The status quo and unmet needs in the management of allergic rhinitis and chronic rhinosinusitis: a Malaysian perspective

Abstract

BackgroundAllergic rhinitis and rhinosinusitis, common and debilitating conditions, should be managed in accordance with guideline recommendations. Guideline adherence shows regional differences. As of now, there is little data from Asia and none from Malaysia on the current treatment practices and unmet needs in the management of these conditions.ObjectiveThe objective of this study was to assess the current practice in the management of allergic rhinitis and rhinosinusitis by conducting a survey among ear, nose and throat (ENT) specialists, pharmacists, and general practitioners (GPs) in Malaysia.MethodsWe conducted a survey study among ENT specialists, pharmacists, and GPs in Malaysia, who answered a multiple choice questionnaire focused on the current practice in the management of allergic rhinitis and rhinosinusitis in their respective field. More than 200 ENT specialists, 100 pharmacists, and 200 GPs participated in the survey.ResultsAntihistamines were the most preferred choice for the treatment of mild allergic rhinitis by ENT specialists (45%), pharmacists (78%), and GPs (51%), with the most preferable duration of <2 weeks. In moderate-to-severe allergic rhinitis, a combination of antihistamines and intranasal steroids was the most preferred treatment of choice in 90% of ENT specialists, 72% of pharmacists, and 69% of GPs. Efficacy of antihistamines was the main criteria of choice in 58%, 53%, and 38% of ENT specialists, pharmacists, and GPs, respectively. Notably, complaints of drowsiness associated with nonsedative antihistamines were the major unmet need identified in the survey. For chronic rhinosinusitis, a combination of antihistamines and intranasal steroids was the most preferred treatment. The majority of the respondents preferred a treatment duration of >3 months with antihistamines. Satisfaction with the recommendations in the current Allergic Rhinitis and its Impact on Asthma (ARIA) guideline was high; 66%, 58%, and 89% of the ENT specialists, pharmacists, GPs, respectively, reported that the current ARIA guidelines are sufficient for their clinical/pharmacy practice.ConclusionThe current practices in the management of allergic rhinitis in Malaysia are largely in line with the ARIA guidelines. The majority of physicians and pharmacists are satisfied with the recommendations in the ARIA guidelines.

ARIA pharmacy 2018 “Allergic rhinitis care pathways for community pharmacy”

“…A large proportion of AR patients actually self‐manage their condition, and the pharmacist is often the first HCP to whom a person with nasal symptoms presents . This further strengthens the important role of pharmacists within multidisciplinary healthcare teams, acting at different steps of the ARIA‐pharmacy ICPs …”

Modern aspects of treatment of allergic rhinitis

“…Несмотря на это, наблюдался регионзависимый эффект: первичная эффективность была значительно выше для антигистаминного препарата по сравнению с плацебо в Европе и Аргентине (P = 0,039), и наоборот: в Южной Африке не наблюдалось значимых отличий, где пациенты показали достаточно высокий уровень ответа на плацебо. Длительная фаза последующего лечения в данном исследовании также показала, что биластин является безопасным и хорошо переносится при длительном применении [18,19].…”

New possibilities of pathogenetic therapy for allergic rhinitis

“…В рандомизированном двойном слепом плацебоконтролируемом исследовании, проводимом в Европе, Аргентине и Южной Африке, сравнивалась эффективность биластина, по сравнению с цетиризином и плацебо, в течение 4 недель у 651 пациента с круглогодичным аллергическим ринитом. В открытой фазе дополнительного лечения 513 пациентов получали биластин в дозе 20 мг в течение 12 месяцев, что является самым длитель- [17,18]. Таким образом, согласно международным и национальным согласительным документам, в качестве первой линии медикаментозной терапии аллергического ринита и поллиноза рекомендуется применение неседативных антигистаминных препаратов второго поколения.…”