Allergic rhinitis, commonly called hay fever, is nothing to sneeze at. In fact, it requires a systematic treatment approach, according to new guidelines that outline the prevalence and health burden of the disorder.
“Allergic rhinitis (AR) is a prevalent disorder responsible for a significant and often underappreciated health burden for individuals and society,” the authors of the document stated. The study was presented at the 2017 American College of Allergy, Asthma and Immunology (ACAAI) annual meeting.
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Allergic rhinitis. (Source: Blausen Medical)
“Guidelines to improve care for patients with AR have been evolving in an effort to respond to the introduction of new treatment approaches, to address the availability of additional studies that compare treatment options, and to incorporate the use of more standardized, evidence-based medicine methods to analyze data and make recommendations.”
The ACAAI estimates that as many as 7.8% of U.S. adults have hay fever, while, worldwide, allergic rhinitis affects between 10% and 30 % of the population and sensitization (IgE antibodies) to foreign proteins in the environment is present in up to 40% of the population. In 2012, 17.6 million adults and 6.6 million children were diagnosed with hay fever over a 12-month period. In 2010, 11.1 million visits to physician offices resulted with a primary diagnosis of allergic rhinitis, according to the physician group.
The new guidelines, published in Annals of Allergy, Asthma and Immunology, include practical advice on selecting optimal medications for treating seasonal allergic rhinitis.
“The Joint Task Force on Practice Parameters (JTFPP) formed a workgroup to develop a focused, systematic review to provide guidance to health care providers for the treatment of seasonal allergic rhinitis (SAR) in patients under the age of 12,” Dana Wallace, MD, past ACAAI president, co-author of the guideline, and allergist based in Florida, said in a press release.
The recommendations state that, for initial treatment of SAR in adults, clinicians should:
- routinely prescribe monotherapy with an intranasal corticosteroid (INCS) rather than INCS in combination with an oral antihistamine.
- recommend an INCS over a leukotriene receptor antagonist, and
- recommend the combination of an INCS and an intranasal antihistamine for initial treatment in severe cases.
“There is a strong message in the guidelines promoting the importance of shared decision-making with patients,” Mark Dykewicz, MD, an allergist at St. Louis University and lead author of the guidelines, said in a press release.
“The guideline encourages physicians to make patients aware that taking two medications, e.g., using a combination of drugs, such as an oral antihistamine and INCS, is not always better than using a single drug such as an INCS. In contrast, the combination of an intranasal antihistamine and an intranasal corticosteroid does lead to greater relief than use of either medication by itself. Yet, using the two types of drugs in a combination nose spray product will likely be more expensive than using either a single nose spray such as an INCS, or using two individual medication sprays to deliver the combination.”
The concern, Dykewicz stated, is that using both medications, either combined or separately, could increase side effects. Among those is a bad taste described by some patients; it is attributed to the nasal antihistamine component.
According to the press release, this is the first JTFPP guideline to use a GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology, which is an evidence-based approach to making clinical recommendations.
“We want physicians to know it is a very different type of guideline than our previous practice parameters,” Dr. Wallace said.
“We believe the first and third recommendations will confirm the experience of most allergists. Physicians will likely consider using the combination recommended in #3 more quickly if not initially for moderate-to-severe patients.”
