Novel Topical Intranasal Therapies in the Management of Allergic Rhinitis
DOI:
https://doi.org/10.58931/cait.2021.1s0649Abstract
Allergic rhinitis (AR) is one the most common immunologic conditions affecting adults. Its prevalence has increased over the last few decades and varies between 10-40% depending on geographical location, with up to 25% of Canadians being affected. It is defined as an IgE-mediated inflammatory process affecting the nasal mucosa in a previously sensitised individual.2 When an atopic patient is exposed to an allergen, the patient develops specific IgE antibodies which become bound to mast cells. Re-exposure to this allergen results in two distinct phases of inflammation: an early phase occurring within minutes, due to mast cell degranulation which causes nasal itching, congestion and discharge; and a late phase occurring after several hours, due to eosinophil activation resulting in increased mucous production, nasal blockage and hyposmia.
References
Keith PK, Desrosiers M, Laister T, Schellenberg RR, Waserman S. The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients. Allergy Asthma Clin Immunol. 2012 Jun 1;8(1):7. doi:10.1186/1710-1492-8-7
Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008 Apr;63(Suppl 86):8-160.
Leynaert B, Neukirch C, Kony S, et al. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol. 2004 Jan;113:86-93.
Marcus S, Roland LT, DelGaudio JM, Wise SK. The relationship between allergy and chronic rhinosinusitis. Laryngoscope Investig Otolaryngol. 2018 Dec 20;4(1):13-17. doi:10.1002/lio2.236
Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. doi:10.1177/0194599814561600
Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mosges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2012 Sep;26(5):e119–e125.
Ural A, Oktemer TK, Kizil Y, Ileri F, Uslu S. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol. 2009 May;123(5):517-21. doi:10.1017/S0022215108003964
Erin EM, Leaker BR, Zacharasiewicz AS, Higgins LA, Williams TJ, Boyce MJ, et al. Single dose topical corticosteroid inhibits IL-5 and IL-13 in nasal lavage following grass pollen challenge. Allergy. 2005 Dec;60(12):1524-9. doi:10.1111/j.1398-9995.2005.00928.x
Holm A, Dijkstra M, Kleinjan A, et al. Fluticasone propionate aqueous nasal spray reduces inflammatory cells in unchallenged allergic nasal mucosa: effects of single allergen challenge. J Allergy Clin Immunol. 2001 Apr;107(4):627-33. doi:10.1067/mai.2001.113520
Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. 1998 Dec 12;317:1624-1629. doi:10.1136/bmj.317.7173.1624
Wilson AM, O’Byrne PM, Parameswaran K. Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis. Am J Med. 2004 Mar 1;116(5):338-344. doi:10.1016/j.amjmed.2003.10.030
Carr WW, Ratner P, Munzel U, et al. Comparison of intranasal azelastine to intranasal fluticasone propionate for symptom control in moderateto- severe seasonal allergic rhinitis.Allergy Asthma Proc. 2012 Nov-Dec;33(6):450-8. doi:10.2500/aap.2012.33.3626
Juel-Berg N, Darling P, Bolvig J, et al. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: a systematic review and metaanalysis. Am J Rhinol Allergy. 2017 Jan 9;31(1):19-28. doi:10.2500/ajra.2016.30.4397
Fokkens WJ, Cserhati E, dos Santos JM, et al. Budesonide aqueous nasal spray is an effective treatment in children with perennial allergic rhinitis, with an onset of action within 12 hours. Ann Allergy Asthma Immunol. 2002 Sep;89(3):279-84. doi:10.1016/s1081-1206(10)61955-2
Jen A, Baroody F, de Tineo M, Haney L, Blair C, Naclerio R. As-needed use of fluticasone propionate nasal spray reduces symptoms of seasonal allergic rhinitis. J Allergy Clin Immunol. 2000 Apr;105(4):732-8. doi:10.1067/mai.2000.105225
Meltzer EO. Formulation considerations of intranasal corticosteroids for the treatment of allergic rhinitis. Ann Allergy Asthma Immunol. 2007;98:12-21.
Rosenblut A, Bardin PG, Muller B, et al. Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis. Allergy. 2007;62:1071–1077.
Ratner PH, Meltzer EO, Teper A. Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis. Int J Pediatr Otorhinolaryngol. 2009;73:651–657.
Tait S, Kallogjeri D, Suko J, Kukuljan S, Schneider J, Piccirillo JF. Effect of Budesonide Added to Large-Volume, Low-pressure Saline Sinus Irrigation for Chronic Rhinosinusitis: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2018 Jul 1;144(7):605-612. doi:10.1001/jamaoto.2018.0667
Nickels AS, Dimov V, Wolf R. Pharmacokinetic evaluation of Oloptadine for the treatment of allergic rhinitis and conjunctivitis. Expert Opin Drug Metab Toxicol. 2011 Dec;7(12):1593-9. doi:10.1517/17425255.2011.630389
Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018 Feb;8(2):108-352. doi:10.1002/alr.22073
Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy. 2008 Jan;38(1):19-42. doi:10.1111/j.1365-2222.2007.02888.x
LaForce CF, Corren J, Wheeler WJ, Berger WE. Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients who remain symptomatic after treatment with fexofenadine. Ann Allergy Asthma Immunol. 2004 Aug;93(2):154-9. doi:10.1016/S1081-1206(10)61468-8
Yanez A, Rodrigo GJ. Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2002 Nov;89(5):479-84. doi:10.1016/S1081-1206(10)62085-6
Carr W, Bernstein J, Lieberman P, et al. A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. J Allergy Clin Immunol. 2012 May;129(5):1282-1289.e10. doi:10.1016/j.jaci.2012.01.077
Debbaneh PM, Bareiss AK, Wise SK, McCoul ED. Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019 Sep;161(3):412-418. doi:10.1177/0194599819841883
Bousquet, Jean, et al. Onset of action of the fixed combination intranasal azelastine- fluticasone propionate in an allergen exposure chamber. J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1726-1732.e6. doi:10.1016/j.jaip.2018.01.031
Price D, Shah S, Bhatia S, et al. A new therapy (MP29-02) is effective for the long-term treatment of chronic rhinitis. J Investig Allergol Clin Immunol. 2013;23(7):495-503.
Cheng LH, Lee JC, Wu PC, Lin YY, Chu YH, Wang HW. Azelastine nasal spray inhibiting sympathetic function on human nasal mucosa in patients with allergy rhinitis. Rhinology. 2019 Aug 1;57(4):268-272. doi:10.4193/Rhin18.274