William W. Storms

Prevalence of allergic rhinitis in the United States

The study objective was to examine the current national prevalence of allergic rhinitis by gender, age, geographic region, population density (urban/rural), and household income. A self-administered questionnaire was sent to 15,000 households representative of the U.S. population in respect to these factors. The household member who knew the most about the familys health status and health history in the previous 12 months was asked to estimate the number of days during which household members had experienced sneezing, runny nose, stuffy nose or head, itchy eyes, or watery eyes. They were also asked about physician diagnosis of hay fever, rhinitis, persistent stuffy nose or head, or allergies involving the eyes, nose, or throat. The 9946 households responding (66.3%) represented 22,285 persons, 8394 of whom had experienced the symptoms described. In a follow-up questionnaire sent to a balanced sample of 1450 responders (>90% white, slightly more females than males), subjects were asked to indicate which of the following best described their symptoms: a common cold; a seasonal allergy (i.e., hay fever); an allergy I have all the time; an allergy only when exposed to triggers (i.e., dust, pollution); or sinus problems. Of the 1065 subjects (73.4%) responding, 31.5% reported ≥7 days of nasal/ocular symptoms, and 17.7% reported ≥31 days of symptoms. Physician-diagnosed hay fever was reported by 8.2% and allergic rhinitis (seasonal plus perennial) by 14.2%. Prevalence was highest among those age 18 to 34 years and 35 to 49 years, decreasing after age 50 years. No major trends were evident with regard to other variables studied. Extrapolation based on 1993 census data suggests that at least 35.9 million persons have symptoms associated with allergic rhinitis and up to 79.5 million persons experience ≥7 days of nasal/ocular symptoms yearly.

Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter

Chief Editors: John M. Weiler, MD, MBA, President, CompleWare Corporation, Professor Emeritus, University of Iowa, Iowa City, Iowa; Sandra D. Anderson, PhD, DSc, Clinical Professor, Sydney Medical School, Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Camperdown NSW 2050, Australia; Christopher Randolph, MD, Clinical Professor of Pediatrics, Yale Affiliated Programs, Waterbury Hospital, Center for Allergy, Asthma and Immunology, Waterbury, Connecticut

Efficacy and Safety of Fexofenadine Hydrochloride for Treatment of Seasonal Allergic Rhinitis

BACKGROUND H1-receptor antagonists are effective for the treatment of seasonal allergic rhinitis. In rare circumstances, some second-generation H1-receptor antagonists have been associated with prolongation of the corrected QT interval (QTc), thus increasing the risk of ventricular arrhythmias. Fexofendine HCl, the carboxylic acid metabolite of terfenadine, is a new second-generation antihistamine that is nonsedating and does not cause electrocardiographic effects. OBJECTIVE To investigate the clinical efficacy and safety of fexofenadine HCl in the treatment of ragweed seasonal allergic rhinitis and to characterize the dose-response relationship of fexofenadine HCl at dosages of 60, 120, and 240 mg bid. METHODS A multicenter, 14-day, placebo-controlled, double-blind trial was conducted with patients suffering from moderate to severe ragweed seasonal allergic rhinitis who met symptom severity criteria after a 3-day placebo baseline period. Patients with minimal or very severe symptoms during the baseline period were excluded. Patients were randomized to receive fexofenadine HCl (60, 120, or 240 mg bid) or placebo at 12-hour dosing intervals (7:00 AM and 7:00 PM). The primary efficacy measure was patient-assessed 12-hour reflective total symptom score before the evening dose (trough). RESULTS Five hundred seventy patients completed the trial. Fexofenadine HCl at each dosage provided significant improvement in total symptom score (P < or = .003) and in all individual nasal symptoms compared with placebo. The frequency of adverse events was similar among fexofenadine HCl and placebo groups, with no dose-related trends. No sedative effects or electrocardiographic abnormalities, including prolongations in QTc were detected. CONCLUSIONS Fexofenadine HCl is both effective and safe for the treatment of ragweed seasonal allergic rhinitis. Because there was no additional efficacy at higher dosages, 60 mg bid appears to be the optimal therapeutic dosage for these patients.

Quality of life and rhinitic symptoms: Results of a nationwide survey with the SF-36 and RQLQ questionnaires

Health care delivery is increasingly driven by results of outcomes studies. The best single instrument or combination of instruments for measurement of outcome in patients with symptoms of rhinitis has not been determined. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), a generic instrument, and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), a disease-specific instrument, have both been used. We carried out a population-based study in 312 subjects with nasal/ocular symptoms who filled out both questionnaires. We then compared their responses with those of healthy controls. Statistically significant differences between patients and controls were observed in seven of nine dimensions in the SF-36 questionnaire and in all of the seven dimensions and the aggregate score of the RQLQ. In all cases, the direction of the changes in health status indicated impairment of quality of life, particularly in ability to perform normal physical roles. Patients were troubled by repeated nose blowing, had a disrupted sleep pattern, were fatigued, and had a reduced ability to concentrate. We conclude that these outcomes should be incorporated into clinical trials, effectiveness research, and therapeutic strategies.

The economic impact of allergic rhinitis

Allergic rhinitis is the most common chronic allergic disease. Symptoms include continuous or periodic nasal congestion, rhinorrhea, sneezing, itching of the nose and eyes, generalized malaise, irritability, and fatigue. We conducted an evaluation of the costs related to management of allergic rhinitis in a U.S. population. Data are based on self-reported trends in medication and health care services usage from a nationwide population sample selected from a base of 15,000 households. The average per-patient expenditure for prescription medications was

Evaluating approved medications to treat allergic rhinitis in the United States: an evidence-based review of efficacy for nasal symptoms by class

56 yearly. The mean per-patient expenditure for nonprescription medications was

Administration of budesonide once daily by means of Turbuhaler to subjects with stable asthma

56 yearly. Based on the findings of this study, the estimated total annual medication cost associated with allergic rhinitis in the United States is

Cromolyn Sodium: Fitting an Old Friend into Current Asthma Treatment

2.4 billion. Because 63% of our study population had consulted a physician within the last 12 months, we estimate that a further

SCH 434: A new antihistamine/decongestant for seasonal allergic rhinitis☆

1.1 billion is associated with physician billing. The cost of the comorbid conditions of asthma and sinusitis originating from or exacerbated by allergic rhinitis could significantly alter these figures. If management of these conditions were allowed to contribute, even in part, to the indirect cost, the financial impact of this disease would be more properly appreciated.

Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology

OBJECTIVE To evaluate how well the medications currently approved in the United States for allergic rhinitis (AR) treat nasal symptoms when examined according to Food and Drug Administration-indicated uses and dosages. DATA SOURCES MEDLINE (1966 onward), EMBASE (1974 onward), and the Cochrane Library (2007) were systematically searched according to the following criteria defined at a roundtable meeting of the authors: randomized controlled trial, at least a 2-week duration, and approved indication and dosage in the United States. STUDY SELECTION Data from studies that met the inclusion criteria were extracted into evidence tables, which were reviewed twice by the full panel of authors. Individual panel members also were asked to comment on abstracts, articles, and summary tables based on their known expertise. The entire faculty approved the selection of studies included in this review. RESULTS Fifty-four randomized, placebo-controlled studies involving more than 14,000 adults and 1,580 children with AR met the criteria for review: 38 studies of seasonal allergic rhinitis (SAR; n = 11,980 adults and 946 children) and 12 studies of perennial allergic rhinitis (PAR; n = 3,800 adults and 366 children). The median percentage changes from baseline for total nasal symptom score for SAR were as follows: nasal antihistamines, -22.2%; oral antihistamines, -23.5%; intranasal steroids (INSs), -40.7%; and placebo, -15.0%. For PAR, the changes were as follows: oral antihistamines, -51.4%; INSs, -37.3%; and placebo, -24.8%. Data for mediator antagonists were limited. CONCLUSIONS The data, although limited, confirm that INSs produce the greatest improvements in nasal symptoms in patients with SAR. In addition, INSs are effective for PAR, but the data were of variable quality, and oral antihistamines may be equally effective for some patients. The reporting of published data should be standardized to permit better comparisons in future studies.