Allergic rhinitis evaluation

Flunisolide is a fast-acting corticoid designed for the treatment of allergic rhinitis, asthma, and other allied respiratory disorders in humans. As the quantum of drug delivered by inhalation (/. e., the usual route of administration of the drug), is invariably small, the plasma-levels attained can also be fairly small. Hence, there is a dire need for a sensitive method of plasma concentration evaluation which is satisfied by radioimmunoassay. 

A study of substrate solubility and phase-partitioning behavior in a wide range of solvent concentrations by Truppo et al. led to a fourfold decrease in enzyme charge with an increase in product enantiomeric excess. The process was successfully run at 400-L scale yielding the desired product with 99.73%ee at 50% conversion with the optimized conditions [86]. The DP receptor antagonist 42 is being evaluated in clinical trials for the treatment of allergic rhinitis. 

The Hi histamine antagonist efletirizine is in Phase 111 clinical evaluation for the treament of allergic rhinitis. It is structurally very close to the marketed cetirizine. 

The effects of budesonide aqueous nasal spray (64 micrograms/day) on adrenal function were studied in a 6-week double-blind, placebo-controlled study in 78 patients with allergic rhinitis aged 2-5 years (39). Adrenal function, evaluated by the mean change in morning plasma cortisol concentration after cosyntropin stimulation, was not suppressed. This dose of budesonide by nasal spray is unlikely to have significant systemic activity. 

It is recommended that patients with persistent allergic rhinitis be evaluated for asthma by history, chest examination and, if possible and when necessary, assessment of airflow obstruction before and after bronchodilator. 

Meltzer EO. Evaluation of the optimal oral antihistamine for patients with allergic rhinitis. Mayo Clin Proc. 2005 80 1170-1176. 

Gibbs TG, Irander K, Salo OP. Acrivastine in seasonal allergic rhinitis two randomized crossover studies to evaluate efficacy and safety. J Int Med Res 1988 16(6) 413-19. 

Meltzer EO, Storms WW, Pierson WE, Cummins LH, Orgel HA, Perhach JL, Hemsworth GR. Efficacy of aze-lastine in perennial allergic rhinitis clinical and rhinoma-nometric evaluation. J Allergy Clin Immunol 1988 82(3 Pt l) 447-55. 

Health-related quality of life and clinical outcomes in 865 adult patients with seasonal allergic rhinitis treated with cetirizine or placebo for 2 weeks have been evaluated in a double-blind, randomized, parallel-group study (3). Cetirizine significantly improved both symptoms and health-related quality of life, while treatment-related adverse effects were comparable with those in the placebo group. 

Murray JJ, Nathan RA, Bronsky EA, Olufade AO, Chapman D, Kramer B. Comprehensive evaluation of cetirizine in the management of seasonal allergic rhinitis impact on symptoms, quality of life, productivity, and activity impairment. Allergy Asthma Proc 2002 23(6) 391-8. 

Without empirically based health economic evaluations to guide an understanding of allergy and asthma prevention strategies, it would seem that the next major step will rest on building valid, reliable, and dynamic health economic models derived from the larger body of literature based on the tertiary control of asthma and allergic rhinitis. 

Both the Medical Outcomes Study 36-Item Short Form Health Survey and the Rhinoconjunctivitis Quality of Life Questionnaire have been used to evaluate outcomes of treatment for seasonal and perennial allergic rhinitis.These tools go beyond measuring improvement in symptoms and include such items as sleep quality, nonal-lergic symptoms (e.g., fatigue, poor concentration, and others), emotions, and participation in a variety of activities. How well each of the current treatment modalities performs and how they compare in improving patient outcomes remain to be determined. 

The therapeutic goal for all patients with allergic rhinitis is to minimize or prevent symptoms. Evaluation of success is accomplished primarily through the discussions with the patient, in whom both relief of symptoms and tolerance of drug therapy must be discussed. 

Klaewsongkram J, Ruxrangtham K, Wannakrairot P, et al. Eosinophil count in nasal mucosa is more suitable than the number of ICAM-1-positive nasal epithelial cells to evaluate the severity of house dust mite-sensitive allergic rhinitis A clinical correlation study. Int Arch Allergy Immunol 2003 132 68-75. 

Koyama, T., Kiijavainen, P. V., Fisher, C., Anukam, K., Summers, K., Hekmat, S., et al. (2010). Development and pilot evaluation of a novel probiotic mixture for the management of seasonal allergic rhinitis. Canadian Journal of Microbiology, 56(9), 730-738. 

When vitamin D status has been evaluated in subjects with allergic rhinitis, the prevalence of deficiency was greater (Arshi et al. 2012). One caution is that both allergic rhinitis and vitamin D deficiency are prevalent conditions, and the association may be fortuitous. 

La Rosa M, Ranno C, Andre C, Carat F, Tosca MA, Canonica GW Double-blind placebo-controlled evaluation of sublingual-swallow immunotherapy with standardized Parietaria judaica extract in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 1999 104 425—432. Clavel R, Bousquet J, Andre C Clinical efficacy of sublingual-swallow immunotherapy A doubleblind, placebo-controlled trial of a standardized five-grass-pollen extract in rhinitis. Allergy 1998 53 493-498. 

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