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.
Furthermore, these newer sprays can be used on an as needed basis, unlike the majority of INS sprays. INS sprays work more effectively when regularly used.
Some of my patients are responding to the combination of INS daily, after the shower or bath, and Astelin (or Patanase or Astepro) once or twice daily at other times of the day.
Potential adverse affects include nasal burning, nose bleeding, headache, and throat irritation (similar to INS). But unlike INS, sedation is also possible, although experienced by a small percentage of people.
Astelin is indicated for treatment of symptoms of allergic rhinitis patients 5 years or older. It has and additional indication for Vasomotor Rhinitis (a form of non-allergic rhinitis). I have found this medication very useful, in that 40% of adults with rhinitis are non-allergic. Many patients with allergic nasal problems also have vasomotor triggers (ash, fumes, fragrances and odors).
Patanase is indicated for relief of seasonal allergic rhinitis and only for adults and children 12 years or older.
Astepro is indicated for patients 12 years and older for relief of symptoms associated with seasonal allergic rhinitis.
Nasal allergy continues to plague many people despite many of the new medications available for treatment. Astelin, Patanase and Astepro may bring relief to some who have not responded to oral antihistamines and/or nasal steroid sprays. Otherwise, allergy shots should be considered for people with moderate to severe seasonal or perennial allergic rhinitis.