Pharmacoeconomics of sublingual immunotherapy with the 5-grass pollen tablets for seasonal allergic rhinitis.

Allergic rhinitis has a very high burden regarding both direct and indirect costs. This makes essential in the management of AR to reduce the clinical severity of the disease and thus to lessen its costs. This particularly concerns allergen immunotherapy (AIT), that, based on its immunological action on the causes of allergy, extends its benefit also after discontinuation of the treatment. From the pharmacoeconomic point of view, any treatment must be evaluated according to its cost-effectiveness, that is, the ratio between the cost of the intervention and its effect. A favorable cost-benefit ratio for AIT was defined, starting from the first studies in the 1990s on subcutaneous immunotherapy (SCIT) in AR patients, that highlighted a clear advantage on costs over the treatment with symptomatic drugs. Such outcome was confirmed also for sublingual immunotherapy (SLIT), that has also the advantage on SCIT to be free of the cost of the injections. Here we review the available literature on pharmacoeconomic data for SLIT with the 5-grass pollen tablets.

Eosinophilic disorders of the gastro-intestinal tract: an update.

Eosinophilic diseases of the gastrointestinal tract, including eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), are rare chronic pathologies of the digestive system, with an immuno-mediated pathogenesis. Recent data suggest that, together with the "classic" IgE-response to allergens, also a delayed hypersensitivity mechanism could be involved in the development of eosinophilic disorders. EoE and EGE were studied only in the latest decades and as a consequence accurate data are not yet available, concerning not only pathogenesis, but also epidemiology, treatment and outcomes. The diagnosis of EoE is centered on endoscopic findings but the certainty is obtained by histological examination from biopsy samples, that has a sensitivity of 100% when based on five samples. The currently available treatments include topical corticosteroids, specific diets and endoscopic treatment. Concerning EGE, three subtypes (mucosal, muscular, and serosal) were identified. The diagnosis is based, as for EoE, on endoscopic and histological assessment, and the treatment includes pharmacological and dietetic approaches. Further studies are warranted in order to better define the etiology and pathogenesis of eosinophilic diseases of the gastrointestinal tract, and thus to develop more appropriate and specific therapies.

A role for the intranasal formulation of azelastine hydrochloride/fluticasone propionate in the treatment of allergic rhinitis.

Rhinitis is a very common disease and represents a health problem for both children and adults globally. Rhinitis can be allergic or occur without any IgE-mediated sensitization to aeroallergens. Common symptoms include nasal congestion, postnasal drainage, nasal itching, rhinorrhea and sneezing. The most effective drugs for the treatment of rhinitis are antihistamines and topical glucocorticoids. MP29-02 (Dymista(®)) is a novel intranasal formulation combining the second-generation antihistamine, azelastine hydrochloride, with fluticasone propionate in a single device that has recently been developed. Here, we review the efficacy and safety profile of this intranasal formulation in the treatment of allergic and nonallergic rhinitis.

Pharmacotherapy of allergic rhinitis: current options and future perspectives.

INTRODUCTION: Allergic rhinitis (AR) is a very common disease, caused by environmental aeroallergen, and clinically expressed by sneezing, nasal itching, rhinorrhea and obstruction. It is often considered a mild illness, but actually it has a significant individual and social burden. The management of AR is based on allergen avoidance, pharmacological treatment and allergen specific immunotherapy. AREAS COVERED: In this article, the authors summarize the current status of pharmacotherapy of AR, its possible options and the future perspective. EXPERT OPINION: In most cases of AR, pharmacotherapy must be considered the cornerstone intervention. Particularly, antihistamines and intranasal corticosteroids should be the first-line agents. Other agents to be considered, depending on clinical features in single patients, are systemic corticosteroids, antileukotrienes, anticholinergics, nasal decongestants and mast cell stabilizers. Specific immunotherapy is able to reduce the drugs consumption and was shown to be effective in severe rhinitis uncontrolled with drugs. The future perspective include combination therapy with intranasal antihistamines and corticosteroids, the anti-IgE antibody omalizumab, histamine H3 and H4 receptor antagonists, cytokine inhibitors and toll-like receptors targeted treatment.