Seasonal allergic rhinitis treatment

Montelukast (Singulair) is a leukotriene receptor antagonist approved for treatment of seasonal allergic rhinitis. It is effective alone or in combination with an antihistamine. 

Meltzer, E. O., Malmstrom, K., Lu, S., et al. (2000) Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis a randomized, placebo-controlled clinical trial. J. Allergy Clin. Immunol. 105, 917-922. 

Unlabeled Uses Treatment of seasonal allergic rhinitis... 

Cetirizine is indicated for the symptomatic treatment of perennial allergic rhinitis, seasonal allergic rhinitis, chronic idiopathic urticaria, conjunctivitis and pruritus in adults and children above two years of age. 

Meltzer E, Malmstrom K, Lu S, Brenner B, Wie L, Weinstein S, et al Concomitant montelukast and loratidine as treatment for seasonal allergic rhinitis. Placebo-controlled clinical trail. J Allergy Clin Immunol 2000 105 917-922. 

Blaiss MS. Antihistamines treatment selection criteria for pediatric seasonal allergic rhinitis. Allergy Asthma Proc. 2005 26 95-102. 

As is implicit from all the above, the measured concentration in plasma is directly linked to the observed effect for these simple mechanistic, pharmacokinetic-dynamic models. Accordingly, these models are called direct-link models since the concentrations in plasma can be used directly in (10.6) and (10.7) for the description of the observed effects. Under the assumptions of the direct-fink model, plasma concentration and effect maxima will occur at the same time, that is, no temporal dissociation between the time courses of concentration and effect is observed. An example of this can be seen in the direct-fink sigmoid Emax model of Racine-Poon et al. [418], which relates the serum concentration of the anti-immunglobulin E antibody CGP 51901, used in patients for the treatment of seasonal allergic rhinitis, with the reduction of free anti-immunglobulin E. 

Van Cauwenberge P, Juniper EF. Comparison of the efficacy, safety and quahty of life provided by fexofenadine hydrochloride 120 mg, loratadine 10 mg and placebo administered once daily for the treatment of seasonal allergic rhinitis. Chn Exp Allergy 2000 30(6) 891-9. 

Tarasido JC. Azatadine maleate/pseudoephedrine sulfate repetabs versus placebo in the treatment of severe seasonal allergic rhinitis. J Int Med Res 1980 8(6) 391-4. 

Seasonal allergic rhinitis affects about 10% of school-age children, and there is evidence of a significant impact of the disease on health-related quality of life. The effect on health-related quality of life of once-daily of cetirizine syrup 10 mg/day for 4 weeks has been studied in 544 children with seasonal allergic rhinitis in a multicenter, open, non-comparative study (2). In addition to improvements in symptom scores the authors also reported significant improvements in health-related quality of life, with good tolerability of the drug. Treatment-related adverse effects were reported in 22 subjects, of which somnolence was the most frequent problem, reported by six of the subjects. Only 12 of subjects discontinued treatment owing to an adverse effect. 

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. 

Brown HM, Engler C, English JR. A comparative trial of flunisolide and sodium cromoglycate nasal sprays in the treatment of seasonal allergic rhinitis. Clin Allergy 1981 ll(2) 169-73. 

Bachert C, Virchow CJ Jr, Plenker A. Desloratadine in the treatment of seasonal allergic rhinitis results of a large observational study. Clin Drug Invest 2002 22 43-52. 

Horak F, Unkauf M, Beckers C, Mittermaier EM. Efficacy and tolerability of intranasally applied dimetindene maleate solution versus placebo in the treatment of seasonal allergic rhinitis. Arzneimittelforschung 2000 50(12) 1099-105. 

Frank H Jr, Gillen M, Rohatagi SS, Lim J, George G Ebastine Study Group. A double-blind, placebo-controlled study of the efficacy and safety of ebastine 20 mg once daily given with and without food in the treatment of seasonal allergic rhinitis J Chn Pharmacol 2002 42(10) 1097-104. 

Perennial or seasonal allergic rhinitis. Mastocytosis, food allergy, treatment of... 

For seasonal allergic rhinitis, begin treatment before allergen exposure. Nonsedating agents should be tried first. If ineffective or too expensive for the patient, the older agents may be used. For perennial allergic rhinitis, use an intranasal steroid as an alternative to or in combination with systemic antihistamines. 

The most cost-effective choice of treatment for allergic rhinitis is an individualized decision. Seasonal allergic rhinitis patients who see improvement and can tolerate nonprescription and/or generic antihistamines will experience the least impact on out-of-pocket medical and drug expenses. If these are not effective, the economic picture becomes more complicated. Choices should follow the logical path based on symptoms, tolerance, and efficacy, as described earlier in this chapter. 

Kuehr J, Brauburger J, Zielen S, et al. Efficacy of combination treatment with anti-IgE plus immunotherapy in polysensitized children and adolescents with seasonal allergic rhinitis. J Allergy Qin Immunol 2002 109 274-280. 

Azelastine is an ophthalmic antihistaminic preparation. It is indicated in the treatment of symptoms of seasonal allergic rhinitis, such as rhinorrhea, sneezing, and nasal pruritus treatment of symptoms of vasomotor rhinitis, such as rhin-orrhea, nasal congestion, and postnasal drip (nasal inhalation) treatment of itching of eye associated with allergic conjunctivitis (ophthalmic). 

Cetirizine competitively antagonizes histamine at the Hi-receptor site and is indicated in the symptomatic relief of symptoms (e.g., nasal, nonnasal) associated with seasonal and perennial allergic rhinitis treatment of uncomplicated skin manifestations of chronic idiopathic urticaria. Histamine is a potent vasodilator, bronchial smooth-muscle constrictor, and stimnlant of nociceptive itch nerves. In addition to histamine, mnltiple chemical itch mediators can act as pruritogens on C-fibers, including neuropeptides, prostaglandins, serotonin, acetylcholine, and bradykinin. Furthermore, new receptor systems such as vanilloid, opioid, and canna-binoid receptors on cutaneous sensory nerve fibers that may modulate itch offer novel targets for antipruritic therapy. 

Dexchlorpheniramine competitively antagonizes histamine Hi at receptor sites. It is indicated in treatment of perennial and seasonal allergic rhinitis vasomotor rhinitis allergic conjunctivitis mild, uncomplicated allergic skin manifestations of urticaria and angioedema amelioration of allergic reactions to blood or plasma dermographism and adjunctive anaphylactic therapy. 

Fexofenadine is a peripherally selective histamine receptor antagonist that competitively antagonizes histamine at the Hj-receptor site. It is indicated in the symptomatic relief of symptoms (nasal and nonnasal) associated with seasonal allergic rhinitis and treatment of uncomplicated skin manifestations of chronic idiopathic urticaria. 

Montelukast sodium is a leukotriene receptor antagonist that blocks the effects of specific leukotrienes in the respiratory airways, thereby reducing bronchoconstriction, edema, and inflammation. It is indicated in the prophylaxis and chronic treatment of asthma in patients 12 months and older and in relief of symptoms of seasonal allergic rhinitis in patients 2 years and older. 

It is frequently employed in the treatment of perennial and seasonal allergic rhinitis, allergic conjunctivitis due to inhalant allergens andfoods, simple allergic skim manifestations of urticaria and angioedema, dermographism and anaphylactic reactions as an adjunct to adrenaline. 

Racine-Poon et al. provided an example for a direct link model by relating the serum concentration of the antihuman immunoglobulin E (IgE) antibody CGP 51901 for the treatment of seasonal allergic rhinitis to the reduction of free IgE via an inhibitory Emax-model [75]. Radwanski et al. used a similar approach to assess the effect of recombinant interleukin-10 on the ex vivo release of the proinflammatory cytokines TNE-a and interleukin-1(IL-1/3) in LPS-stimulated leukocytes [76]. 

Schata, M., Jorde, W., and Richarz-Barthauer, U., 1991, Levocabastine nasal spray better than sodium cromoglycate and placebo in the topical treatment of seasonal allergic rhinitis, J. Allergy Clin. Immunol. 87 873-878. 

Therapeutic profile The drug is a second-generation antihistamine, lacking sedative activity, for the treatment of allergic diseases, including allergic rhino-conjunctivitis, seasonal allergic rhinitis, urticaria and atopic dermatitis. 

It is clinically effective in the treatment of seasonal allergic rhinitis and chronic idiophatic urticaria and is not associated with adverse cardiac or cognitive/psycho-motor effects. These qualities have led to the ranking of fexofenadine in eighth place among the 200 best marketed drugs, and in 2007, it led to approximately 0.9 billion in sales. 

The efficacy of anti-IgE MAb for the treatment of seasonal allergic rhinitis has been tested in several phase n/III clinical studies. Given the fundamental role of IgE in the pathogenesis of seasonal allergic rhinitis (SAR), decreasing total serum IgE in atopic patients was expected to decrease antigen-specific IgE, reduce IgE-mediated symptoms, and improve control of this disease (79). 

Casale T, Condemi J, Miller SD, Pick R, McAlary M, Fowler-Taylor A, Gupta N, Rohane PW. rhuMAb-E25 in the treatment of seasonal allergic rhinitis (abstr). Ann Allergy Asthma Immunol 1999 82 75. 

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