Management of Allergic Rhinitis Aggravated by Air Pollution

How does Air Pollution aggravate Allergic Rhinitis?

Aeroallergens and air pollutants lead to allergy sensitization.

Antibody-mediated hypersensitivity

Oxidative stress-mediated hypersensitivity

Following the acute response, an inflammatory response occurs creating late-phase symptoms which manifest over hours.

Repeated exposure, like during pollen season, leads to increased tissue inflammation which may last for days.

Most common Allergic Rhinitis symptoms

• Sneezing
• Itching
• Blocked/runny nose

Management of Allergic Rhinitis in the setting of air pollution

Management of Allergic Rhinitis Aggravated by Air Pollution

Pollution is the introduction of harmful substances, or pollutants, into the environment that leads to the deterioration of the quality of air, water, and land.

The impact of air pollution on allergic symptoms is modulated by 4 factors.

Air pollutants

A mixture of solid particles, liquid droplets and gases. Air pollutants can be natural, such as bush fires, or created by human activity, such as motor vehicles.

Allergens

Biological air pollutants derive from living organisms. Some allergens are more significant indoors, while others are more important outdoors.

• Particulate matter
  • Ultra-fine (<1 μm)
  • Fine (<1–2.5 μm)
  • Coarse (2.5–10 μm)
• Diesel Exhaust Particles (DEP)
• Ozone
• House dust mites
• Pet dander
• Pollen

Outdoor air pollution constituted more than 3% of the annual Disability-Adjusted Life Year in 2010.

Recommendations for patients

• Avoidance
  • Remain indoors during high pollen levels.
• Elimination
  • Eliminate sources of indoor mold spores, clean thoroughly.
• Treatment
  • Recommend 2^nd generation antihistamines or intranasal corticosteroids, anticholinergics, and nasal lavage

How to create a healthy environment

Effect of fexofenadine hydrochloride on allergic rhinitis aggravated by air pollutants

Worldwide prevalence of allergic rhinitis (AR)

Main allergic rhinitis symptoms

This was a phase III, single-centre, sequential, parallel-group, double-blind, randomized studya conducted in an environmental exposure unit

Inclusion criteria:

• 2-year history of seasonal allergic rhinitis (SAR) with positive skin prick test to ragweed
• Self-reported history of SAR symptoms aggravated by pollen or air pollutants exposure
• Total nasal symptom score ≥3 in Period 1 (Visit 2)

^aNCT03664882, conducted in Kingston Health Sciences Centre, KGH Site, ON, Canada. Posology: fexofenadine HCl 180 mg or placebo once daily. Baseline: for Period 1 defined as hour 0; for Period 3 defined as hour-2. V, visit. 

Effect of fexofenadine hydrochloride on allergic rhinitis aggravated by air pollutants

Primary endpoints

Participants graded their Total nasal symptom score (TNSS) on a 0–3-point scale over 12-hours from baseline for each Period.

TNSS was calculated as the sum of rhinorrhoea, sneezing, and nasal itching scores.

First primary objective: to demonstrate the aggravation of the SAR symptoms caused by DEP exposure

• Period 2 vs Period 1
  • Change in TNSS area under the curve (AUC) from baseline to hour 12 TNSS AUC_0—12)

Second primary objective: to evaluate the efficacy of fexofenadine HCl in alleviating symptoms aggravated by DEP presence

• Period 3
  • Change in TNSS AUC from hour 2 to 12 TNSS AUC(_2—12)

TNSS AUC₀₋₁₂ in Period 1 and 2

A significant increase in SAR symptoms from Period 1 to Period 2 was observed

Figure 3. Mean (SE) TNSS AUC_0-12 in Periods 1 and 2 (EP)

TNSS AUC₂₋₁₂ in Period 3

A significant decrease in DEP-aggravated, SAR symptoms was observed with fexofenadine HCl compared with placebo

Figure 4. Mean (SE) TNSS AUC2-12 in Period 3 (mITT population)

The proportion of subjects reporting a treatment-emergent adverse events was higher in the placebo group

• 15.1% Placebo group
• 12.6% Fexofenadine HCl group

Reference: Telfast^® 180 mg film-coated tablets Patient Information leaflet ; Revision Date November 2020

Sanofi Consumer Health Care 87 Yarraman Place; Virginia QLD 4014, Australia.

 Disclaimer:^*Fexofenadine HCl 180 mg is registered in both markets of UAE and KSA please refer to the respective Patient Information leaflet.

 Consumer HealthCare Details:

Opella Healthcare International SAS

First Floor , Office 101, Building 25, Dubai Healthcare City, Dubai, United Arab Emirates

For further medical information, please contact the following: For UAE: 800 OPELLAAE (800 67355223) Direct Line (+971522163940)

For all Gulf Countries: CHCMedical-Information.ME@sanofi.com

To report adverse events, please call +971522164011 or contact Opella Country Safety Head at CHCPVME@sanofi.com

For UAE only you may also contact MOHAP PV department at: PV@mohap.gov.ae

To report any Product Technical Complaint please contact CHC.me.quality@sanofi.com