The cost of treating allergic rhinitis

Abstract

Allergic rhinitis is a high-cost, high-prevalence disease. In the year 2000, over $6 billion was spent on prescription medications to treat this illness. Although it is not associated with severe morbidity and mortality, allergic rhinitis has a major effect on the quality of life of the more than 50 million Americans with this illness. Intranasal corticosteroids (INCS) and nonsedating antihistamines (NSAH) are the most common prescription medications for this disease. INCS are recognized as the most effective treatment regimen for chronic symptoms. NSAH are perceived as important in the treatment of patients with mild disease, or as add-on therapy to INCS. When the literature is reviewed, the INCS produce the greatest decrease in total nasal symptom scores, the largest effect size, when compared with NSAH. Both classes of medications produce similar effects on concurrent allergic conjunctivitis. Further recent studies indicate that the INCS are also superior when used on an as-needed basis, and that there is little clinical benefit from the addition of loratadine to intranasal fluticasone. INCS have lower average wholesale prices as a class than the NSAH. Since the INCS are the dominant medication in efficacy studies and cost less, cost-effectiveness studies always favor intranasal corticosteroids.

Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

“…2,3 Most patients with asthma also have rhinitis, while 10-40% of patients with rhinitis have comorbid asthma. 4 Several mechanisms have been postulated for this close association between upper and lower airway morbidity, including (1) aspiration of inflamed or infected secretions to the lower airway, (2) nasal blockage that leads to mouth breathing cold, dry air increasing allergen entry into the lower airway, (3) systemic absorption of inflammatory mediators in the nasal mucosa, or (4) a nasobronchial reflex.…”

“…During study participation, child participants underwent an asthma and AR clinical evaluation. Herein we report the extent to which AR was diagnosed and treated by urban healthcare providers in this sample of urban school-aged children with persistent asthma symptoms, specifically (1) proportion of children who met criteria for AR, (2) proportion whose caregivers reported no previous diagnosis of their child's allergies, (3) This work was performed at Rhode Island Hospital, Providence, Rhode Island. Divisions of 1 Pediatric Allergy and Immunology, 2 Child and Adolescent Psychiatry, and caregivers' and healthcare providers' perceptions of child's allergic status, compared with the study assessment of allergic status, and (4) proportion of children with AR who were undertreated or lacked treatment for the condition.…”

Depression, Anxiety, and Health-Related Quality of Life in Adolescents and Young Adults With Allergies and Asthma

“…This treatment method works best for allergens that can readily be avoided, such as specific foods, medications, animals, and plants. However, it can be hard for some individuals with allergic rhinitis to determine the specific trigger and eliminate the substance which may be commonly occurring such as pollen, mold, and dust (Naclerio, 1991;Stempel & Woolf, 2002). To limit exposure to pollens and mold, the individual with these allergies can wear a mask or reduce outdoor activities when the pollen levels are high (NIAID, 2003).…”

“…These medications can include antihistamines, decongestants, and corticosteroids (Berger, 2003;Stempel & Woolf, 2002). Antihistamines counter the body system's response to the allergen, preventing the symptoms from occurring (NIAID, 2003).…”

“…Antihistamines counter the body system's response to the allergen, preventing the symptoms from occurring (NIAID, 2003). Antihistamines have advanced considerably from the first formulas, and now are used to control symptoms for 24 hours and prevent drowsiness (Stempel & Woolf, 2002).…”