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PubMed2003

Recognizing and treating non-infectious rhinitis.

PURPOSE: To increase clinicians' familiarity with nonallergic and mixed rhinitis and to differentiate these from allergic rhinitis, thus providing for an accurate diagnosis and facilitating a successful initial treatment program. DATA SOURCES: A Medline search of published journal articles was supplemented with known books and proceedings pertaining to rhinitis. CONCLUSIONS: Although there is significant overlap of symptoms among the three types of rhinitis (i.e., allergic, nonallergic, and mixed), the patient history often contains clues that can aid in establishing a correct diagnosis. The new Patient Rhinitis Screen, a questionnaire developed for use in the primary care arena, facilitates the diagnostic process. IMPLICATIONS FOR PRACTICE: As the most common condition in the outpatient practice of medicine, rhinitis is frequently treated by primary care practitioners. Recent guidelines for the diagnosis and management of rhinitis suggest that a specific diagnosis of allergic, nonallergic, or mixed rhinitis leads to more effective treatment strategies. The result is successful and efficient care utilizing, as appropriate, broad-based and symptom-specific therapies.

Clinical Competence↗
PubMed1980

Medical management of noninfectious rhinitis.

Noninfectious rhinitis and the clinical pharmacology of drugs used in its treatment, including specific treatment recommendations, are reviewed. Characterized by hyperreactivity of the nasal mucosa to a variety of stimuli, noninfectious rhinitis can be classified either as seasonal or perennial allergic rhinitis (when antigens can be identified) or as vasomotor or nonallergic rhinitis (when antigens are not identifiable). However, noninfectious rhinitis is probably better viewed as a continuum between these extremes rather than as definitive categories. Treatment measures include removal of offending agents when possible, and injection of allergenic extracts to decrease sensitivity to inhalant allergens. Among the pharmacologic alternatives, the classical H1 antihistamines competitively inhibit the action of mast-cell histamine at its receptor sites and thus decrease sneezing, nasal pruritus, rhinorrhea, and conjunctivitis. Orally bioavailable alpha-adrenergic agents such as pseudoephedrine and phenylpropanolamine decrease nasal congestion that responds poorly to antihistamines. Topical vasoconstrictors are contraindicated in chronic rhinitis because of the complications of rebound congestion. Systemic corticosteroids are effective but rarely appropriate for chronic rhinitis. Potent topical corticosteroids such as intranasal beclomethasone dipropionate are useful for severe nasal congestion. Cromolyn sodium, an inhibitor of histamine release from mast cells, appears to have some efficacy in suppressing symptoms of allergic rhinitis and conjunctivitis when used topically. Anticholinergics have occasionally been recommended to reduce rhinorrhea, but little data on their efficacy are available.

Adolescent↗
PubMed1997

Air pollution in relation to allergic and nonallergic rhinitis.

OBJECTIVE: To investigate the relationship between allergic and nonallergic rhinitis and the exposure to air pollution. DESIGN: Blood cadmium levels were measured in 30 patients with allergic rhinitis, 30 patients with nonallergic rhinitis, and 16 normal control subjects using atomic absorption spectrophotometry. The cadmium level was used as a parameter of degree and proximity of exposure to air pollution from various sources. SETTING: Ain Shams University, a tertiary care referral center in Cairo, Egypt. RESULTS: Blood cadmium levels were significantly high in the allergic rhinitis group compared with the nonallergic rhinitis and control groups (P < .001). The mean blood cadmium level in the nonallergic rhinitis group was higher than that in the controls, yet the difference was statistically insignificant. Also, cadmium levels were above the 95% confidence interval in only 7% of this group. Blood cadmium levels in the controls (16.33 +/- 2.98 [SD] micromol/L [183.62 +/- 33.5 micrograms/dL) were much higher than those reported from areas of high cadmium pollution (0.88-2.66 micromol/L [10-30 micrograms/dL]). CONCLUSION: The significantly high blood cadmium levels in patients with allergic rhinitis may reflect a causal relationship between air pollution and this condition. The exact mechanism, however, remains to be determined. In nonallergic rhinitis, it seems that the contribution of air pollution as a predisposing factor is small compared with the other known predisposing factors.

Adolescent↗
PubMed2004

The suggestive association of eotaxin-2 and eotaxin-3 gene polymorphisms in Korean population with allergic rhinitis.

The eotaxin gene family (eotaxin, eotaxin-2 and eotaxin-3) has been implicated in the recruitment of eosinophils, basophiles and Th2 lymphocytes that are central aspects of allergic diseases. To determine whether single-nucleotide polymorphisms (SNPs) of the eotaxin-2 and eotaxin-3 genes are associated with susceptibility to allergic rhinitis, we scanned 178 allergic rhinitis patients and 281 controls without allergic rhinitis using the direct sequencing and single-base extension (SBE) methods. We also calculated the haplotype frequencies between +179T>C and +275C>T of eotaxin-2 and +2497T>G of eotaxin-3 in both controls and allergic rhinitis patients. The haplotype frequency between controls and allergic rhinitis patients was suggestively associated (P=0.0001). The genotype frequencies of eotaxin-3 +2497T>G in allergic rhinitis patients were suggestively different from those in non-allergic rhinitis controls (P=<0.0007). Our results strongly suggest that the SNP of eotaxin-3 might be associated with susceptibility to allergic rhinitis.

Chemokine CCL24↗
PubMed2004

Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis.

PURPOSE: To compare the clinical efficacy of leukotriene receptor antagonists with that of placebo, antihistamines, and nasal corticosteroids in patients with allergic rhinitis or nasal polyposis. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials of the effectiveness of leukotriene receptor antagonists in patients with rhinitis. Composite daily rhinitis symptom scores (as a percentage of the maximum score) and rhinitis-specific quality of life (unit scores ranging from 0 to 6) were pooled after assessing heterogeneity among studies. The pooled estimates were expressed as weighted mean differences between treatments in a random-effects model. We considered a difference of 10% in nasal score and 0.6 units in quality-of-life score to be clinically relevant. RESULTS: Of the 196 citations, 11 studies on seasonal allergic rhinitis were used in the analysis: eight evaluating leukotriene receptor antagonists alone or in combination with other treatments versus placebo or other treatments (n = 3924) and three evaluating leukotriene receptor antagonists plus an antihistamine (n = 80). Leukotriene receptor antagonists reduced mean daily rhinitis symptom scores (in absolute terms) 5% (95% confidence interval [CI]: 3% to 7%) more than did placebo. However, antihistamines improved the nasal symptoms score 2% (95% CI: 0% to 4%) more than did leukotriene receptor antagonists, and nasal corticosteroids improved the score 12% (95% CI: 5% to 18%) more than did leukotriene antagonists. Leukotriene receptor antagonists significantly improved rhinoconjunctivitis quality of life by 0.3 units (95% CI: 0.24 to 0.36 units) when compared with placebo. There were no randomized controlled trials evaluating the effect of leukotriene receptor antagonists on perennial allergic rhinitis or polyposis. CONCLUSION: Leukotriene receptor antagonists are modestly better than placebo, as effective as antihistamines, but less effective than nasal corticosteroids in improving symptoms and quality of life in patients with seasonal allergic rhinitis.

Drug Therapy, Combination↗
PubMed2006

Dietary intake of seaweed and minerals and prevalence of allergic rhinitis in Japanese pregnant females: baseline data from the Osaka Maternal and Child Health Study.

PURPOSE: It may be worthwhile to assess the possible protective effect of the traditional Japanese diet on allergic disorders. This cross-sectional study investigated the relationship between dietary intake of seaweed, vegetables, fruit, antioxidants, fiber, and minerals and the prevalence of allergic rhinitis. METHODS: Study subjects were 1002 Japanese pregnant women. Allergic rhinitis (including cedar pollinosis) was defined as present if subjects had received drug treatment at some point during the previous 12 months. Information on dietary factors was collected by using a self-administered diet history questionnaire. RESULTS: Seaweed intake was associated independently with a decreased prevalence of allergic rhinitis. Significant inverse dose-response relationships were found between calcium and phosphorus intake and allergic rhinitis prevalence. There also was a tendency for an inverse association between magnesium consumption and allergic rhinitis. Additional adjustment for calcium or magnesium intake apparently did not influence the inverse association with seaweed consumption. Consumption of vegetables, fruit, vitamins C and E, fiber, and zinc showed no association with allergic rhinitis, whereas a significant positive relationship was observed between beta-carotene intake and allergic rhinitis. CONCLUSIONS: High dietary intake of seaweed, calcium, magnesium, and phosphorus may be associated with a decreased prevalence of allergic rhinitis.

Adult↗
PubMed2006

Impact of occupational and inhalant allergy on rhinitis-specific quality of life in employees of bell pepper greenhouses in the Netherlands.

BACKGROUND: Rhinitis symptoms among bell pepper greenhouse employees can be caused by an allergy to occupational allergens, such as bell pepper pollen and predatory mites, and common inhalant allergens. OBJECTIVES: To estimate the effect of sensitization to these allergens on rhinitis-specific quality of life (QoL) during and outside the flowering period and to evaluate whether the QoL of sensitized employees is comparable with that of chrysanthemum greenhouse employees with rhinitis and an average population sample with perennial rhinitis. METHODS: We invited 233 employees with rhinitis symptoms to complete 2 rhinitis QoL questionnaires and to undergo skin prick testing with common inhalant allergens and occupational allergen extracts. Multiple regression analysis was used to estimate the impact of sensitization to the various allergens on QoL. RESULTS: Sensitization to bell pepper pollen had a significant negative effect on all the domain and mean QoL scores. The other allergens had no effect on QoL. A significant decrease in all the rhinitis scores was found outside the flowering period. There were no relevant differences in the mean scores of the different domains for both occupational groups. Greenhouse employees scored higher on limitations in activities and much lower on emotional, sleeping, and practical problems compared with individuals with perennial rhinitis. CONCLUSIONS: Bell pepper greenhouse employees are impaired in QoL because of their sensitization to bell pepper pollen, suggesting that bell pepper pollen is the most important occupational allergen in greenhouse workers with allergic symptoms. A common allergy does not have more impact on a person's day-to-day life than an occupational allergy; however, there is a clear difference in the way in which an occupational group is hampered compared with a nonoccupational group.

Adolescent↗
PubMed1999

Changing prevalence of allergic rhinitis and asthma.

OBJECTIVE: This review will enable the reader to discuss prevalence, risk factors, and prognosis of allergic rhinitis and asthma. DATA SOURCES: MEDLINE (PubMed) search using the terms allergic rhinitis, asthma, prevalence, risk factors. STUDY SELECTION: Human studies published in the English language since 1978, especially studies of relatively large populations in the United States, Great Britain, Australia, and New Zealand, with cross referencing to earlier relevant studies. RESULTS: Current prevalence of allergic rhinitis at 16 years of age in cohorts of British children born in 1958 and 1970 increased from 12% in the earlier cohort to 23% and in the later cohort. Local surveys of allergic rhinitis at approximately 18 years of age in the United States in 1962 to 1965 disclosed prevalence of 15% to 28%, while the national survey of 1976 to 1980 disclosed a prevalence of 26%. Thus, it is uncertain whether prevalence of allergic rhinitis has changed in the United States based on these limited data. Data from several sources indicate worldwide increases in prevalence of asthma. Annual Health Interview surveys indicate increases in prevalence of asthma in the United States from 3.1% in 1980 to 5.4% in 1994, but prevalence among impoverished inner city children has been much higher. Combined prevalence of diagnosed and undiagnosed asthma among inner city children has been 26% and 27% at 9 to 12 years of age in Detroit and San Diego. Positive family history and allergy are important risk factors for allergic rhinitis and asthma. Prognosis is guarded; allergic rhinitis resolves in only 10% to 20% of children within 10 years, and at least 25% of young adults who have had asthma during early childhood are symptomatic as adults. CONCLUSION: Increases in prevalence remain unexplained, but avoidance of recognized allergens should reduce the prevalence of allergic rhinitis and asthma.

Adolescent↗
PubMed1998

Variability of peak expiratory flow rate in allergic rhinitis and mild asthma: relationship to maximal airway narrowing.

BACKGROUND: Previous studies have demonstrated a significant correlation between airway sensitivity to pharmacologic agents and daily peak expiratory flow rate (PEF) variation in asthmatic and nonasthmatic subjects. OBJECTIVE: The aim of this study was to investigate, both in patients with asthma and in subjects with allergic rhinitis, differences in daily PEF variation between subjects with plateau on the concentration-response curves to methacholine and those without plateau. METHODS: A total of 120 adults (50 with mild asthma, 52 with allergic rhinitis, and 18 healthy control subjects) were challenged with methacholine (up to 200 mg/mL) and, for the next 14 days, measured their PEF three times daily. The response to methacholine was measured by the percent decrease in FEV1. A maximal response plateau was considered if three or more of the highest concentrations fell within a 5% response range. Diurnal PEF variation was expressed as the amplitude percent mean. RESULTS: A plateau response was detected in 11 (22%) asthmatic patients, in 33 (63%) subjects with allergic rhinitis, and in 17 (94%) healthy subjects. Diurnal PEF variation was significantly greater (P < .01) in the asthmatic group without a plateau (8.8 +/- 3.7%) compared with the three groups with a plateau (asthma = 5.5 +/- 2.9%; allergic rhinitis = 4.6 +/- 2.1%; healthy = 4.7 +/- 2.3%). Those three groups with a plateau were not significantly different from each other with respect to PEF variability. Diurnal PEF variation was significantly higher in allergic rhinitis patients without plateau (7.6 +/- 3.5%) than in allergic rhinitis patients with plateau (P < .01) and healthy subjects (P < .05). The rhinitic group without a plateau, however, was not significantly different from either the asthmatic group without plateau or the asthmatic group with plateau. CONCLUSIONS: We conclude that in both asthmatic patients and subjects with allergic rhinitis, the shape of the concentration-response curve to methacholine provides new information on the relationship between airway responsiveness and PEF variability. Further, allergic rhinitis subjects without evidence of plateau have a degree of diurnal PEF variation similar to that found in patients with mild asthma. This could indicate that those subjects may have subclinical inflammatory changes in the airways.

Adolescent↗
PubMed1998

Nasal cytology in the diagnosis of allergic rhinitis in children.

BACKGROUND: Inflammatory cellular infiltrates of eosinophils and basophilic metachromatic cells are the hallmark of the atopic nasal responses in allergic rhinitis. Nasal cytologic examination for these cells not only establishes the diagnosis of allergic rhinitis but is also useful in the followup of patients with this condition. OBJECTIVES: To determine the usefulness of quantitative nasal cytology as an adjunctive diagnostic tool for children with allergic rhinitis in addition to history, physical examination and allergy skin testing. MATERIALS AND METHODS: Forty-eight children with allergic rhinitis less than 15 years of age were recruited and evaluated for the following variables: symptoms and signs of allergic rhinitis, skin prick tests to common aeroallergens, paranasal sinus radiographs, and nasal cytology. Forty-one normal and healthy children less than 15 years of age served as controls. Nasal mucosal specimens were obtained by scraping the middle one-third of inferior turbinates with Rhinoprobes and were stained with Wright-Giemsa stain. Nasal cytology was examined under a light microscope and graded according to a previously suggested scoring system. RESULTS: There were distinctive differences in the scores for nasal eosinophils and basophilic metachromatic cells between the allergic rhinitis and the control groups (P < .001). The sensitivity for nasal eosinophil scores or nasal basophilic metachromatic cell scores more than 0.5 in the diagnosis of allergic rhinitis was 91.7% with a specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.1%. Presence of polymorphonuclear cells did not correlate with the presence of sinusitis as diagnosed by paranasal sinus radiographs. Nasal eosinophil scores correlated significantly with sign scores (P = .009). House dust mites were the most common allergens sensitized by this group of children (67.4% to 88.4%). CONCLUSION: Nasal cytology is a quick, simple, and inexpensive tool not only for the diagnosis of allergic rhinitis but also for serial evaluations of children with this condition as well.

Basophils↗
PubMed1997

Inhibition of the sodium, potassium adenosine triphosphatase enzyme in peripheral blood mononuclear cells of subjects with allergic rhinitis.

BACKGROUND: Previous investigations have documented that a sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme inhibitor is bound to the platelet membrane, displaced from the platelet membrane by freezing, and present in the plasma of subjects with allergic rhinitis. Others have shown that stimulation of Na+,K+ ATPase is an important early event in mitogen-induced activation of peripheral blood mononuclear cells. OBJECTIVE: The purpose of this study was to determine whether the Na+,K+ ATPase enzyme inhibition observed in the platelets of subjects with allergic rhinitis also extends to peripheral blood mononuclear cells. METHODS: Na+,K+ ATPase activity of a particulate fraction of sonicated peripheral blood mononuclear cells was determined by spectrophotometry in asymptomatic adults with and without allergic rhinitis. RESULTS: The mean Na+,K+ ATPase activity of peripheral blood mononuclear cells expressed as nanomoles per microgram protein per minute (nM/ microgram protein/ min) +/-1 standard deviation of the subjects with allergic rhinitis (n = 14) was 1.04 +/- 1.01, while that of the control subjects (n = 12) was 3.57 +/- 1.60 (P < or = .001). In contrast, when the peripheral blood mononuclear cell membranes were frozen and then thawed prior to assay, the mean Na+,K+ ATPase activity for the subjects with allergic rhinitis (n = 24) was 5.33 +/- 2.62, while that of the control subjects (n = 23) was 1.12 +/- 1.24 (P < or = .001). Samples from a subset of subjects (n = 5) were assayed for both pre-freezing and post-freezing Na+,K+ ATPase activity. The freezing process was associated with a striking increase in Na+,K+ ATPase levels of subjects with allergic rhinitis (4.42 +/- 2.06) but a decrease in those of the control subjects (-3.89 +/- 0.95; P < or = .001). CONCLUSIONS: These data demonstrate that peripheral blood mononuclear cells from subjects with allergic rhinitis, like platelets, possess a membrane-bound Na+,K+ ATPase inhibitor that is displaced from the membrane by freezing. In vivo Na+,K+ ATPase inhibition could have significant effects on the activation and function of peripheral blood mononuclear cells in subjects with allergic rhinitis.

Freezing↗
PubMed2004

Mucosal T-cell phenotypes in persistent atopic and nonatopic rhinitis show an association with mast cells.

BACKGROUND: Allergic rhinitis is characterized by selective expansion of T cell subsets with a CD4+ phenotype. Recently, we identified a subpopulation of nonallergic rhinitis subjects with increased epithelial mast cell and eosinophil populations, suggestive of local mucosal allergy. Previously, T cell subsets have not been characterized in this subselection of nonallergic subjects and furthermore, their relationship to mast cell and basophil effector cells remain unidentified. OBJECTIVE: To determine if a subpopulation of nonallergic subjects with idiopathic rhinitis (IR) have localized allergy confined to their nasal mucosa by comparing the T cell subsets and major histocompatibility complex (MHC) II expressing cells to persistent allergic rhinitis (PAR). Furthermore, the relationship between T cell subsets and mast cells/basophils was investigated. METHODS: None of the symptomatic patients in this study were clinically allergen-challenged. Nasal turbinate mucosa was removed from patients with PAR, IR and normal controls. Morphometry was performed on immunostained sections for T cell subset populations including CD3+, CD4+, CD8+, CD25+, CD45RA+, CD45RO+, human leucocyte antigen (HLA)-DRalpha (MHC class II), mast cell tryptase and for basophils. RESULTS: Subjects with persistent allergic rhinitis differed to normal controls in showing significantly increased numbers of total (CD3+), activated (CD25+) and allergen-naïve (CD45RA+) T lymphocytes in their nasal mucosa (P < 0.025). The naïve CD45RA+ memory T cells correlated to mucosal mast cells in PAR (P = 0.03). IR patients differ to allergic subjects in showing significantly reduced numbers of epithelial HLA-DRalpha+ cells (P = 0.007), but increased numbers of CD8+ lymphocytes (P = 0.02). The CD8+ T cells correlated with mucosal mast cell numbers (P = 0.02). In both rhinitis groups, basophils were present in very low numbers obviating the need for statistical analysis. CONCLUSION: PAR is characterized by increased numbers of CD3+, CD25+ and CD45RA+ T lymphocytes compared with normal mucosa. Allergic and nonallergic rhinitis groups can be separated by significant differences in the number of epithelial antigen presenting cells (APCs) (HLA-DRalpha+) and sub-epithelial activated (CD25+) T cells. Moreover, IR patients do not significantly differ to their allergic counterparts with respect to total (CD3+) and naïve (CD45RA+) T cell numbers, or numbers of epithelial activated (CD25+) lymphocytes. IR subjects show significantly increased numbers of CD8+ lymphocytes compared with control mucosa and although our findings suggest that the initiating inflammatory events may differ, both rhinitis groups show a similarity in pathology involving mucosal mast cells with an association to infiltrating T cells.

Adolescent↗
PubMed2006

Local mucosal immunoglobulin E production: does allergy exist in non-allergic rhinitis?

In this review, we critically evaluate the evidence for local IgE production in allergic rhinitis mucosa and the concept of local allergy in non-atopic idiopathic rhinitis. Significantly, fewer studies have focused on the disease pathways associated with non-allergic rhinitis compared with their allergic counterparts. Recently, there's been a revival of the hypothesis concerning the existence of local tissue-specific allergic disease confined to the nasal mucosa of some systemically non-atopic rhinitis subjects. Providing the evidence for local mucosal IgE production in allergic rhinitis is a pre-requisite to reviewing its existence in non-allergic rhinitis. In addition, practical and theoretical approaches useful in the detection of allergy in non-allergic rhinitis will be discussed. Furthermore, successful therapeutic regimens used in the treatment of non-allergic rhinitis will be examined as these could provide an insight into the underlying pathophysiology of this common but poorly understood disease.

Allergens↗
PubMed1992

A 10-year prognosis for childhood allergic rhinitis.

The prognosis of allergic rhinitis was studied in 154 children aged 3-17 years at diagnosis by means of a detailed questionnaire administered 8-11 years later. The symptoms had completely disappeared in only 15 (10%) patients. The conjunctival symptoms, however, had disappeared or were controlled successfully by topical drug therapy in almost all, and 77 (50%) were managing without medication for allergic rhinitis. Twenty-five (23%) of the 110 children with seasonal allergic rhinitis had a perennial disease at follow-up, in contrast to seven (16%) of 44 with perennial allergic rhinitis originally who had only seasonal symptoms at follow-up. Asthma or wheezing had developed in 29 cases (19%) and was more common (p less than 0.01) among those with perennial allergic rhinitis (15 of 44) than among those with seasonal allergic rhinitis (14 of 110). No significant association was found between age at onset of symptoms, family history of atopic disease or type of treatment for allergic rhinitis and allergic rhinitis still present at follow-up or development of asthma during the observation period.

Adolescent↗
PubMed2000

Onset and remission of allergic rhinitis and asthma and the relationship with atopic sensitization and smoking.

The aim of this study was to assess the influence of some risk factors for onset and remission of allergic rhinitis and asthma in Swedish adults. A random sample of 1,370 subjects, age 20 to 44 yr was investigated by means of postal questionnaires in 1990 and 1993. Skin prick tests were conducted in 1991-1992. The association between risk factors and onset or remission of allergic rhinitis and asthma was estimated using multivariate logistic regression analysis. Onset of allergic rhinitis was associated with sensitization to birch (odds ratio [OR] = 6.5), Parietaria (OR = 7.4); and pets (OR = 3.0) and with female sex (OR = 1.9). Onset of asthma was associated with allergic rhinitis (OR = 4.9), sensitization to pets (OR = 2.4); and with smoking (OR = 3.0). Onset of asthma was strongly associated with allergic rhinitis among atopics (OR = 5.7), but onset of asthma and rhinitis also tended to be related among nonatopics (OR = 3.5). A strong association between smoking and onset of asthma was found among nonatopics (OR = 5.7). In conclusion, sensitization to pollens and pets were risk factors for onset of allergic rhinitis, whereas allergic rhinitis, sensitization to pets, and smoking were risk factors for onset of asthma.

Adult↗
PubMed1998

Mometasone furoate. A review of its intranasal use in allergic rhinitis.

UNLABELLED: Mometasone furoate is a synthetic corticosteroid which has been evaluated for intranasal use in the treatment of adults and children with allergic rhinitis. In several large, well-controlled clinical trials, mometasone furoate 200 micrograms administered once daily as an aqueous intranasal spray was significantly more effective than placebo in controlling the symptoms associated with moderate to severe seasonal or perennial allergic rhinitis. Mometasone furoate was as effective as twice-daily beclomethasone dipropionate or once-daily fluticasone propionate in the treatment of perennial allergic rhinitis, and was as effective as twice-daily beclomethasone dipropionate and slightly more effective than once-daily oral loratadine in the treatment of seasonal allergic rhinitis. Mometasone furoate was also as effective as twice-daily beclomethasone dipropionate or once-daily budesonide, and significantly more effective than placebo in the prophylaxis of seasonal allergic rhinitis. The onset of action of mometasone furoate was approximately 7 hours in patients with seasonal allergic rhinitis. Mometasone furoate was as well tolerated as beclomethasone dipropionate, fluticasone propionate and budesonide in clinical trials, with an overall incidence of adverse events similar to placebo. Adverse events were generally mild to moderate and of limited duration. The most common adverse events associated with mometasone furoate therapy were nasal irritation and/or burning, headache, epistaxis and pharyngitis. Intranasal or oral mometasone furoate had no detectable effect on hypothalamic-pituitary-adrenal axis function in studies of < or = 1 year in duration. CONCLUSIONS: Mometasone furoate is a well tolerated intranasal corticosteroid with minimal systemic activity and an onset of action of < or = 7 hours. It is effective in the prophylaxis and treatment of seasonal allergic rhinitis and the treatment of perennial allergic rhinitis in patients with moderate to severe symptoms.

Anti-Allergic Agents↗
PubMed2004

Cost-benefit analysis of first-generation antihistamines in the treatment of allergic rhinitis.

BACKGROUND: The majority of individuals with allergic rhinitis in the US take first-generation antihistamines (FGAs). Although FGAs have been proven effective in alleviating allergic rhinitis symptoms, they have been associated with an increased risk of motor vehicle, aviation and occupational injuries and deaths, reduced productivity and impaired learning. OBJECTIVE: The objective of this analysis was to quantify the total costs and benefits of FGA use in the US from the societal perspective. METHODS: We used a decision-analytic model to quantify the annual societal costs and benefits of treatment with FGAs compared with the hypothetical alternative of no treatment for the population of individuals with allergic rhinitis and taking FGAs in the US in 2001. The benefit associated with FGA use was estimated using the willingness-to-pay framework and projected to the US population using published estimates of the prevalence of allergic rhinitis. The costs of FGA-associated sedation included lost productivity and the direct and indirect cost of unintentional injuries (including motor vehicle, occupational, public and home injuries and fatalities). The incidence of injuries and fatalities associated with FGA use was estimated using the risk of injury attributable to the sedentary effects of FGAs in the allergic rhinitis population. To evaluate uncertainty in the model assumptions, a probabilistic sensitivity analysis was conducted using Bayesian second-order Monte Carlo simulation. Costs and benefits are expressed in 2001 US dollars, using a 3% discount rate. RESULTS: Based on current utilisation, the total societal benefit (95% credible interval) associated with the use of FGAs for the treatment of allergic rhinitis was US 7.7 billion dollars (US 1.3 billion dollars to US 21 billion dollars). The societal cost of purchasing FGAs was only US 697 million dollars. However, the societal cost of FGA-associated sedation was US 11.3 billion dollars (US 2.4 billion dollars to US 50.8 billion dollars). The annual societal net benefit of FGA use for the treatment of allergic rhinitis in the US was -US4.2 billion dollars (-US 36 billion dollars to +US 0.296 billion dollars). The net benefit was negative in 97% of the 10,000 Monte Carlo simulations. CONCLUSIONS: The societal benefits of FGA use in alleviating the symptoms of allergic rhinitis are significant. However, based on the assumptions, probability distributions and parameter estimate ranges used in the current model, it is very likely that the costs associated with sedation exceed the benefits of FGA use in the US. The cost of FGA-associated sedation is comparable to estimates of the cost of all medical care expenditures on respiratory conditions in the US (US 12.1 billion dollars to US 31.3 billion dollars) [1996 values] and provides compelling evidence of the economic burden of sedation associated with FGA use.

Accidents↗
PubMed2000

[Nasal soluble levels of ICAM-1 in allergic rhinitis].

UNLABELLED: Adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1), play an important role in the development of the inflammatory allergic response in the nose. ICAM-1 expression on nasal epithelial cells during allergic reaction is regarded as a major hallmark of allergic inflammation. OBJECTIVE: The aim of the study was to evaluate the levels of soluble ICAM-1 (sICAM-1) in nasal epithelial lining fluid (ELF) in patients with allergic rhinitis. PATIENTS: Seventeen patients with perennial allergic rhinitis (age: 34,6 +/- 14,6) were screened and the results were compared with those from 11 seasonal allergic rhinitis patients (age: 25.9 +/- 7.4) and 10 non-allergic patients. METHODS: The study was performed outside the pollen season. The scores of subjective symptoms were estimated by two differents methods. First, on the basis of a visual analog scale for the symptoms including nasal obstruction, rhinorrhea, sneezing and pruritus. This score was called "Autoscore" (fullmark =40 points). Second, on the basis of a four mark scale for each symptom defined (0 =no symptom, 1 =mild, 2 =moderate, 3 =severe). This score was called "Heteroscore" (fullmark =12 points). Specimens of nasal mucosa were collected by brushing the surface of nasal cavity. Levels of sICAM-1 and sECP (soluble Eosinophilic cationic protein) were measured by specific enzyme-linked immunosorbent assay. RESULTS: The levels of sICAM-1 in ELF were significantly higher (p <0.01) in patients with perennial rhinitis compared to patients with seasonal rhinitis outside the pollen season and to non allergic patients. Levels of sICAM-1 in patients with perennial allergic rhinitis were correlated with levels of sECP (p <0.003) and with the four mark scale scores (p <0. 03) but did not correlate with the visual analog scale scores. CONCLUSIONS: sICAM-1 increased in nasal secretions during natural perennial rhinitis and could be considered as a representative hallmark for clinical severity and follow-up evaluation in perennial allergic rhinitis.

Adult↗