Elsevier

Auris Nasus Larynx

Volume 40, Issue 5, October 2013, Pages 447-451
Auris Nasus Larynx

Intranasal phototherapy versus azelastine in the treatment of seasonal allergic rhinitis

https://doi.org/10.1016/j.anl.2012.10.005Get rights and content

Abstract

Objective

It has been suggested that intranasal phototherapy represents an alternative choice in the treatment of seasonal allergic rhinitis (SAR). Our aim was to compare the efficacy of intranasal phototherapy with that of azelastine in patients with SAR.

Methods

Seventy seven patients were randomly assigned to the two treatment groups: Group A (phototherapy) and Group B (azelastine). Subjective and objective outcomes were represented by changes in Total Nasal Symptom Score (TNSS), Quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire – RQLQ), and nasal resistance.

Results

The study demonstrated that both azelastine and intranasal phototherapy are able to significantly improve TNSS, including individual nasal symptoms. Nevertheless, phototherapy reduced nasal obstruction better than azelastine (p = 0.038). Both treatments were highly effective in improving RQLQ scores overall and in seven separate domains.

Conclusion

Whether intranasal phototheraphy will be a standard treatment of SAR or not should be appraised in future studies and clinical trials.

Introduction

Allergic rhinitis (AR) is an allergen-induced, IgE-mediated inflammatory disease of the nasal mucosa that causes major illness and disability worldwide [1]. It is estimated that the prevalence of AR is between 10% and 30% of adults in the United States and around 25% of the general population in Europe [2], [3].

Guidelines issued by the Allergic Rhinitis and its Impact on Asthma group recommend use of second-generation antihistamines as first-line treatment for AR [4]. Intranasal antihistamines can be used as first-line therapy for the treatment of seasonal allergic rhinitis (SAR) [5], [6]. Azelastine hydrochloride is a second-generation antihistamine that selectively antagonizes the H1-receptor [7]. In addition to blocking the effects of histamine, azelastine has been shown to inhibit the effects of other chemical mediators of the inflammatory response, including leukotrienes [8], substance P [9], cytokines, and intercellular adhesion molecule-1 [10]. These physiological effects may explain the efficacy of azelastine for treating nasal congestion as well as histamine-mediated symptoms. Several clinical studies with the original azelastine nasal spray showed its efficacy for the treatment of allergic and nonallergic rhinitis [11].

It has been recently demonstrated that intranasal phototherapy is an effective treatment for SAR. Koreck et al. in a randomized controlled double-blind study demonstrated the efficacy of intranasal phototherapy in ragweed-induced hay fever [12]. A recent prospective, randomized, single-blind, placebo controlled study in AR patients demonstrated a highly significant reduction in the TNSS in the phototherapy group as compared with the placebo group [13]. Rhinophototherapy with low doses of mixed ultraviolet and visible light significantly improve the clinical symptoms of AR by acting at multiple points such as induction of T-cell and eosinophil apoptosis and suppression of release of mediators like eosinophil cationic protein (ECP) and interleukin 5 (IL5) [13], [14].

The use of second-generation antihistamines in the treatment of SAR is well established [15]. However, in clinical practice, SAR symptoms are not always satisfactorily controlled by medication and some patients fail to respond to treatment. Furthermore, many patients with allergic rhinitis fail to achieve optimal symptom relief with pharmacologic monotherapy. In fact, a survey conducted by the American College of Allergy, Asthma and Immunology found that 75% of clinicians cited inadequate symptom relief as their reason for changing medications and/or prescribing combination therapy for SAR [16].

The aim of this study was to compare the efficacy of intranasal phototherapy with that of azelastine in patients with SAR. Subjective and objective outcomes were represented by changes in Total Nasal Symptom Score (TNSS), nasal resistance, and effects on quality of life (Qol).

Section snippets

Materials and methods

This study was approved by the Ethical Committee of “Vasile Goldiş” University of Arad, Romania. All participating patients, adults above 18 years of age, were legally able to give informed consent. A prospective, randomized, open study was performed in patients with a history of at least 2 years of moderate to severe grass pollen-induced SAR poorly controlled by anti-allergic drugs. In addition to clinical symptoms, positive skin prick test results and an elevated level of specific IgE

Results

In Group A, 39 patients completed the treatment and two patients from Group B did not complete the study. In Group A one patient discarded the treatment because of a modified holiday schedule and in Group B the two dropouts were caused by upper respiratory tract infections. The 2 groups did not differ in age, disease duration, or clinical scores at the beginning of the treatment protocol (see Table 1). The data analyzed in this study was normally distributed (K–S test d = 0.053, p > 0.200).

Both

Discussion

The treatment of SAR, a very common allergic disorder, is a complex problem, including elimination of the inhaled allergens from the patient's environment, specific pharmacotherapy, and immunotherapy. According to the Allergic Rhinitis and Its Impact on Asthma (ARIA) treatment guidelines [4], for moderate/severe rhinitis, intranasal corticosteroids are suggested as first-line therapy in combination with oral or intranasal antihistamines. Nevertheless, the same guidelines acknowledge also that

Conclusion

In the present study we demonstrated that both azelastine and intranasal phototherapy are able to significantly improve individual nasal symptoms such as rhinorrhea, congestion, itching, and sneezing in patient affected by SAR. Nevertheless, intranasal phototherapy reduced nasal obstruction better than azelastine. After a 14 days treatment period, the RQLQ measures revealed that both treatments were effective in improving the quality of life overall and in seven separate domains. However, there

Conflict of interest

We do not have a financial relationship with any organization or any company. No sponsorship was made for this study.

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