Meta-analysis of azelastine nasal spray for the treatment of allergic rhinitis.
ABSTRACT To systematically review the efficacy of azelastine nasal spray for the treatment of allergic rhinitis.
Meta-analysis of published randomized controlled trials reported in English.
Published literature from the PubMed-MEDLINE database.
Patients aged at least 12 (United States) or 16 years (Europe) with allergic rhinitis or nonallergic vasomotor rhinitis.
A global assessment of efficacy was used to estimate the number needed to treat for azelastine nasal spray compared with placebo or active comparators. The total symptom score was used to compare the effect size between azelastine and placebo. In five comparisons of azelastine and placebo, azelastine was most efficacious, with a summary number needed to treat of 5.0 (95% confidence interval [CI] 3.3-10.0). In reviewing 11 studies of azelastine versus active comparators, we found no significant difference between azelastine and active comparators (number needed to treat 66.7, 95% CI 14.3 to infinity to 25). Azelastine was more efficacious than placebo in terms of total symptom score (effect size of 0.36, 95% CI 0.26-0.46).
Azelastine nasal spray was more efficacious than placebo in the treatment of allergic rhinitis. No significant differences were observed between azelastine and active comparators for the treatment of allergic rhinitis; however, when azelastine was compared with oral antihistamines as monotherapy, the trend favored azelastine. Because azelastine appears to be as efficacious as oral antihistamines, the choice of treatment for seasonal allergic rhinitis should depend on the patient's preference regarding the route of administration, adverse effects, and the cost of the drug.
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ABSTRACT: Topical nasal sprays are commonly prescribed for sinonasal disease. Nasal drops applied in a head-down position are described alternatively to sprays. Multiple research methods have investigated the deposition pattern of intranasal medications, each with limitations. This pilot study analyzed the use of a conebeam computed tomography (CBCT) scanner to study deposition patterns of intranasal sprays and drops using radiopaque contrast solution. Nine volunteers participated in this two-trial study. In trial 1, participants instilled 3 sprays of contrast into each nostril. After 3 minutes a CBCT scan was performed. In trial 2, 3 drops of contrast were instilled into the participants' nostrils in the "vertex-to-floor" position. Again, after 3 minutes a CBCT scan was performed. Two otolaryngologists and a neuroradiologist reviewed the images and scored 21 sites within the sinonasal cavity for the presence of contrast. Contrast was detected in the nasal vestibule and inferior nasal vault in nearly every trial with the spray and drops. Nasal spray was more diffusely distributed within the nasal cavity and was detected at a greater proportion on the floor of the nose, inferior meatus, anterior inferior nasal cavity, and nasopharynx. Neither spray nor drops were consistently detected in spaces superior to the middle turbinate. Radiopaque contrast delivered by nasal spray and drops were detected by the CBCT scanner, with a significant difference at one subsite. Neither spray nor drops were detected in superior nasal spaces. The CBCT scan provides an alternative to conventional CT scans in future studies using this technique.American Journal of Rhinology and Allergy 03/2011; 25(2):94-7. DOI:10.2500/ajra.2011.25.3569 · 2.18 Impact Factor
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ABSTRACT: 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," "treatment guidelines," 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.Allergy and Asthma Proceedings 07/2013; 34(4):301-11. DOI:10.2500/aap.2013.34.3676 · 3.35 Impact Factor
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ABSTRACT: Background Pharmacotherapy for allergic rhinitis is a mainstay of treatment for patients with mild to severe nasal allergy symptoms. A wide array of medical treatment options is available for both episodic relief and prevention of symptoms. Treatment regimens can be tailored to individual patients based on nasal symptoms, severity, and associated atopic disorders. The purposes of this review are to identify available pharmacotherapies for allergic rhinitis, to discuss the benefits and limitations of each treatment option, and to help guide practitioners in providing optimal medical treatment for patients with allergic rhinitis. MethodsA comprehensive review of pharmacotherapies for allergic rhinitis was performed using a PubMed search. Secondary sources within indexed studies were also compiled to review current medication options for patients with allergic rhinitis. The benefits and limitations of each class of allergy medication were reviewed to provide information on selecting the optimal treatment regimen for patients with allergic rhinitis. ResultsPharmacotherapies for allergic rhinitis that are currently used in clinical practice include antihistamines, corticosteroids, leukotriene modifiers, mast cell stabilizers, expectorants, and decongestants. Symptoms of nasal congestion, itching, sneezing, and rhinorrhea can be targeted with specific therapies that modulate the acute-phase or late-phase allergic reactions. Associated atopic disorders, including conjunctivitis and asthma, can help guide medication selection. Conclusion Pharmacotherapies for allergic rhinitis offer numerous options that are safe, effective, and readily available to target specific nasal symptoms. Symptom-based selection of allergy medications can result in optimal treatment for patients with allergic rhinitis. (C) 2014 ARS-AAOA, LLC.International Forum of Allergy and Rhinology 09/2014; 4 Suppl 2(S2):S35-40. DOI:10.1002/alr.21381 · 2.37 Impact Factor