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Severe Chronic Upper Airways Disease (SCUAD) affects approximately 20% of allergic rhinitis patients - treatment refractory. Dr Scadding - approx 20% of allergic rhinitis patients have SCUAD (severe combined upper airways disease).
Dr Scadding @AllerGKS is now discussing the impact of allergic rhinitis on quality of life.
40% of AR patients note their rhinitis affects sleep and causes tiredness, leads to decreased work and school productivity .
Dr. Scadding - Hay Fever can seriously impact people's lives. We do know a lot more about impacts of allergic rhinitis now & burden.
Allergic rhinitis can impact sleep & therefore cognitive functions. Work and school productivity affected by it as a result. AR has direct effects on sleep quality, QOL, asthma control, and even school performance. Hayfever shown to reduce marks by a grade during the pollen season - symptoms as well as sedating antihistamines contribute.
AR and asthma
Dr Scadding: Allergic rhinitis is associated with a OR of 4 for poorly controlled asthma. More than half of the asthmatics noted a need to increase asthma medications when hay fever was 'acting up'.
Evidence of greater need for asthma therapies if seasonal AR not being treated.
AR is not controlled by current medications
Paul Keith's survey of Canadians showed 44% of randomly contacted people reported nasal symptoms. Burden of AR in Canada surveyed 1001 adult sufferers, most (2/3) not well controlled. Disconnect between patients satisfaction and physician perspective of disease control.
Over half of AR patients were unsatisfied with intranasal steroids as a treatment for their symptoms - mainly b/c ineffective.
Scaddings' UK study showed that on average, patients with moderate AR took 4 days off work due to rhinitis symptoms.
Antihistamines and intranasal steroids both leave therapeutic gaps in the management of AR.
Dr Scadding: vast redundancy in the allergic inflammatory pathway - why single target therapies like antihistamines can't solve all. Predominant effect of intranasal steroids is on the late phase response, don't help early on. This leads to the rationale for developing a therapy that contains both an intranasal steroid and antihistamine together.
No significant differences in the efficacy of different INS preparations (may be some patient preference differences though). INS have an "efficacy ceiling", can only expect so much improvement with them alone for moderate to severe AR. Addition of oral antihistamine not of much benefit to INS. Switching between different intra nasal steroids may not offer more control of allergic rhinitis symptoms.
MP29-02 (Dymista, FP and azelastine) now approved in Canada for moderate to severe SAR inadequately controlled with INS alone. MP29-02 resulted in much greater response rate compared to INS or azelastine alone, starting from first day of treatment. Dymista statisically superior to fluticasone or azelastine alone. MP29-02 almost twice as effective as other AR therapies alone, and dramatically more effective for ocular symptoms. Very impressive clinical research portfolio for Dymista, but of course this is a sponsored symposium.
Efficacy & speed of azelastine nasal spray, vs loratadine/cetirizine in seasonal allergic rhinitis: http://www.aacijournal.com/content/9/1/16