Protective efficacy of sunglasses on the conjunctival symptoms of seasonal rhinitis

Non-pharmacological interventions for pollen-induced allergic symptoms: Systematic literature review

BACKGROUND

Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of non-pharmacologic interventions to reduce allergic symptoms.

METHODS

PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included.

RESULTS

Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filtering, artisanal tears, individual allergen avoidance advice, various nasal applications, self-hypnosis, rhinophototherapy, and wraparound sunglasses.

CONCLUSION

Most studies had a high risk of bias and small sample sizes. There were only a few high-quality studies that give hints about the effectiveness of non-pharmacological interventions. For future research, more high-quality studies are required to confirm the effectiveness of simple, safe, and cost-effective interventions.

Nonpharmacological measures to prevent allergic symptoms in pollen allergy: A critical review

Allergic rhinoconjunctivitis (hay fever) is the most common chronic disease in all industrialized nations. Therapy consists essentially in the use of anti-allergic and anti-inflammatory drugs, which mostly show a good and quick effect. With allergen-specific immunotherapy, there is also a causal possibility of tolerance induction. There is currently a considerable undersupply, as those affected trivialize the symptoms and often have concerns about long-term drug therapy. There is also great interest in using non-medicinal measures to prevent and/or relieve allergic symptoms on the assumption that these are free from side effects. In this publication, we present non-drug methods for which clinical studies are available in the literature. The methods have varying degrees of effectiveness. An evidence-based comparative assessment between the methods is not possible. There are also hardly any studies in comparison to standard drug therapy. A large number of the interventions consist of allergen reduction, e.g., with air filters, or cleaning of the mucous membranes with nasal irrigation, etc., none of which should be seen as a substitute but as a supplement to drug therapy.

Inventory of the Recommendations for Patients with Pollen Allergies and Evaluation of Their Scientific Relevance

Pollens are responsible for allergic rhinitis, conjunctivitis, and asthma. The incidence of these diseases, which have adversely impacted the social and professional lives of people who are allergic to pollen, has tripled in the past 25 years. Official institutes, health care institutions, public interest groups, and mainstream news media provide people who are allergic to pollen with advice aimed at reducing their symptoms. The aim of this work was to provide an inventory of the prevention guidelines in the world and to evaluate their scientific relevance. A PubMed search was carried out using specific keywords. The scientific relevance of the recommendations was evaluated based on the publications disproving or confirming their merit. The guidelines issued by 12 countries in Europe, North America, and Australia were inventoried. The recommendations for avoidance were most often based on scientific data regarding their impact on pollen exposures, but they have not been clinically validated. Several studies provided additional details, however, that allowed the guidelines to be further substantiated. These guidelines have been adopted in numerous industrialized countries in the world, and they generally appear to be of relevance.

ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.

BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007)

This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.

Emerging drugs for allergic conjunctivitis

INTRODUCTION

Allergic conjunctivitis (AC) is a very common disease, especially in association with allergic rhinitis but may also occur in isolated presentation. The treatment of AC has long been based on antihistamines, cromones and topical corticosteroids, but none of these drugs completely abolishes the clinical expression of AC.

AREAS COVERED

The development of new drugs for AC is analyzed highlighting the recent insights into the pathophysiological mechanisms of the disease. The major aim of development of drugs for AC is to have agents able to prevent the inflammatory effects of the interaction between the allergen and the specific IgE antibodies on mast cell surface. This may be obtained by blocking the effects of histamine (the main mediator of early allergic response) by H1-receptor antagonists, inhibiting the release of soluble factors able to recruit inflammatory cells (that sustain prolonged inflammation) by mast-cell stabilizers, inhibiting the effects of single mediators, inducing tolerance to the allergen by specific immunotherapy or even acting on factors related to activation and differentiation of T lymphocytes such as the toll-like receptors.

EXPERT OPINION

AC is an underestimated disease for which there is a search of more effective treatments. The availability of the drugs under current evaluation will allow more refined therapeutic strategies to apply according to the characteristics and the clinical severity of AC.