The American Academy of Otolaryngic Allergy (AAOA) convened an expert, multidisciplinary Working Group on Allergic Rhinitis to discuss patients' self-treatment behaviors and how health care providers approach and treat the condition. PROCEDURES AND DATA SOURCES: Co-moderators, who were chosen by the AAOA Board of Directors, were responsible for initial agenda development and selection of presenters and participants, based on their expertise in diagnosis and treatment of allergic rhinitis. Each presenter performed a literature search from which a presentation was developed, portions of which were utilized in developing this review article.
Allergic rhinitis is a common chronic condition that has a significant negative impact on general health, co-morbid illnesses, productivity, and quality of life. Treatment of allergic rhinitis includes avoidance of allergens, immunotherapy, and/or pharmacotherapy (ie, antihistamines, decongestants, corticosteroids, mast cell stabilizers, anti-leukotriene agents, anticholinergics). Despite abundant treatment options, 60% of all allergic rhinitis patients in an Asthma and Allergy Foundation of America survey responded that they are "very interested" in finding a new medication and 25% are "constantly" trying different medications to find one that "works." Those who were dissatisfied also said their health care provider does not understand their allergy treatment needs and does not take their allergy symptoms seriously. Dissatisfaction leads to decreased compliance and an increased reliance on multiple agents and over-the-counter products. Furthermore, a lack of effective communication between health care provider and patient leads to poor disease control, noncompliance, and unhappiness in a significant portion of patients.
Health care providers must gain a greater understanding of patient expectations to increase medication compliance and patient satisfaction and confidence.
"Overall, between 8 and 9 patients out of 10 declared being satisfied with their second generation oral H1A, which significantly improved their quality of life during treatment. This ratio is high, compared to the 60% of dissatisfied allergic rhinitis patients seeking another medication to improve their health . "
[Show abstract][Hide abstract] ABSTRACT: Second generation H1 antihistamines (H1A) are currently recommended as first choice medications for allergic rhinitis and rhinoconjunctivitis. However, little is known about what influences the choice of prescription of one second generation (H1A) as opposed to another in real-life conditions.
The aim of the study was to identify the main criteria determining the choice of a second generation H1A by allergy specialists in mainland France.
Consecutive patients suffering from allergic rhinitis or rhinoconjunctivitis were included and followed prospectively for 30 days from the prescription of a second generation H1A in monotherapy. Patients were asked to fill in auto-questionnaires at baseline, daily during the first 10 days of the new treatment, and at the end of follow-up. Data on efficacy, tolerance, safety, rate and type of response to treatment, as well as patient satisfaction were recorded and analyzed.
1,080 patients were included between March 2011 and October 2012, mostly suffering from moderate to severe rhinitis (82.0%). The most frequently cited reason for choosing a specific H1A was the expected efficacy (85.3%). The mean time to nasal and ocular recovery was 6 days and 78.2% of patients responded to treatment within this interval. The presence of conjunctivitis was significantly associated with a more rapid response. At the end of follow-up, the satisfaction rate was higher for patients who were switched from a previous treatment (87.5%), compared to those receiving their first treatment (78.8%).
Conclusion and clinical relevance
The main reason for choosing a specific second generation H1A was its expected efficacy. Concomitant conjunctivitis is associated with a more rapid response to treatment. Symptom recovery necessitates a mean of 6 days.
"Allergic respiratory diseases (including allergic rhinitis (AR) and allergic asthma (AA)) are major public health issues, with high prevalence and significant burden [1-5]. The management of respiratory allergy is based on allergen avoidance (when possible) , treatment with symptomatic drugs (such as antihistamines, inhaled, intranasal and systemic corticosteroids, bronchodilators and leukotriene receptor antagonists [1,7-9]) and allergen immunotherapy (AIT). The latter is a guidelines-supported therapy for moderate-to-severe AR and mild-to-moderate AA in patients in whom pharmacological treatment is ineffective, poorly tolerated or unwanted over the long term [1,2,8,9]. "
[Show abstract][Hide abstract] ABSTRACT: The type of allergic sensitization is of central importance in the diagnosis and treatment of respiratory allergic diseases. At least 10% of the general population (and more than 50% of patients consulting for respiratory allergies) are polysensitized. Here, we review the recent literature on (i) the concepts of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity, cross-sensitization, and polyallergy, (ii) the prevalence of polysensitization and (iii) the relationships between sensitization status, disease severity and treatment strategies. In molecular terms, clinical polysensitization can be divided into cross-sensitization (also known as cross-reactivity, in which the same IgE molecule binds to several allergens with common structural features) and co-sensitization (the simultaneous presence of different IgEs binding to allergens that may not necessarily have common structural features). There is a strong overall association between sensitization in skin prick tests and total IgE values but there is debate as to whether IgE thresholds are useful guides to the presence or absence of clinical symptoms in individual cases. Molecular information from component-resolved techniques appears to be of value for diagnosis and treatment decisions. Polysensitization develops over time and is a risk factor for respiratory allergy (being associated with disease severity) and therefore has clinical relevance for treatment decisions. The subterm polysensitization has been defined as polysensitization to between two and four allergens. Polyallergy is defined as clinically confirmed allergy to two or more allergens. Single-allergen grass pollen allergen immunotherapy (AIT) is safe and effective in polysensitized patients, whereas multi-allergen AIT requires more supporting evidence. Given that AIT may be more efficacious in moderate-to-severe disease than in mild disease, polysensitization could be an indication for this type of treatment. There is a need for flowcharts or decision trees for choosing the allergens for AIT in polysensitized patients and polyallergic patients.
"Recent patient preference studies have shown that patients have high expectations of their anti-allergic treatment, desiring attributes such as good symptom relief, quick-onset and long-lasting effects and favourable side effect profile [15,16]. However, patients are often dissatisfied with the efficacy of their treatment which can lead to poor compliance and supplementation with over the counter products . A study of patients under specialist care reported that patients preferred nasal spray to oral treatment, however feared adverse events (such as habituation, damage to mucous membranes, addiction and influence on other organs) of INS therapies . "
[Show abstract][Hide abstract] ABSTRACT: Allergic Rhinitis is an inflammatory disease which is characterised by burdensome nasal and/or ocular symptoms. This study aimed to assess the impact of symptoms (number of symptom-free days (SFD) and Quality of Life (QoL)) in patients with Seasonal Allergic Rhinitis (SAR) being treated with fluticasone furoate (FF), mometasone furoate (MF) or fluticasone propionate (FP).
In a cross-sectional, non-interventional, cohort analysis, primary care physicians and allergy specialists in France, Germany, and Spain were recruited via telephone interviews. Each physician prospectively recruited 4 SAR patients - 2 receiving FF, 1 receiving MF and 1 receiving FP - during June 2009. Patients answered questions on symptoms and completed questionnaires on QoL (mini-rhinoconjunctivitis Quality of Life Questionnaire, RQLQ) and burden of illness (Pittsburgh Sleep Quality Index). ClinicalTrials.gov identifier: NCT01199757.
A total of 540 patients were recruited during June 2009. 88 patients were subsequently found to be ineligible and excluded from the analyses. In the 4 weeks prior to assessment, patients reported a mean of 14.58 (+/-8.42) SFD. Patients receiving FF had more SFD (mean 15.45 +/-8.29) than patients receiving MF (adjusted mean difference -1.22, 95% Confidence Interval (CI) [-3.16 to 0.72], p=0.434) or FP (adjusted mean difference -1.95, 95% CI [-3.87 to -0.03], p=0.092), although statistical significance was not achieved. The mean RQLQ score was 1.54 (+/-1.06). Patients receiving FF had a better quality of life in the previous week (mini-RQLQ score: mean 1.42, +/-1.04) than patients receiving MF (adjusted mean difference 0.28, 95% CI [0.03 to 0.52], p=0.052) or FP (adjusted mean difference 0.18, 95% CI [-0.05 to 0.41], p=0.244) Again, none of these results achieved statistical significance.
At the height of the allergy season, patients with SAR suffer symptoms approximately 50% of the time, and report an impact on their QoL. No significant differences were observed between FF, FP and MF related to SFD or QoL.
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