Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis

Abstract

Patients suffering from allergic rhinitis often attempt to self-manage their symptoms and may seek advice from pharmacists about nonprescription product choices. Several drug classes, both prescription and over-the-counter (OTC), are available, including intranasal corticosteroids (INCSs); oral, intranasal, and ocular antihistamines; leukotriene antagonists; and topical and systemic decongestants, as well as immunotherapies. Selection of the optimal treatment approach depends on the temporal pattern, frequency, and severity of symptoms as well as the patient’s age. Nasal congestion is typically the most bothersome symptom, although rhinorrhea, postnasal drip, and ocular symptoms are also problematic. Together, these symptoms may adversely impact the quality of life, work productivity, sleep quality, and the ability to perform daily activities, particularly when uncontrolled. Practice guidelines recognize that INCSs are the most effective medications for controlling allergic rhinitis symptoms, including nasal congestion. Available INCS products have comparable safety and efficacy profiles, but they differ in formulation characteristics and sensory attributes. Several barriers can impede the use of INCSs, including concerns about safety, misperceptions regarding the loss of response from frequent use, and undesirable sensations associated with intranasal administration. Given the increasing number of INCSs available OTC, pharmacists can help allay these concerns by discussing treatment expectations, recommending INCS products with favorable formulation characteristics, and reviewing proper use and technique for the administration of the selected product. These steps can help to foster a collaborative relationship between the patient and the pharmacist in the treatment of allergic rhinitis.

The Pharmacokinetics of Fluticasone Furoate Given Intranasally in Healthy Subjects Using an Ultra-Sensitive Analytical Assay

“…Fluticasone furoate is one of the newest INCS, is available as prescription or over-the-counter medicine, and may be more preferred by patients compared to other INCS [12]. It is one of the first-line treatments recommended in AR treatment [13][14][15].…”

Functionally Crippled Nose

“…Fear of side effects has been reported in 48% of patients with allergic rhinitis, including fear of habituation or damage to intranasal tissue. 18 The safety profile of these medications should be discussed with patients and daily use should be encouraged. In addition, correct application with administration away from the nasal septum may limit unwanted side effects such as nasal irritation and epistaxis.…”

Innovative technology full volume lavage of the nasal cavity in the treatment of allergic and vasomotor rhinitis

“…Лечение аллергического ринита включает фармакотерапию антигистаминными препаратами местного и системного действия, топическими глюкокортикоидами или их комбинацией, иммунотерапию, что при длительном применении может способствовать развитию побочных эффектов и осложнений [6,7]. Однонаправленная ситуация отмечается и в отношении вазомоторного ринита, в лечении которого пациенты широко используют интраназальные деконгестанты, которые, обеспечивая быстрое улучшение носового дыхания, при длительном применении формируют появление медикаментозного ринита [8].…”