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Ostrom N.K.,Allergy and Asthma Medical Group and Research Center
Allergy and Asthma Proceedings | Year: 2014

This article intends to place new treatments in the context of allergic rhinitis (AR) treatment history. The medical literature was searched for significant advances and changes in AR treatment. Historical data on AR treatment options and management were selected. Reviews of AR management published throughout the 20th century were included to provide context for treatment advances. Modern AR treatment began in the early 20th century with immunotherapy and was soon followed by the emergence of antihistamine therapy in the 1930s. Numerous treatments for AR have been used over the ensuing decades, including decongestants, mast cell stabilizers, and leukotriene receptor antagonists. Topical corticosteroid options were developed the 1950s, and, added to baseline antihistamine therapy, became the foundation of AR treatment. Treatment options were significantly impacted after the 1987 Montreal Protocol, which phased out the use of chlorofluorocarbon propellant aerosols because of environmental concerns. From the mid-1990s until recently, this left only aqueous solution options for intranasal corticosteroids (INSs). The approval of the first hydrofluoroalkane propellant aerosol INSs for AR in 2012 restored a "dry" aerosol treatment option. The first combination intranasal antihistamine/INSs was also approved in 2012, providing a novel treatment option for AR. Treatment of AR has progressed with new therapeutic options now available. This should continue to move forward with agents to alter the allergic mechanism itself and impact the disease burden that has a significant impact on patient outcomes. Copyright © 2014, OceanSide Publications, Inc. Source

Meltzer E.O.,Allergy and Asthma Medical Group and Research Center | Hamilos D.L.,Massachusetts General Hospital
Mayo Clinic Proceedings | Year: 2011

Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed. © 2011 Mayo Foundation for Medical Education and Research. Source

Meltzer E.O.,Allergy and Asthma Medical Group and Research Center | Ratner P.H.,Sylvana Research | McGraw T.,Merck And Co.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2015

Background: Phenylephrine hydrochloride (PE HCl) is widely used for the treatment of nasal congestion, but efficacy at the 10-mg dose is not known for certain. The Food and Drug Administration has requested that sufficiently powered, multicenter, dose-ranging studies be conducted to assess the efficacy and safety of PE HCl. Objective: To evaluate subjective nasal congestion symptom relief and safety of 4 different doses of PE HCl immediate-release 10-mg tablets and placebo in adults with seasonal allergic rhinitis (SAR). Methods: This multicenter, phase 2, parallel, open-label trial randomized 539 adults with SAR (but otherwise healthy) to 7 days of treatment with either PE HCl 10-mg tablets at fixed doses of 10, 20, 30, or 40 mg or placebo. The primary efficacy end point was the mean change from baseline over the entire treatment period in daily reflective nasal congestion score. Other efficacy end points and safety were also evaluated. Results: None of the PE HCl treatment groups had a statistically significant change from baseline in instantaneous or reflective nasal congestion scores compared with the placebo group. PE HCl was well tolerated at doses of up to 30 mg. At least 1 treatment-emergent adverse event was experienced by 18.4% of the participants, the most common being headache (3.0%). Conclusions: PE HCl, at doses of up to 40 mg every 4 hours, is not significantly better than placebo at relieving nasal congestion in adults with SAR. The phenylephrine section of the Food and Drug Administration monograph on over-the-counter cold, cough, allergy, bronchodilator, and antiasthmatic products should be revised accordingly. © 2015 American Academy of Allergy, Asthma & Immunology. Source

Meltzer E.O.,Allergy and Asthma Medical Group and Research Center
Allergy and asthma proceedings : the official journal of regional and state allergy societies | Year: 2012

Allergic rhinitis (AR; also nasal allergies or "hay fever") is a chronic upper airway inflammatory disease that affects ∼60 million adults and children in the United States. The duration and severity of AR symptoms contribute to a substantial burden on patients' quality of life (QoL), sleep, work productivity, and activity. This study was designed to examine symptoms, QoL, productivity, comorbidities, disease management, and pharmacologic treatment of AR in United States and ex-U.S. sufferers. Allergies in America was a comprehensive telephone-based survey of 2500 adults with AR. These data are compared and contrasted with findings from the Pediatric Allergies in America, Allergies in Latin America, and Allergies in Asia-Pacific telephone surveys. The prevalence of physician-diagnosed AR was 14% in U.S. adults, 7% in Latin America adults, and 9% in Asia-Pacific adults. Nasal congestion is the most common and bothersome symptom for adults. Approximately two-thirds of adults rely on medication to relieve intolerable AR symptoms. Incomplete relief, slow onset, <24-hour relief, and reduced efficacy with sustained use were commonly reported with AR medications, including intranasal corticosteroids. One in seven U.S. adults reported achieving little to no relief with AR medications. Bothersome adverse effects of AR medications included drowsiness, a drying feeling, medication dripping down the throat, and bad taste. Perception of inadequate efficacy was the leading cause of medication discontinuation or change and contributed to treatment dissatisfaction. These findings support the assertion that AR burden has been substantially underestimated and identify several important challenges to successful management of AR. Source

Meltzer E.O.,Allergy and Asthma Medical Group and Research Center
Allergy and Asthma Proceedings | Year: 2013

The selection of specific pharmacotherapy for patients with allergic rhinitis (AR)depends on several factors, including age, most prominent symptoms, symptom severity, patient preference, cost, and comorbid conditions. Guidelines focus on immediate symptoms and monotherapy. However, given the often variable course of disease, understanding symptom patterns, and recommending intervention transitions among agents and classes (and from alternative single and combination medications) can aid in optimization of treatment. This review focuses on considerations for combination therapy for AR, particularly in the context of step-up and step-down treatment, and individual symptoms and comorbidities that may benefit from such treatment (e.g., asthma). Relevant clinical studies for treatment of AR and of AR with comorbid asthma and information on treatment guidelines were identified through MEDLINE searches from inception through 2012. Search terms and phrases included "allergic rhinitis," "asthma," "treatmentguidelines," and "stepwise treatment." Stepped methodology is individualized according to patient-specific factors and severity of disease. A possible step-up/step-down approach might move through five stages: step 1, for mild intermittent symptoms, intranasal or oral antihistamine, as needed; step 2, daily intranasal antihistamine(an oral antihistamine or leukotriene antagonist may be considered as an alternative); step 3, daily intranasal corticosteroids (INS); step 4, combination INS and intranasal antihistamines; step 5, further add-on therapy options in severe cases. A step-up/step-down approach to AR pharmacotherapy based on patient response may hold the potential for optimal control of AR symptoms while minimizing side effects and cost of treatment. © 2013, OceanSide Publications, Inc., U.S.A. Source

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