DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20175615

Comparative clinical evaluation of effect of topical verses systemic anti -allergic drug in allergic rhinitis: a prospective study

Sunil Kumar Singh Bhadouriya, Mohit Srivastava, Rohit Saxena, Abhinav Srivastava

Abstract


Background: Nasal passages form one of the chief sources of contact of the human with his environment. Hence, it is natural that the mucosa of the area is the victim of assault with multitudes of potential allergens. Allergic rhinitis is an inflammatory disease with worldwide prevalence of 10-40%. Allergic rhinitis is a disease with low mortality but significantly lowers the quality of life and functioning. Both oral and intranasal antihistamines are approved for the first-line treatment of allergic rhinitis and both formulations result in a reduction in symptoms and an improvement in quality of life.

Methods: The following study was designed to assess the efficacy and safety of the azelastine nasal spray in comparison to levocetrizine in patients with allergic rhinitis. Out of the 68 patients, 34 cases were treated with topical azelastine (group A), while remaining 34 with systemic levocetrizine (group B). The effects of anti-allergic drugs have been studied on the basis of relief of symptoms and change in histopathology.  

Results: The effect of levocetrizine has been studied on the basis of relief of symptoms and change in histopathology and found to have complete response in 58% and fair response in 23.5% patients of allergic rhinitis. The effect of topical azelastine nasal spray have complete response in 70.5% and fair response in 23.5% patients of allergic rhinitis.

Conclusions: Comparing the post therapy clinical and histopathological results in this study, azelastine nasal spray was found to be more effective and safe in the treatment of allergic rhinitis than levocetrizine.


Keywords


Rhinitis, Allergy, Antihistamines, Levocetrizine, Azelastine

Full Text:

PDF

References


Von PC. Allergie. Munchener Medizinische Wochenschrift. 1906;53:1457-8.

White MV, Kalinar MA. Mediators of allergic rhinitis. J Allergy Clinical Immunol. 1992;90:699-704.

Shaikh WA. Allergies in India: An analysis of 1619 patients attending an allergy clinic in Bombay, India. Int Rev Allergol Clin Immunol. 1997;3:101-4.

Bray GW. Recent advances in allergy. J Laryngol Otol. 1952;58:219.

Shaikh WA. Allergic Rhinitis. In: Gupte S, editor. Recent advances in pediatrics Pulmonology. Special Volume 10. New Delhi: Jaypee Brothers medical publisher; 2002: 1-17.

Shambaugh. Nasal allergy for practicing rhinologist. Annals Otol Rhinol Laryngol. 1945;54(1):43.

Thomson St. C, Negus VE. Inflammatory diseases.Chronic Rhinitis. Diseases of the nose and throat. 6th edition. London: Cassel & Co. Lmt; 1955: 124-145.

Cook RA, van der Veer A. Human sensitization. J Immunol. 1916;1:201-305.

Sibbald B. Familial inheritance of asthma and allergy. In: Kay AB, Allergy and allergic disease. Oxford: Blackwell Science; 1997: 1177-1186.

Stafford. Allergic rhinitis– A useful guide to diagnosis and treatment. Postgraduate Med J. 1987;81:147-57.

Mygind N. Perennial rhinitis. In: Mygind N, editor. Nasal allergy. Second Edition. London: Blackwell Scientific Publications Oxford; 1979: 224-232.

Dannenberg TB, Feinberg SM. The development of tolerance to antihistamines: A study of the quantitative inhibiting capacity of antihistamines on the skin and mucous membrane reaction to histamine and antigens. J Allergy Clin Immunol. 1951;22(4):330-9.

Whil JA. Recent progress in treatment of nasal allergy; intranasal steroid treatment. Rhinology. 1984;22:27-31.

Gill BS. Intraturbinate use of steroids in nasal allergy. J Laryngol Otol. 1966;80:506-10.

Brown HM, Storey G, Jackson FA. Beclomethasonedipropionatc aerosol in treatment of perennial and seasonal rhinitis. Br J Clinical Pharmacol. 1977;4(3):283S-6S.

Ozenberger JM. Cryosurgery in cronic rhinitis. The laryngoscope. 1970;80:723-7.

Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clinical Immunol. 2008;122:1–77.

Schad CA, Skoner DP. Antihistamines in the pediatric population: Achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria. Allergy Asthma Proceedings. 2008;29:7–13.

Dolen WK. Antihistamine onset of action: the importance to the patient. Allergy Asthma Proceedings. 2004;25:85-7.

Marple BF, Fornadley JA, Patel AA, Fineman SM, Fromer L, Krouse JH, et al. Keys to successful management of patients with allergic rhinitis: Focus on patient confidence, compliance, and satisfaction. J Otolaryngol Head Neck Surg. 2007;136:107–24.

McNeely W, Wiseman LR. Intranasal azelastine.A review of its efficacy in the management of allergic rhinitis. Drugs. 1998;56:91-114.

Portnoy JM, Van Osdol T, Williams PB. Evidence-based strategies for treatment of allergic rhinitis. Current Allergy and Asthma Reports. 2004;4:439-46.

Newson-Smith G, Powell M, Baehre M, Garnham SP, MacMahon MT. A placebo controlled study comparing the efficacy of intranasal azelastine and beclomethasone in the treatment of seasonal allergic rhinitis. Eur Arch Otorhinolaryngol. 1997;254:236-41.

Lange B, Lukat KF, Rettig K, Holtappels G, Bachert C. Efficacy, cost-effectiveness, and tolerability of mometasonefuroate, levocabastine, and disodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. Annals Allergy, Asthma Immunol. 2005;95:272-82

Hagy GW, Saltipane GA. Risk factors for developing asthma and allergic rhinitis. J Allergy Clin Immunol. 1976;58:330-6.

Alsowaidi S, Abdulle A, Bernsen R, Zuberbier T. Allergic rhinitis and asthma: a large cross sectional study in the UAE. 2011;153(3):274-9.

Cookson WO, Sharp PA, Faux JA, Hopkin JM. Linkage between immunoglobulin E responses underlying asthma and rhinitis and chromosome 11q. Lancet. 1989;333:1292-5.

Sandford AJ, Shirakawa T, Moffat MF, Daniels SE, Faux JA, Young RP, et al. Localization of atopy and subunit of high affinity IgE receptor on chromosome 11q. Lancet. 1993;341:332-4.

Lindqvist N, Balle VH, Karma P, Kärjä J, Lindström D, Mäkinen J, et al. Long term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. Allergy. 1986;41:179-86.

Binder E, Holopainen E, Malmberg H, Salo OP. Clinical findings in patients with allergic rhinitis. Rhinology. 1984;22(4):255-60

Bunnang C, Jareoncharsri P, Wong EC. A double blind comparison of nasal budesonide and oral astemizole for the treatment of perennial rhinitis. Allergy. 1992;47:313-7.

Wight RG, Jones AS, Beckingham E, Anderson B. A double blind comparison of intranasal budesonide 400 micrograms and 800 micrograms in perennial rhinitis. Clinical Otolaryngol. 1992;17(4):354-8.

Mc. Arthur JG. A comparison of budesonide and beclomethasonedipropionate sprays in the treatment of seasonal allergic rhinitis. Clin Otolaryngol. 1994;19:537:542.

Cooren J, Storms W, Bernstein J, Berger W, Nayak A, Sacks H. Azelastine Cetirizine Trial No. 1 (ACT 1) Study Group. Effectiveness of azelastine nasal spray compared with oral ceterizine in patients with seasonal allergic rhinitis. Clin Therapeutics. 2005;27:543-53.

Horak F. Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis. J Therapeutics Clin Risk Mang. 2008;4:1009-22.

Berger WE, White MV. Rhinitis Study Group. Efficacy of azelastine nasal spray in patients with an unsatisfactory response to loratadine. Annals Allergy, Asthma Immunol. 2003;91:205-11.

Horak F, Zieglmayer UP, Zieglmayer R, Kavina A, Marschall K, Munzel U, Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: A pharmacodynamic study of onset of action and efficacy. Current Med Res Opinion. 2006;22:151-7.