Allergic Rhinitis Overview

At GSK we are committed to helping your patients with respiratory allergies feel better and to reducing their symptom burden and adverse consequences.

What is an allergy?

An allergy is an excessive or abnormal adaptive immune response directed against non-infectious, often inert environmental substances (allergens), including non-infectious components of certain infectious organisms.¹

Allergic disorders, which include anaphylaxis, allergic rhinitis/hay fever, eczema, and asthma, afflict approximately 25% of people in the developed world. For people with allergies, persistent or repetitive exposure to allergens, which are typically innocuous substances, results in chronic allergic inflammation.¹

In Norway around 20% of the population suffers from severe pollen allergy. ¹⁶

Among younger schoolchildren app. 10–20% suffer from pollen allergy, while app. 15– 30% of teenagers. In total app. 1 mill Norwegians suffer from pollen allergy.¹⁶

In turn, this can produce long-term changes in the structure of the affected organs and substantial abnormalities in their function.¹

Triggers
Allergy triggers

Where are patients encountering these allergens? Some allergens are more obvious than others.

Some common allergens are³:

Tree, grass, and weed pollen

Dust mites

Mold

Pet dander

Some less obvious allergens are⁴:

Dirty pillows

Carpeting

Back yard leaf piles
Allergy signs & symptoms
What is allergic rhinitis?
Allergic rhinitis (AR) is defined as an IgE antibody-mediated, inflammatory disease characterized by one or more of the following symptoms: nasal congestion, rhinorrhea (runny nose), and sneezing and itching².

There are several AR classification characteristics that can be helpful to determine appropriate patient treatment strategies, including²:

Temporal pattern and context of exposure to a triggering allergen: a) Seasonal (eg, pollens) or perennial (year-round exposures such as house dust mites), or b) Episodic environmental (from allergen exposures not normally encountered in the patient’s home or occupational environment, eg, visiting a home with pets not present in an individual’s home)

Frequency and duration of symptoms

Severity of symptoms

AR has traditionally been categorized as seasonal AR (SAR) or perennial AR (PAR), both of which are conditions recognized as having similar pathophysiologic and end-organ manifestations. In general, the differences between the two conditions are primarily based on the causes and duration of disease.²

Third type of allergic rhinitis, vasomotoric AR (VAR) is an inflammation of the nasal mucosa of unknown cause.
Management
Management of allergic rhinitis (AR)

In addition to oral antihistamines and intranasal corticosteroids, first‐line treatment for allergies also involves the avoidance of triggers that may cause an allergic reaction⁶.

Avoidance strategies include⁶:

Use of allergen‐impermeable covers for bedding

Maintaining relative humidity in the home below 50% to inhibit mite growth

Reducing pollen exposure by keeping windows closed, using air conditioning, and limiting the amount of time spent outside during peak pollen season

Avoiding exposure to or ownership of pets

Unfortunately, while avoidance is ideal, it is not always realistic.

Mode of action of antihistamines

Antihistamines work by binding to the H1 receptor, therefore inhibiting histamine (a mediator of the inflammatory response) from binding to the H1 receptor. This hinders the body’s response when exposed to an allergen, thus preventing symptoms such as wheezing, sneezing, coughing, itchy nose and eyes, runny nose, and shortness of breath⁷

MOA of intranasal corticosteroids (INSs)

INSs, often used as treatment for patients with mild persistent or moderate‐to‐severe symptoms, work locally in the nasal mucosa to block multiple mediators involved in the allergic cascade, including histamine, cytokines, leukotrienes, chemokines, prostaglandins, and tryptase.^10-13

INSs^10-13

Act on both early and late phases of the inflammation process, therefore relieving the symptoms they cause

Provide relief of nasal congestion and itching, runny nose and sneezing, and itchy, watery eyes.
Impact on patient quality of life
Quality of life impact

Many patients will “suffer in silence” without talking about their symptoms. They may be purposefully diminishing their allergy symptoms and the impact they have on their quality of life for a variety of reasons¹⁴:

They believe allergies aren’t that serious or are not a “real disease,” but more of a nuisance ¹⁵

They may not know that while allergies may seem benign, they can still significantly impact their quality of life ¹⁴

They may be unaware that untreated allergies can increase the risk for more serious diseases, such as anaphylaxis, asthma, sinusitis, altered mood, and cognitive impairment^14,16

Patients may not recognize some symptoms as being related to allergies. In addition to these more obvious symptoms, there are a few other surprising symptoms that may be due to allergies, namely⁵:

Chronic fatigue

Asthma

Upper respiratory infection

Bronchitis

Sinus infection

Depression

Sleeping problems

Difficulty concentrating

Lack of exercise endurance