Allergists Explore Rising Prevalence And Unmet Needs Attributed To Allergic Rhinitis
As the prevalence of allergic rhinitis appears to be rising, there are increasing concerns about its impact on health, sleep, work and school performance, as well as unmet patient needs regarding its treatment according to experts presenting new data at the Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).
“There is epidemiological evidence that the prevalence of allergic rhinitis is rising worldwide. Reports indicate that it has increased 100 percent in each of the last three decades in developed countries,” said Eli O. Meltzer, M.D., co-director, Allergy & Asthma Medical Group & Research Center, and clinical professor of pediatrics at the University of California in San Diego.
“With allergic disorders estimated to affect some 1.4 billion people globally, there appears to be a worldwide epidemic of allergic diseases. Studies suggest this is likely a consequence of our changing environment, reduced infections and genetic susceptibilities.”
According to Dr. Meltzer, the true prevalence of allergic rhinitis is unknown. Published prevalence rates differ because:
— It is largely undiagnosed
— There are differences in definitions of the condition
— There are differences in sampling frame and data collections methods
— The data are not collected by the federal government.
Current estimates indicate that more than 50 million people in the United States suffer from allergic rhinitis. It is the most prevalent chronic condition in patients under age 18. In one study, 42 percent of children had physician-diagnosed allergic rhinitis by 6 years of age.
Two landmark U.S. surveys – the Burden of Rhinitis Survey 2004 and the Allergies in America Survey 2006 – document the high prevalence and substantial burden of allergic rhinitis. Both surveys indicate a strong relationship between allergic rhinitis and co-morbidities including depression, migraine and asthma.
According to Michael S. Blaiss, M.D., clinical professor of pediatrics and medicine at the University of Tennessee Health Science Center in Memphis, Tenn., the scope and impact of allergic rhinitis has reached epidemic proportions and is estimated to account for 100 million days of lost work annually, 28 million days of lost productivity and 1.5 million missed school days per year. Allergic rhinitis is responsible for 16.7 million physician office visits per year and results in 5.9 billion dollars annually in direct expenditures.
“Many patients with allergic rhinitis suffer from symptoms that cause them to feel tired, miserable and irritable during allergy season,” Dr. Blaiss said. “Lack of treatment, under-treatment, or non-adherence to treatment in allergic rhinitis may increase direct and indirect costs. This reinforces the need for patient education and for physicians to implement existing evidence-based guidelines for prevention and treatment.”
Allergic rhinitis symptoms profoundly affect the quality of life as well as work productivity according to Myron J. Zitt, M.D., clinical associate professor of medicine, State University of New York, Stony Brook, N.Y. “Adults may have mood swings and be less efficient at work or at home. They often have a poor quality of sleep, may suffer from obstructive sleep apnea and thereby experience daytime fatigue.” He noted a correlation between high pollen counts and low work productivity.
“Children with allergic rhinitis often experience increased shyness, anxiety and fatigue. Nasal congestion and other symptoms can cause significant impairment in learning and cognition,” he said.
“Another area of concern is the trivialization of allergic rhinitis. It is an important illness, but it is underappreciated, under-diagnosed and under-treated. Polls show that only 19 percent of people taking medications for allergic rhinitis are being seen by a specialist, who are the best qualified to treat the disease,” Dr. Zitt said.
In a Harris Interactive Survey of 4,000 patients who experience congestion, 93 percent of patients surveyed awaken feeling congested and 87 percent awaken feeling tired. Lack of relief of congestion affects their ability to concentrate (54 percent), performance of physical exercise and sports (63 percent) and time spent outdoors (73 percent).
Typical physical findings reported by Bobby Q. Lanier, M.D., clinical professor of pediatrics at the University North Texas Health Science Center in Fort Worth, include: the “Allergic Salute” wiping of the nose; “Allergic Shiners” referring to dark circles under the eyes; “Allergic Crease” around the nose; “Dennie’s Lines” under the eyes; mouth breathing; red, itchy eyes and eye tearing.
“Comorbidities of allergic rhinitis are significant. Allergic rhinitis is present in 58 percent of asthma patients, and the treatment of allergic rhinitis reduces the incidence and severity of asthma. It also contributes between 40 percent to 80 percent of chronic rhinosinusitis. Nasal polyps reoccur in 36 percent of allergic individuals versus 18 percent in non-allergic individuals,” said Dr. Lanier.
Treatment of Allergic Rhinitis
Recent surveys show that 37 percent of patients are not satisfied with their current allergy treatment, and patients may take up to 2 to 4 medications at a time for relief of allergy symptoms noted Dr. Lanier.
“Patients are not as well informed as they should be about their allergy medications,” he said. Of those surveyed, 42 percent were confused by choices of medication, and 59 percent wished they knew more about the drugs they take.
“Healthcare providers overestimate patient satisfaction with therapy. Patient dissatisfaction often results in frequent medication changes or noncompliance. Lack of insurance coverage for prescribed medications influences patients’ willingness to try new medications,” Dr. Lanier said.
Current treatment options for allergic rhinitis are environmental control measures, medications, subcutaneous specific immunotherapy and allergen avoidance. Medications include oral antihistamines (sedating and non-sedating or low-sedating), intranasal antihistamines, intranasal corticosteroids or intranasal cromolyn sodium.
“New and emerging solutions for the treatment of allergic rhinitis are on the horizon,” said William E. Berger, M.D., M.B.A., clinical professor, Department of Pediatrics, Division of Allergy and Immunology at the University of California in Irvine. “These therapies include sublingual immunotherapy (SLIT), anti-IgE therapy, new topical nasal antihistamines (olopatadine) and new topical nasal corticosteroids (ciclesonide).”
In Europe, SLIT is widely used for monosensitized patients with mild allergic disease. There is no product approved by the FDA, although clinical trials of SLIT are underway in the United States.
Anti-IgE therapy, a recombinant humanized monoclonal antibody (rhuMab) to IgE, is currently approved for allergic asthma and may have application for patients with severe allergic rhinitis.
According to Dr. Berger, the emerging allergic rhinitis treatments focus on meeting both patient and provider needs for rapid onset, long-lasting and convenient dosing. They will be safer and more cost-effective, and improve patient adherence. Physician’s needs will be met for the introduction of newer, enhanced treatment choices that improve patient quality of life and immune tolerance. The newer therapies will also enhance the effective treatment of co-morbidities of allergic rhinitis.
Non-allergic rhinitis is characterized by recurrent or chronic symptoms similar to those of allergic rhinitis, but the disorder is not caused by allergy. Examples of rhinitis are infectious rhinitis (the common cold), vasomotor rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES), hormonal rhinitis, certain types of occupational rhinitis, and gustatory and drug-induced rhinitis.
Irritants that can trigger vasomotor rhinitis include cigarette smoke, strong odors and fumes, including perfume, hair spray, other cosmetics, laundry detergents, cleaning solutions, pool chlorine, car exhaust and other air pollution. Other irritants are spices used in cooking, alcoholic beverages (particularly beer and wine), aspirin and certain medications.
Patient information on allergic diseases is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org/.
The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.
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