hEALTH

ALLERGY

Hayfever - Allergic rhinitis

Runny nose, sneezing and itchy, watery eyes - often the result of hayfever, an allergic reaction against pollen and other allergens. What can you do to feel better? Which medication is preferred?

(Caution is advised when using a nasal spray containing preservatives).

Antihistamines versus Corticosteroids - which one is superior?

Antihistamines are useful and often applied drugs for the treatment of hayfever. Newer drugs are based on anti-inflammatory corticosteroids which act locally (so-called “topical glucocorticosteroids”) and are administered as a nasal spray. Both drugs have a lasting effect if applied continuously. However, for the acute need - and that’s what most patients do -, corticosteroids seem to be more potent. This was shown in a study with 88 hayfever patients. After 4 weeks of treatment, the patients using the nasal spray had less symptoms of hayfever. In addition, they had a lower level of allergic markers in blood.

Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis.
Kaszuba SM, Baroody FM, deTineo M, Haney L, Blair C, Naclerio RM.
Arch Intern Med 161: 2581-7 (2001).

Further studies emphasize:

“On the basis of current data, intranasal corticosteroids seem to offer superior relief in allergic rhinitis than antihistamines”.

Intranasal corticosteroids for allergic rhinitis: superior relief?
Nielsen LP, Mygind N, Dahl R.
Drugs 61: 1563-79 (2001).

Emerging data suggest that the corticosteroids “mometasone furoate and fluticasone propionate may have less potential for systemic effects during prolonged use, particularly in children”.

Intranasal corticosteroids for allergic rhinitis: how do different agents compare?
Corren J.
J Allergy Clin Immunol 104: S144-9 (1999).

“Overall, the newer corticosteroids, including mometasone furoate, beclomethasone dipropionate, and budesonide have an improved risk-benefit ratio compared with older cortico-steroids and are now considered the drug of choice for pediatric allergic rhinitis”.

Corticosteroids in the treatment of pediatric allergic rhinitis.
Scadding GK.
J Allergy Clin Immunol 108 (1 Suppl): S59-64 (2001).

An alternative medication: extractive of butterbur

An extract of butterbur (Petasites hybridus) may be an alternative for the treatment of hayfever. 125 patients were treated either an antihistamine or an extractive of butterbur. Both drugs showed comparable effects. However, the antihistamine often resulted in sleepiness.

Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis.
Thome OA, Schapowal A, Heinisch IV, Wiesmann UN, Simon HU.
Int Immunopharmacol 2: 997-1006 (2002).

Anti-hayfever injection

A new strategy for the treatment of (chronical) hayfever was developed at the John Hopkins University. It was presented in March 2002 on a meeting of the American Academy of Allergy, Asthma and Immunology in New York. The approach is based on the novel immuno-therapeuticum AIC. This is a complex of purified ragweed allergen (Amb a 1) conjugated to an immunostimulatory polynucleotide DNA sequence, which can bind the target antigen. In a phase II trial, AIC demonstrated its potency. No systemic allergic reactions were observed. However, the usefulness of AIC has to be proven in further clinical trials.

Immunostimulatory DNA--Dynavax.
Drugs R D 3: 193-6 (2002).

A pure vaccine for the desenzitation against grass pollen

Desenzitation is a method for the treatment of hayfever. The allergen is injected repeatedly over several month to develop a "resistance" against this allergen. However, commonly used antigens are barely defined extractives, which may contain unknown or even toxic substances. These may result in an anaphylactic shock, a perilous overreaction of the immune system. A major source of allergens are grass pollen - more than 400 million individuals are sensitized to them. Recently, a recombinant protein of the pollen of perennial ryegrass (Lolium perenne) was cloned in E.coli, expressed, and purified. To reduce its allergic potential, point mutations were introduced into the protein. This modified and purified protein was shown to activate the immune system. Because of its reduced allergic effects (about 10 percent of the wild type protein), a desenzitation using this recombinant protein seems to be more effective and with less risks than current methods.

Mutants of the major ryegrass pollen allergen, Lol p 5, with reduced IgE-binding capacity: candidates for grass pollen-specific immunotherapy.
Swoboda I, De Weerd N, Bhalla PL, Niederberger V, Sperr WR, Valent P, Kahlert H, Fiebig H, Verdino P, Keller W, Ebner C, Spitzauer S, Valenta R, Singh MB.
Eur J Immunol 32: 270-280 (2002).

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