MARCH 2008


Research Roundup

New tools help MDs treat allergies

New versions of old drugs fight rhinitis better

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.

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.

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.

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.



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