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Aug. 18, 2004 -- It's allergy time again. Ragweed season, to be precise, but mold is another big trigger of sniffles and sneezing in late summer and early fall. Millions of people are treated with antihistamine pills for relief of allergy symptoms, but new research shows an antihistamine nasal spray may work when pills don't give adequate symptom relief.
In a study involving more than 300 patients with moderate to severe allergies who got little symptom relief with the drug Allegra, the nasal spray Astelin (azelastine) was found to be an effective treatment. An earlier study showed similar results in seasonal allergy patients who did not respond to the over-the-counter antihistamine pill Claritin. Both studies were paid for by MedPointe Pharmaceuticals, which manufactures Astelin.
"Astelin is an excellent alternative for patients who find themselves using multiple oral antihistamines or frequently switching antihistamines to find satisfactory relief," says researcher Craig LaForce, MD, who is medical director of North Carolina Clinical Research.
Cost-Effective Single Treatment
Seasonal allergy sufferers whose allergy symptoms -- running nose, sneezing, itchy nose, and nasal congestion -- failed to improve by more than 30% after taking Allegra for one week were divided into three treatment groups: Astelin nasal spray with two sprays per nostril twice a day, Astelin plus 60 milligrams of Allegra twice a day, or a placebo pill and placebo nasal spray.
After two weeks of the treatment, both groups receiving Astelin saw a dramatic drop in symptoms, however allergy sufferers taking only the nasal spray fared as well as those taking Astelin plus Allegra. The study is published in the August issue of the journal Annals of Allergy, Asthma, & Immunology.
LaForce tells WebMD that inadequate symptom relief is a common problem with the oral antihistamines because they don't do much to relieve nasal stuffiness. The nasal antihistamine spray does act as a decongestant, but it is not clear why.
"It is an antihistamine, but it also has some of the properties of an anti-inflammatory," he says.
He added that the studies indicate that Astelin is a cost-effective single treatment for seasonal allergies, either as the first drug to choose for treatment or as an alternative therapy when antihistamines pills fail to relieve symptoms.
Other Treatments
Astelin is the only nasal antihistamine approved for use in the United States and allergy expert Michael Blaiss, MD, says it is not clear how it stacks up to the more widely used nasal allergy sprays, such as steroids sprays Flonase and Rhinocort.
"The studies are pretty clear that nasal steroids are more effective than the oral antihistamines," says Blaiss, who is president of the American College of Allergy, Asthma, & Immunology. "They are widely accepted to be the first choice for moderate to severe allergies."
But he adds that compliance is a significant problem with the nasal steroids, as it is with Astelin, because patients would often rather take a pill than use a nasal spray.
"People just don't like spraying things up their noses," he tells WebMD. "That is especially true of children. And taste is a particular problem with Astelin. Some patients don't taste it at all, but for others it tastes terrible."
Allergist Frank Virant, MD, tells WebMD, that as many as a quarter of his patients either refuse to use nasal sprays or don't stick with them. He says he encourages patients with moderate to severe allergies to use the anti-inflammatory nasal steroids sprays because they both treat allergy symptoms and keep allergies from getting worse.
"If the inflammation is not addressed the message is sent to make more allergy antibodies the next year," he says. "That is why over time pollen allergy worsens. The nasal steroids do many things. They address acute allergy symptoms and reduce asthma risk and also keep allergies from getting worse year after year."
SOURCES: LaForce, C. Annals of Allergy, Asthma and Immunology, August 2004; Vol. 93: pp. 154-159. Craig F. LaForce, MD, medical director, North Carolina Clinical Research, Chapel Hill, N.C. Michael Blaiss, MD, president, American College of Allergy, Asthma & Immunology; clinical professor of pediatrics and medicine, University of Tennessee Health Sciences Center, Memphis. Frank Virant, MD, clinical professor of pediatrics, University of Washington School of Medicine; spokesman, America Academy of Allergy, Asthma, and Immunology.
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