ruffin Road, San Diego, CA 92123, USA.
| |
Collapse
|
29
|
César IC, Byrro RMD, de Santana e Silva Cardoso FF, Mundim IM, de Souza Teixeira L, de Sousa WC, Gomes SA, Bellorio KB, Brêtas JM, Pianetti GA. Determination of triamcinolone in human plasma by a sensitive HPLC-ESI-MS/MS method: application for a pharmacokinetic study using nasal spray formulation. JOURNAL OF MASS SPECTROMETRY : JMS 2011; 46:320-326. [PMID: 21394848 DOI: 10.1002/jms.1896] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) method for the quantitation of triamcinolone in human plasma after nasal spray application was developed and validated. Betamethasone was used as internal standard (IS). The analytes were extracted by a liquid-liquid procedure and separated on a Zorbax Eclipse XDB C(18) column with a mobile phase composed of 2 mM aqueous ammonium acetate pH 3.2 and acetonitrile (55:45). Selected reaction monitoring was performed using the transitions m/z 435 → 415 and m/z 393 → 373 to quantify triamcinolone acetonide and betamethasone, respectively. Calibration curve was constructed over the range of 20-2000 pg/ml for triamcinolone acetonide. The lower limit of quantitation was 20 pg/ml. The mean RSD values were 4.6% and 5.7% for the intra-run and inter-run precision, respectively. The mean accuracy value was 98.5% and a recovery rate corresponding to 97.5% was achieved. No matrix effect was detected in the samples. The validated method was successfully applied to determine the plasma concentrations of triamcinolone acetonide in healthy volunteers, in a pharmacokinetic study with nasal spray formulation.
Collapse
Affiliation(s)
- Isabela Costa César
- Instituto de Ciências Farmacêuticas, Alameda Coronel Eugênio Jardim 53, 74175-100 Goiânia, GO, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Pudrith C, Kim YH, Martin D, Gupta A, Inman J, Wareham R, Jahng P, Chung YS, Wall GM, Jung T. Effect of topical glucocorticoid treatment in chinchilla model of lipopolysaccharide induced otitis media with effusion. Int J Pediatr Otorhinolaryngol 2010; 74:1273-5. [PMID: 20846731 DOI: 10.1016/j.ijporl.2010.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/05/2010] [Accepted: 08/05/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the efficacy of topical treatment with three glucocorticoids in lipopolysaccharide induced otitis media with effusion (OME). METHODS Chinchillas were divided into seven treatment groups consisting of vehicle and three glucocorticoids: dexamethasone sodium phosphate (DSP), fluticasone propionate (FP), and hydrocortisone, each at concentrations of 0.1% and 1.0%. LPS (300 μg) was injected into the superior bullae of chinchillas to induce OME. Animals were treated with test substances at -2, 24, and 48 h relative to LPS inoculation. After 96 h, chinchillas were euthanized, samples of middle ear effusion (MEE) were collected, and temporal bones were removed for histopathological examination. Reduction of OME was evaluated by measuring MEE volume and thickness of mucosal lining for each bulla. RESULTS One percent treatment of FP significantly reduced MEE. One percent treatment of DSP and HC significantly reduced the mucosal thickness (MT), DSP (15.0 μM) more than HC (30.8 μM). Treatment with 0.1% glucocorticoids did not lead to any significant reduction. CONCLUSIONS Clearance of otitis media with effusion seems to be a class effect among glucocorticoids. DSP was the best in reducing MT. It is important to evaluate treatment with various glucocorticoids in order to discover alternative drugs for OME.
Collapse
Affiliation(s)
- Charles Pudrith
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University School of Medicine, Jerry L. Pettis Memorial Veterans Affairs Medical Center, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Spontaneous sub-conjunctival haemorrhage in patients using long-term topical corticosteroids. Eye (Lond) 2010; 24:1770-1. [DOI: 10.1038/eye.2010.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
32
|
Abstract
Epistaxis is a common clinical problem often seen by primary care physicians. This can be caused by multiple factors, each of which should be explored to treat the epistaxis and prevent recurrences. In this article, etiologies and methods of evaluation for the patient with epistaxis are discussed. Treatment strategies are outlined in a stepwise fashion, as are recommendations for situations requiring referral to an otolaryngologist.
Collapse
Affiliation(s)
- R Peter Manes
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| |
Collapse
|
33
|
Roland PS, Ryan MW, Wall GM. Olopatadine nasal spray for the treatment of seasonal allergic rhinitis in patients aged 6 years and older. Expert Opin Pharmacother 2010; 11:1559-67. [PMID: 20482305 DOI: 10.1517/14656566.2010.485609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Allergic rhinitis is an IgE-mediated condition that produces inflammation of the mucosa of the nose, paranasal sinuses and, frequently, of the ocular conjunctiva. Allergic rhinitis causes a significant disease burden in terms of quality of life, lost productivity and medical treatment costs. One of the newest treatments approved by the FDA is Patanase (olopatadine hydrochloride) Nasal Spray, 665 microg/spray (OLO). Olopatadine is an antihistamine with selective H(1)-receptor antagonist activity. AREAS COVERED IN THIS REVIEW This review details the basic and clinical research on the olopatadine molecule and OLO nasal spray from 1996 to the present day. WHAT THE READER WILL GAIN The reader will gain a better understanding of the pharmacology of OLO nasal spray, the clinical trial data that have established the efficacy of OLO nasal spray and the overall role of OLO nasal spray in the management of allergic rhinitis. TAKE HOME MESSAGE Olopatadine nasal spray is one of the newest treatments approved by the FDA for the management of allergic rhinitis. OLO has a rapid onset of action, efficacy comparable to intranasal steroid sprays and is approved for seasonal allergic rhinitis in patients aged > or = 6 years.
Collapse
Affiliation(s)
- Peter S Roland
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
| | | | | |
Collapse
|
34
|
Anolik R. Fluticasone furoate nasal spray: Profile of an enhanced-affinity corticosteroid in treatment of seasonal allergic rhinitis. J Asthma Allergy 2010; 3:87-99. [PMID: 21437043 PMCID: PMC3047912 DOI: 10.2147/jaa.s10839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 11/23/2022] Open
Abstract
Of the classes of pharmacotherapy for seasonal allergic rhinitis, intranasal corticosteroids are the preferred treatment and are recommended in practice guidelines as first-line pharmacotherapy for rhinitis with prominent nasal congestion. The enhanced-affinity intranasal corticosteroid fluticasone furoate nasal spray (GW685698X), is one of the newest additions to the armamentarium for allergic rhinitis. This review summarizes the preclinical and clinical data on fluticasone furoate nasal spray and discusses its place in pharmacotherapy for seasonal allergic rhinitis. Important attributes of fluticasone furoate in seasonal allergic rhinitis include low systemic bioavailability (<0.5%), onset of symptom relief as early as eight hours after initiation of treatment, 24-hour symptom relief with once-daily dosing, comprehensive coverage of both nasal and ocular symptoms, safety and tolerability with daily use, and availability in a side-actuated device that makes medication delivery simple and consistent. With these attributes, fluticasone furoate nasal spray has the potential to enhance patient satisfaction and compliance and reduce the need for polypharmacy in the management of seasonal allergic rhinitis.
Collapse
Affiliation(s)
- Robert Anolik
- Allergy and Asthma Specialists, PC, Blue Bell, Pennsylvania, USA
| |
Collapse
|
35
|
Nasser M, Fedorowicz Z, Aljufairi H, McKerrow W. Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children. Cochrane Database Syst Rev 2010; 2010:CD006989. [PMID: 20614452 PMCID: PMC7388927 DOI: 10.1002/14651858.cd006989.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Allergic rhinitis is a very common chronic illness affecting 10% to 40% of children worldwide and its prevalence among children has significantly increased over the last two decades. Prevalence and severity are related to age, with children of school age most commonly affected. OBJECTIVES To assess the effectiveness and adverse event profile of antihistamines (oral or topical) used as an adjunct to topical nasal steroids for intermittent and persistent allergic rhinitis in children. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 21 September 2009. SELECTION CRITERIA Randomised controlled trials (RCTs) in children under the age of 18 with a history of allergic rhinitis, with or without allergic conjunctivitis or asthma, comparing topical nasal steroids with antihistamines to topical nasal steroids only. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data and assessed risk of bias. MAIN RESULTS One study including 24 participants met the inclusion criteria for this review. This study compared the administration of topical nasal steroids with oral antihistamines to topical nasal steroids only in children, but it did not provide sufficient data to address the clinical question of this review. AUTHORS' CONCLUSIONS In view of the lack of evidence for the benefit or lack of benefit of antihistamine add-on therapy with topical nasal steroids for children with intermittent or persistent allergic rhinitis, it is important that clinicians are mindful of the adverse effects of antihistamines and the additional costs that may be incurred.
Collapse
Affiliation(s)
- Mona Nasser
- Institute for Quality and Efficiency in Health CareDepartment of Health InformationDillenburger Street27, D‐51105CologneGermanyD‐51105
| | - Zbys Fedorowicz
- Ministry of Health, BahrainUKCC (Bahrain Branch)Box 25438AwaliBahrain
| | - Hamad Aljufairi
- Royal College of Surgeons in Ireland ‐ BahrainSchool of MedicineP.O. Box 15503AdliyaBahrain
| | | | | |
Collapse
|
36
|
Roland PS, Marple BF, Wall GM. Olopatadine nasal spray for the treatment of allergic rhinitis. Expert Rev Clin Immunol 2010; 6:197-204. [PMID: 20402382 DOI: 10.1586/eci.09.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Olopatadine hydrochloride nasal spray (Patanase Nasal Spray, Alcon Laboratories, TX, USA) was approved by the US FDA in 2008, and is indicated for the relief of symptoms of seasonal allergic rhinitis (SAR), also referred to as allergic rhinosinusitis. Olopatadine is an antihistamine with selective H1-receptor antagonist activity. Clinical trials of olopatadine nasal spray have demonstrated safety and efficacy in the treatment of SAR patients. With an onset of action of 30 min, olopatadine nasal spray has also been shown to improve quality of life, ability to perform work and the conduct of usual activities in SAR patients.
Collapse
Affiliation(s)
- Peter S Roland
- Department of Otolaryngology, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9035, USA.
| | | | | |
Collapse
|
37
|
Scadding G, Erkan AN, Chau H, Maskell S. Audit of nasal steroid use and effectiveness in a rhinitis clinic. Expert Rev Pharmacoecon Outcomes Res 2010; 10:87-90. [PMID: 20121566 DOI: 10.1586/erp.09.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intranasal corticosteroids are the most effective treatment for allergic rhinitis based on meta-analyses of clinical trials; however, the population in such trials is restricted and may not be representative of patients who are later treated with the medication. The effectiveness of intranasal steroids in the real world has not been assessed. AIMS AND METHODS We asked patients returning to a rhinitis clinic having been treated with intranasal corticosteroids for 3 months to fill in an anonymous questionnaire about their use of this treatment, its effectiveness and any adverse events. RESULTS A total of 126 out of 134 patients completed the questionnaire. At least 119 of these had used the intranasal steroid spray; 79% found the sprays helpful, 40% found nasal blockage was reduced and 24% noted reduction of all symptoms. A total of 20% experienced no benefit, 21% noted minor adverse events - the most common being epistaxis in 9%. CONCLUSION The real world effectiveness and adverse event profile of intranasal steroid sprays is similar in clinical practice to that seen in trials. The number needed to treat to obtain symptomatic benefit is 1.26 and to reduce all symptoms is 4. The number needed to harm is 11. Intranasal steroids are an effective and safe first line treatment for rhinitis.
Collapse
Affiliation(s)
- Glenis Scadding
- Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London, UK.
| | | | | | | |
Collapse
|
38
|
Graf P, Eccles R, Chen S. Efficacy and safety of intranasal xylometazoline and ipratropium in patients with common cold. Expert Opin Pharmacother 2009; 10:889-908. [PMID: 19351236 DOI: 10.1517/14656560902783051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many over-the-counter medications are available to treat common cold nasal symptoms, but patients may be unsure which one to use. METHODS This review assesses two widely used intranasal treatments for nasal congestion and rhinorrhea in the common cold: xylometazoline hydrochloride and ipratropium bromide. RESULTS Xylometazoline quickly and effectively relieves nasal congestion, while ipratropium is effective at reducing rhinorrhea. When used in combination, a novel approach to treatment, nasal congestion and rhinorrhea are treated simultaneously, providing effective relief from two of the most troublesome symptoms of the common cold Both drugs are well tolerated, with only mild to moderate, nasal-related side effects. CONCLUSIONS The efficacy and safety of the combination product suggest that it should be used first-line in the symptomatic relief of nasal congestion and rhinorrhea, before the use of oral treatments.
Collapse
Affiliation(s)
- P Graf
- Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
| | | | | |
Collapse
|
39
|
Abstract
Objective Intranasal steroids (INS) are firmly established as the therapy for choice for allergic rhinitis, but their role in vasomotor rhinitis (VMR) is not fully characterized. This review examines the potential mechanisms of action and reported efficacy of INS in patients with VMR. Results INS, through intracellular activation of the glucocorticoid receptor, down-regulate the recruitment and activation of inflammatory cells (T-lymphocytes, eosinophils, mast cells, basophils, neutrophils, macrophages), increase degradation of neuropeptides, and reduce epithelial cell activity, vascular permeability, and chemokine secretion. It is likely that more than vasoconstriction is responsible for the clinical effects of INS. Eight INS can be prescribed for rhinitis in the US; only 4 have been studied for VMR. Seventy-four percent of patients treated with beclomethasone dipropionate considered themselves symptom-free or greatly improved versus 31% with placebo. Budesonide significantly reduced rhinitis symptoms and methacholine-induced nasal secretions compared with placebo. Fluticasone propionate compared with placebo provided significantly greater relief from nasal obstruction; computed tomographic scans showed significant reductions in the mucosal area of the lower turbinates. Mometasone furoate produced numerically better rhinitis symptom scores and, when discontinued, lower relapse rates than placebo. Conclusion Data supports INS as beneficial pharmacotherapy for VMR.
Collapse
|
40
|
Garris C, Shah M, DʼSouza A, Stanford R. Comparison of Corticosteroid Nasal Sprays in Relation to Concomitant Use and Cost of Other Prescription Medications to Treat Allergic Rhinitis Symptoms. Clin Drug Investig 2009; 29:515-26. [DOI: 10.2165/00044011-200929080-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
41
|
Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
| |
Collapse
|
42
|
Abstract
Mometasone furoate (Nasonex) is a high-potency intranasal corticosteroid available for the treatment and/or prophylaxis of the nasal symptoms of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). In the EU, it is approved for use in patients aged > or =6 years and, in the US, it is approved as a treatment in patients aged > or =2 years and as prophylaxis in those > or =12 years of age.Extensive experience in both clinical trials and the clinical practice setting has firmly established the efficacy and good tolerability profile of intranasal mometasone furoate in children and adults with PAR or SAR. Thus, intranasal mometasone furoate is a useful first-line option for the treatment and prophylactic management of these conditions, including in children as young as 2 years of age in some countries and 6 years of age in others.
Collapse
|
43
|
Suturing of Little's area of the nasal septum for epistaxis. The Journal of Laryngology & Otology 2009; 123:787-8. [PMID: 19152725 DOI: 10.1017/s0022215109004526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Epistaxis is a common condition presenting to emergency and ENT clinics. Most epistaxis bleeding originates from Little's area of the nasal septum. Some cases of refractory epistaxis cannot be resolved with packing or electrocoagulation. METHOD The suturing technique applied is widely used in surgery. When faced with pulsatile, recurrent bleeding from Little's area of the nasal septum, all rhinologists should possess the skills to be able to suture the bleeding site, especially after failure of local cautery or packing. CASE REPORT The authors have successfully treated four difficult cases of nasal bleeding from Little's area by suturing. CONCLUSION This technique could eliminate the discomfort and complications of nasal packing. To the best of our knowledge, this report probably represents the first published case series of suturing of Little's area to treat recurrent nasal bleeding. More cases need to be treated in this way to enable further evaluation of the technique.
Collapse
|
44
|
Williams B, Smith WB, Kette FE. Intranasal ciclesonide for allergic rhinitis. J Asthma Allergy 2008; 1:49-54. [PMID: 21436985 PMCID: PMC3121337 DOI: 10.2147/jaa.s3082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ciclesonide is a novel corticosteroid which is optimized for topical use. It is a pro-drug which is activated locally in the airway mucosa, lipid-conjugated for local retention, and has very high protein binding in circulation leading to low systemic bioavailability. These characteristics should lead to highly selective activity with reduced local and systemic side effects. It has been established as an inhaled medication for asthma and has also been shown in double-blind trials to be efficacious for the treatment of seasonal and perennial allergic rhinitis. However no data have yet demonstrated superiority over existing nasal topical corticosteroids, either in terms of efficacy or adverse effects, and trials have not yet clearly shown efficacy in rhinitis in children. Therefore the place of ciclesonide in the treatment of allergic rhinitis relative to other existing products remains unclear.
Collapse
Affiliation(s)
- Ben Williams
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide South Australia
| | | | | |
Collapse
|
45
|
Derendorf H, Meltzer EO. Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications. Allergy 2008; 63:1292-300. [PMID: 18782107 DOI: 10.1111/j.1398-9995.2008.01750.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intranasal corticosteroids (INSs) are effective treatments for allergic rhinitis, rhinosinusitis, and nasal polyposis. In recent years, increased understanding of corticosteroid and glucocorticoid receptor pharmacology has enabled the development of molecules designed specifically to achieve potent, localized activity with minimal risk of systemic exposure. Pharmacologic potency studies using affinity and other assessments have produced similar rank orders of potency, with the most potent being mometasone furoate, fluticasone propionate, and its modification, fluticasone furoate. The furoate and propionate ester side chains render these agents highly lipophilic, which may facilitate their absorption through nasal mucosa and uptake across phospholipid cell membranes. These compounds demonstrate negligible systemic absorption. Systemic absorption rates are higher among the older corticosteroids (flunisolide, beclomethasone dipropionate, triamcinolone acetonide, and budesonide), which have bioavailabilities in the range of 34-49%. Studies, including 1-year studies with mometasone furoate, fluticasone propionate, and budesonide that evaluated potential systemic effects of INSs in children have generally found no adverse effects on hypothalamic-pituitary-adrenal axis function or growth. Clinical data suggest no significant differences in efficacy between the INSs. Theoretically, newer agents with lower systemic availability may be preferable, and may come closer to the pharmacokinetic/pharmacologic criteria for the ideal therapeutic choice.
Collapse
Affiliation(s)
- H Derendorf
- Department of Pharmaceutics, University of Florida, Gainesville, FL 32610-0494, USA
| | | |
Collapse
|
46
|
Kirtsreesakul V, Chansaksung P, Ruttanaphol S. Dose-related effect of intranasal corticosteroids on treatment outcome of persistent allergic rhinitis. Otolaryngol Head Neck Surg 2008; 139:565-9. [DOI: 10.1016/j.otohns.2008.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/14/2008] [Accepted: 07/21/2008] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the efficacy of the self-adjustable dosing regimen and explore potential dose-response relationships of intranasal corticosteroids in persistent allergic rhinitis. Study Design Prospective cohort study. Subjects and Methods Sixty-nine persistent allergic rhinitis patients were treated with 220 mcg of intranasal triamcinolone acetonide for 28 days. Patients with mild, intermittent symptoms were instructed to use the medication only after symptoms occurred once a day. Patients with symptoms that lasted more than 1 day and/or interrupted daily activities/sleep were instructed to continue the morning daily dose until they were symptom-free for 24 hours before stopping usage. Results All nasal symptom scores and peak expiratory flow index (PEFI) showed statistically significant improvements after treatment. At 28 days after treatment, the number of puffs and weight of steroids used were positively correlated with percentages of improvement in total symptoms score (TSS) and PEFI (ρ = 0.529, r = 0.571 and ρ = 0.350, r = 0.509 respectively). When at least 1400 mcg or 44 puffs were used, 60% TSS and 10% PEFI improvement were achieved. Conclusion A self-adjustable dosing approach proved to be an efficacious approach to controlling allergic rhinitis.
Collapse
Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Prichaya Chansaksung
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
47
|
Berger WE, Nayak A, Lanier BQ, Kaiser HB, LaForce C, Darken P, Hall N, Wingertzahn M. Efficacy and Safety of Once-Daily Ciclesonide Nasal Spray in Children With Allergic Rhinitis. ACTA ACUST UNITED AC 2008. [DOI: 10.1089/pai.2007.0022.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
48
|
Berger WE, Godfrey JW, Slater AL. Intranasal corticosteroids: the development of a drug delivery device for fluticasone furoate as a potential step toward improved compliance. Expert Opin Drug Deliv 2008; 4:689-701. [PMID: 17970670 DOI: 10.1517/17425247.4.6.689] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Devices for the aqueous delivery of intranasal corticosteroids to patients with allergic rhinitis have been available since 1984, so there is a need for new devices to be developed to provide ease of use, efficacy and safety. A novel drug delivery system has been developed for fluticasone furoate (FF; GlaxoSmithKline): a new enhanced-affinity glucocorticoid with a scent-free formulation. The FF system was developed, giving attention to patients' unmet needs, in order to promote acceptance and compliance. It demonstrates a number of key features including its ergonomic design, side-actuation system and short delivery nozzle. Exploiting issues with present devices highlighted the need for the FF system. This review reports data from key studies and surveys conducted by GlaxoSmithKline during development, to determine ease of use and acceptance of the FF system. Findings suggest that the FF system should aid in improving attitudes to the use of intranasal corticosteroids amongst physicians and patients.
Collapse
Affiliation(s)
- William E Berger
- Allergy and Asthma Associates, 27800 Medical Center Road, Suite # 244, Mission Viejo, California 92691, USA.
| | | | | |
Collapse
|
49
|
Kim K, Weiswasser M, Nave R, Ratner P, Nayak A, Herron J, Hall N, Wingertzahn M. Safety of Once-Daily Ciclesonide Nasal Spray in Children 2 to 5 Years of Age with Perennial Allergic Rhinitis. ACTA ACUST UNITED AC 2007. [DOI: 10.1089/pai.2007.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
50
|
Affiliation(s)
- Hans de Groot
- Section of Allergology, Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
| | | | | | | |
Collapse
|