November 2020

Allergic rhinitis is the most common chronic inflammatory condition. It affects more than 100 million people living in Europe, with a significant impact on individuals, society, and health economies. Most times, patients prefer to self-manage the condition by visiting pharmacies rather than seeking medical advice due to the long wait for an appointment.

Other difficulties to an effective and appropriate allergic rhinitis treatment include the inability to recognize and diagnose it and adequately prescribe a treatment. Lately, there has been a shift into more patient-approach to allergic rhinitis management, focusing on personalized, predictive, preventative, and participatory strategies.

The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and global key opinion leaders have developed a treatment algorithm to facilitate allergic rhinitis treatment in real-life settings. This guide includes a checklist of what to do when assessing patients, including a list of symptoms suggestive of allergic rhinitis, questions on suspected asthma, and instructions on using the visual scales. It consists of five steps: diagnosis, patients classification, therapy definition, product selection, and treatment plan activation. Patient education is central at all stages and their participation in the decision-making process and goal-setting.

This algorithm is concise, simple to use, suitable for all stakeholders, including pharmacies, primary care physicians, ENT doctors, pulmonologists, allergologists, and pediatricians. It provides evidence-based and expert-endorsed recommendations for the management of allergic rhinitis. The full pocket guide is available on the EUFOREA website (www.euforea.eu).

Allergic rhinitis is one of the most common diseases globally, and its prevalence is up to 50 % in children and 40 % in adults. It has a high economic burden and impacts the quality of life of patients. Allergic rhinitis related to house-dust mites or common indoor allergens is denominated perennial allergic rhinitis. The regular use of intranasal corticosteroids is recommended for the treatment of perennial allergic rhinitis. Due to the lack of studies that evaluate the “as-needed” use of intranasal corticosteroids, this study aimed to compare the efficacy between the as-needed and regular use of these products moderate-to-severe perennial allergic rhinitis.

This randomized controlled trial included 103 participants for six weeks. Participants were assigned to fluticasone furoate nasal spray (27,5 mg), two sprays once daily for one week, followed by as-needed use for five weeks (FF-as-needed) or two sprays once daily for six weeks (FF-regular). The primary endpoint was a change in the total nasal symptom score (TNSS), and secondary endpoints included a change in nasal peak inspiratory flow (NPIF), rhinoconjunctivitis quality of life-36 questionnaire score (RCQ-36), and cumulative fluticasone furoate dose.

Participants were divided into FF-as-needed (n = 51) and FF-regular (n = 52). The mean change of TNSS between the two groups was not significant at six weeks; however, the FF-regular group tendency was to a greater improvement in TNSS. The NPIF mean change was greater in the FF-regular group. Both groups had similar improvements in RCQ-36. The mean cumulative FF dose in the as-needed group was half of the regular group.

In conclusion, perennial allergic rhinitis patients from both groups had similar improvements in TNSS and quality of life, with those from the as-needed group having half of the exposure to intranasal corticosteroids.