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      Fluticasone furoate nasal spray: Profile of an enhanced-affinity corticosteroid in treatment of seasonal allergic rhinitis

      review-article
      Journal of asthma and allergy
      Dove Medical Press
      seasonal allergic rhinitis, allergy, corticosteroid, fluticasone furoate

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          Abstract

          Of the classes of pharmacotherapy for seasonal allergic rhinitis, intranasal corticosteroids are the preferred treatment and are recommended in practice guidelines as first-line pharmacotherapy for rhinitis with prominent nasal congestion. The enhanced-affinity intranasal corticosteroid fluticasone furoate nasal spray (GW685698X), is one of the newest additions to the armamentarium for allergic rhinitis. This review summarizes the preclinical and clinical data on fluticasone furoate nasal spray and discusses its place in pharmacotherapy for seasonal allergic rhinitis. Important attributes of fluticasone furoate in seasonal allergic rhinitis include low systemic bioavailability (<0.5%), onset of symptom relief as early as eight hours after initiation of treatment, 24-hour symptom relief with once-daily dosing, comprehensive coverage of both nasal and ocular symptoms, safety and tolerability with daily use, and availability in a side-actuated device that makes medication delivery simple and consistent. With these attributes, fluticasone furoate nasal spray has the potential to enhance patient satisfaction and compliance and reduce the need for polypharmacy in the management of seasonal allergic rhinitis.

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          Most cited references49

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          The burden of allergic rhinitis.

          Although formerly regarded as a nuisance disease, allergic rhinitis (AR) has a considerable effect on quality of life and can have significant consequences if left untreated. The total burden of this disease lies not only in impaired physical and social functioning but also in a financial burden made greater when considering evidence that AR is a possible causal factor in comorbid diseases such as asthma or sinusitis. Compared with matched controls, patients with AR have an approximate twofold increase in medication costs and 1.8-fold the number of visits to health practitioners. Hidden direct costs include the treatment of comorbid asthma, chronic sinusitis, otitis media, upper respiratory infection, and nasal polyposis. Nasal congestion, the most prominent symptom in AR, is associated with sleep-disordered breathing, a condition that can have a profound effect on mental health, including increased psychiatric disorders, depression, anxiety, and alcohol abuse. Furthermore, sleep-disordered breathing in childhood and adolescence is associated with increased disorders of learning performance, behavior, and attention. In the United States, AR results in 3.5 million lost workdays and 2 million lost schooldays annually. Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects. Ironically, health care providers overestimate patient satisfaction with therapy. Therefore, improvement in patient-practitioner communication may enhance patient adherence with prescribed regimens.
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            Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire.

            In the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), the 3 activity questions are selected by the patients themselves. For greater efficiency, a version with standardized activities is required. Our purpose was to develop and validate a standardized version of the RQLQ, the RQLQ(S). With use of 5 RQLQ databases, we identified the activities most frequently selected by patients and formulated 3 generic questions that would encompass the majority of these activities. The RQLQ(S) was tested in a 5-week observational study in 100 adults with symptomatic rhinoconjunctivitis. Patients completed the RQLQ(S), the RQLQ, and other measures of health status at baseline and 1 and 5 weeks. The activity domain of the RQLQ(S) consistently gave lower scores than did the activity domain of the RQLQ (P <.001). However, this made very little difference to the overall scores (RQLQ[S] = 2.36 +/- 1.23, RQLQ = 2.43 +/- 1.23), and overall concordance was high (intraclass correlation coefficient = 0.996). In patients whose rhinoconjunctivitis was stable between clinic visits, reliability (reproducibility and ability to discriminate between patients of different impairment) was high for both instruments and almost identical (intraclass correlation coefficient = 0.97). Responsiveness to change was also very similar and good (P <.001). Construct validity (correlation with other index values of health status) was strong for both the RQLQ(S) and the RQLQ. The RQLQ(S) has strong measurement properties and measures the same construct as the original RQLQ. The choice of questionnaire should depend on the task at hand.
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              Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials.

              To determine whether intranasal corticosteroids are superior to oral H1 receptor antagonists (antihistamines) in the treatment of allergic rhinitis. Meta-analysis of randomised controlled trials comparing intranasal corticosteroids with oral antihistamines. Randomised controlled trials conducted worldwide and published between 1966 and 1997. 2267 subjects with allergic rhinitis in 16 randomised controlled trials. Nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, and eye symptoms and global ratings. Outcomes measured on different scales were combined to determine pooled odds ratios (categorical outcomes) or standardised mean differences (continuous outcomes). Assessment of heterogeneity between studies, and subgroup analyses of eye symptoms, were undertaken. Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage (standardised mean difference 0.63, 95% confidence interval - 0.73 to - 0.53), nasal discharge (-0.5, - 0.6 to - 0.4), sneezing (- 0.49, - 0.59 to - 0.39), nasal itch (- 0.38,- 0.49 to - 0.21), postnasal drip (- 0.24,- 0.42 to - 0.06), and total nasal symptoms (- 0.42,- 0.53 to - 0.32), and global ratings gave an odds ratio for deterioration of symptoms of 0.26 (0.08 to 0.8). There were no significant differences between treatments for nasal discomfort, nasal resistance, or eye symptoms. The effects on sneezing, total nasal symptoms, and eye symptoms were significantly heterogeneous between studies. Other combined outcomes were homogeneous between studies. Subgroup analysis of the outcome of eye symptoms suggested that the duration of assessment (averaged mean score over the study period versus mean score at end of study period) might have accounted for the heterogeneity. The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.
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                Author and article information

                Journal
                J Asthma Allergy
                Journal of Asthma and Allergy
                Journal of asthma and allergy
                Dove Medical Press
                1178-6965
                2010
                10 August 2010
                : 3
                : 87-99
                Affiliations
                Allergy and Asthma Specialists, PC, Blue Bell, Pennsylvania, USA
                Author notes
                Correspondence: Robert Anolik, Allergy and Asthma Specialists, PC, 470 Sentry Parkway East, Suite 200, Blue Bell, PA 19422, USA Tel +1 610 825 5800, Fax +1 610 397 0980, Email ranolik@ 123456allergypc.com
                Article
                jaa-3-087
                3047912
                21437043
                e965ae1b-aacf-4166-ae7d-b664031369c9
                © 2010 Anolik, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 6 August 2010
                Categories
                Review

                Immunology
                seasonal allergic rhinitis,allergy,corticosteroid,fluticasone furoate
                Immunology
                seasonal allergic rhinitis, allergy, corticosteroid, fluticasone furoate

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