Allergic Rhinitis (Hay Fever) affects about 30 million people in America and has increased in prevalence over the last 25 years. Allergy medications have dominated the shelves in many pharmacies as a result of the increasing brands of antihistamines, nasal sprays and decongestants. Despite the plethora of remedies, both over the counter (OTC) and by prescription, many people continue to suffer from chronic nasal congestion and post-nasal drainage.
Twenty five years ago intranasal steroids (INS) were ushered into the market as a novel approach to treating allergic rhinitis. Nasalid (flunisolide) led the way. Vancenase (Beclomethasone) and Nasacort (Triamcinolone) nasal sprays soon followed. These sprays offered a class of topically active steroids that, unlike previous nasal steroid sprays, had minimal systemic impact. This means the majority of the spray worked on the inner surface of the nose with very little absorption into blood vessels (reducing the exposure of other parts of the body).
At about the same time (25 years ago) long-acting, non-drowsy, oral antihistamines came on the scene like gangbusters and immediately appealed to seasonal allergy sufferers nationwide. The sedation and fatigue experienced by so many people after taking older forms of antihistamines (Benadryl, for example) set the table for this new generation of allergy medication. The impact of terfenadine (brand name Seldane and Seldane -D) was unmatched by many previous, blockbuster drugs. But the jubilation over terfenadine didn't last long.
Seldane was removed from the market in 1998 because of the potential for dangerous heart rhythm disturbances, especially when taken with certain other drugs or foods. Since that time, safer and more effective antihistamines have emerged which continue to be used, for example: loratadine (Claritin), cetirizine, (Zyrtec), fexofenadine (Allegra) and levocetirizine (Xyzal). Fexofenadine and levocetirazine require a prescription.
Present Day Dilemma
Allergists continue to see many adults and children who fail to respond to antihistamines (with or without decongestant) and INS. Many of these patients will be offered a course of allergy shots (if allergic) but this treatment often takes several months to work.
Three Nasal Sprays In A New Class
Three nasal sprays unique in mechanism of action (how they work) compared to the INS are: Astelin (azelastine HCL), Patanase (olopatadine HCL) and Astepro (a new formulation of azelastine).
These nasal sprays are topically effective antihistamines. That's right! They are in the same class as the oral antihistamine medications that have been around for decades. They block histamine, which is naturally released when an allergic person breathes in an allergy trigger (such as ragweed or grass pollen). Interestingly, their impact inside the nose goes beyond drying up drainage and reducing itching and sneezing. Nasal congestion may be reduced within 30 to 40 minutes. The nasal decongestant action has a faster onset of action compared to intranasal steroid sprays.