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Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis.
Expert Opin Pharmacother. 2016; 17(5):657-69.EO

Abstract

INTRODUCTION

Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER.

AREAS COVERED

Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here.

EXPERT OPINION

A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.

Authors+Show Affiliations

a Center for Rhinology and Allergology , Wiesbaden , Germany.b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain.c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium.d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium.e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany.f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

26800187

Citation

Klimek, Ludger, et al. "Recent Pharmacological Developments in the Treatment of Perennial and Persistent Allergic Rhinitis." Expert Opinion On Pharmacotherapy, vol. 17, no. 5, 2016, pp. 657-69.
Klimek L, Mullol J, Hellings P, et al. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother. 2016;17(5):657-69.
Klimek, L., Mullol, J., Hellings, P., Gevaert, P., Mösges, R., & Fokkens, W. (2016). Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opinion On Pharmacotherapy, 17(5), 657-69. https://doi.org/10.1517/14656566.2016.1145661
Klimek L, et al. Recent Pharmacological Developments in the Treatment of Perennial and Persistent Allergic Rhinitis. Expert Opin Pharmacother. 2016;17(5):657-69. PubMed PMID: 26800187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. AU - Klimek,Ludger, AU - Mullol,Joaquim, AU - Hellings,Peter, AU - Gevaert,Philippe, AU - Mösges,Ralph, AU - Fokkens,Wytske, Y1 - 2016/03/03/ PY - 2016/1/23/entrez PY - 2016/1/23/pubmed PY - 2016/8/26/medline KW - Antihistamines KW - MP-AzeFlu KW - glucocorticosteroids KW - perennial allergic rhinitis KW - persistent allergic rhinitis SP - 657 EP - 69 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 17 IS - 5 N2 - INTRODUCTION: Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED: Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION: A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated. SN - 1744-7666 UR - https://www.unboundmedicine.com/medline/citation/26800187/Recent_pharmacological_developments_in_the_treatment_of_perennial_and_persistent_allergic_rhinitis_ L2 - https://www.tandfonline.com/doi/full/10.1517/14656566.2016.1145661 DB - PRIME DP - Unbound Medicine ER -