Allergic rhinitis is nothing to
sneeze at. One in four Canadians grapples with this
inflammation of the nasal mucous membranes. Now, with
spring on its way, your allergy patients are bracing
for yet another season of runny noses and constant congestion
— and you should be bracing for their return to
your office, en masse, looking for advice on how to
cope.
To help you treat your allergy
sufferers, here's a roundup of current and upcoming
therapies.
OLD
MEDS UPGRADED
Corticosteroids Steroid nasal sprays are the
meds of choice to reduce the inflammation in the nose.
"The two newest on the market, mometasone furoate and
fluticasone furoate, don't get into the blood," says
Dr Anne Ellis, a McMaster University allergist and investigator
for research network AllerGen, so there's less potential
for side effects. But there are still local side effects
like a dry nose or nosebleed. However, Dr Ellis offers
one tip that will reduce those as well. "Instruct your
patients to angle the spray towards the ear — that's
where the inflammation is," she says. Pumping it straight
up will direct the med to the cartilage, leading to
local side effects.
Antihistamines Blocking
the histamine produced in the allergy response will
reduce the symptoms — that's hardly news to you
— and many oral antihistamines are available OTC,
so your patients have easy access to them. But here's
something to look forward to: an intranasal antihistamine.
"Azelastine [available in the US, but not yet approved
in Canada] looks very promising, because you're targeting
the therapy where the action is rather than circulating
it in the blood," says Dr Ellis. A study in January's
Annals of Allergy & Asthma Immunology found
that a combo therapy of azelastine and fluticasone furoate
works even better than either one alone.
Immunotherapy If all else
fails, immunotherapy is a last resort for your patients.
"It is the only potential cure, but it has a risk of
anaphylaxis," says Dr Ellis. Right now, the treatment
involves three to five years of regular allergen injections,
but other types are in the works. "A capsule formulation
is in clinical trials," says Dr Ellis.
THE
OLD STANDBYS
It's important to keep up with the latest developments,
of course, but don't forget about the tried and true
therapies.
Decongestants The problem
with nasal spray decongestants is that once your patient
stops using them after a few days, they'll develop a
severe rebound congestion. "To get around that, your
patients can use oral decongestants," suggests Dr Ellis.
But they're not recommended for people with high blood
pressure, she adds.
Leukotriene modifiers These
drugs block the effect of leukotrienes, which are produced
in response to inflammation. Two are available in Canada
— montelukast and zafirlukast — and they are
safe medications, according to Dr Ellis. But they should
only be used as add-on therapy, when decongestants and
corticosteroids aren't enough; these pills get everywhere,
so they tend to be used mostly for asthma patients,
she adds.
Mast cell stabilizers These
nasal sprays work one step up of the histamine pathway,
by preventing histamine release altogether, and ending
the symptoms before they start. The downside? They work
best if they're taken before symptoms develop.
UPCOMING
OPTIONS
p110delta blockers Scientists have identified
a key protein in the allergic reaction, p110delta, according
to a study in the February 15 issue of Immunology. A
drug targeting this protein can nip the allergic response
in the bud without shutting down the immune system —
so fewer side effects. Preclinical trials are set to
start soon.
Phosphodiesterase inhibitor
RPL554 — a drug so new it's still just a number
— is about to go into clinical trials, according
to a February 26 press release from manufacturer Verona
Pharma. The drug blocks the action of two enzymes, PDE
3 and PDE 4, to bring on bronchodilation and reduce
inflammation.
|
