Tag Archives: Rhinitis

Provocative study!

 Or at least as sexy as you can get for a vitamin.  Of all the vitamins out there, vitamin D has the most PROVEN benefit for allergies & asthma.  Remember the cod liver oilWhat we grew up on for Vit D!Of course you don’t….you’re not that old!

Curr Opin Allergy Clin Immunol. 2012;12(1):13-17. © 2012

The importance of vitamin D as an essential nutrient is well known, given its role in calcium and phosphate homeostasis. Over the past two decades, the influence of vitamin D on the immune system has become increasingly clear.  Recent work has elucidated that vitamin D harbors actions more akin to hormones and pro-hormones. The discovery of the vitamin D receptor (VDR) has stimulated more research into the nature of this vitamin which has, subsequently, been shown to be a steroid hormone. This steroid constitutes a component of a complex endocrine pathway termed the ‘Vitamin D endocrine system’.  Investigators have found that vitamin D plays an integral role in the induction of cell differentiation, inhibition of cell growth, immunomodulation, and regulation of other hormonal systems.  This review seeks to highlight the recent research with respect to vitamin D and its role in chronic rhinitis and chronic rhinosinusitis (CRS).  The results show higher levels of Vit D are associated with fewer problems with allergy and sinusitis.

The effects of Vitamin D

Although these results are extremely compelling, the Mulligan study suffers from a small sample size. Future work may extrapolate these data to a larger patient set, ideally through a prospective study, which would help clarify the role of vitamin D in the pathophysiology of CRS. Systemic vitamin D levels could, potentially, be added to the routine workup of patients suffering from CRS and these data could be used to help determine the disease severity and possibly even treatment. To this end, a recent Polish study evaluated the role of vitamin D in the reduction of fibroblast proliferation in vitro from nasal polyps in patients with CRS.  A statistically significant decrease in fibroblast proliferation was noted with calcitriol and tacalcitol treatment. Furthermore, increasingly higher doses induced a greater suppressive effect on fibroblast proliferation. This study is a first step towards investigating the utility of topical vitamin D analogs for the treatment of CRS.  Wow–topical Vitamin D for treatment of sinusitis?!

Conclusions from this work:

  • Early research suggests that vitamin D is involved in the pathophysiology of chronic rhinitis and chronic rhinosinusitis (CRS).
  • It is intriguing to consider the possibility that abnormal vitamin D blood levels – or even the local tissue concentration of vitamin D – could be a critical influencing factor in chronic rhinitis and CRS pathophysiology.
  • The concept of the unified airway “one airway, one disease” would suggest that similar associations from the asthma literature will be found with regards to allergic rhinitis, chronic rhinitis, and CRS.
  • Randomized controlled trials are needed to further evaluate vitamin D and its relationship to allergic rhinitis, chronic rhinitis, and CRS.
  • These findings may then direct researchers to pursue clinical trials aimed at evaluating vitamin D and its analogs as potential therapeutic interventions.

So…..in other words, OPEN UP! 

Now Here’s a New Medication I haven’t seen in a while

I have trouble getting patients to use ONE much less TWO nasal sprays for nasal allergy & congestion.  Now I may have a solution this year.  The buzz on the street is Meda pharmacueticals

First combination spray for the nose!

will be introducing a nasal spray product with two ingredients for patients suffering from congestion, runny nose and sneezing.  Yes, for what ails you! 

I’ll give you some tidbits from the College of Allergy/Asthma/Immunology meeting this past fall about this new medication.

November 16, 2011 (Boston, Massachusetts) — A novel nasal-spray formulation that combines the intranasal antihistamine azelastine with the intranasal corticosteroid fluticasone provides greater pharmacotherapeutic benefits for the treatment of seasonal allergic rhinitis than either of these agents alone, according to a study presented during an oral session here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.

“There are many patients with moderate or severe allergic rhinitis whose symptoms are not adequately controlled with the currently available pharmacological agents,” Eli O. Meltzer, from the Allergy and Asthma Medical Group and Research Center in San Diego, California, told Medscape Medical News. “Because of their morbidity, it is important to seek new treatments.”

National guidelines have been in agreement with this for the past several years, said session comoderator Mark Dykewicz, MD, from Wake Forest University in Winston-Salem, North Carolina.

Dr. Dykewicz, who was invited to comment on the study by Medscape Medical News, said that the 2008 Rhinitis Parameter Update of the US Joint Task Force on Practice Parameters stated that using this combination was effective.

“In contrast, most studies have failed to demonstrate that the addition of an oral antihistamine to an intranasal corticosteroid adds to the benefit of the intranasal corticosteroid,” Dr. Dykewicz said.

American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract 39. Presented November 7, 2011.

What does this mean for you? 

But Wait!

For years, patients have added OTC antihistamines (Allegra, Zyrtec, Claritin) for allergy symptoms.  Research shows you are much better off adding another nasal spray (like Astelin) than adding an oral tablet to the steroid nose spray you’re already taking.  That’s why antihistamines are often ineffective….you might as well take a vitamin!

My nose won’t stop running

Patients often come into the office with the complaint of “my allergies are bothering me!” 

Grab the Kleenex!

So what’s really going on with allergies?  What if skin testing is negative–I know I have allergies.

1.  The basic problem for patients with runny nose, sneezing, and congestion (you know the allergy nose) is nasal INFLAMMATION.  Nasal inflammation can be a result of allergic and non-allergic causes–and sometimes both!

2.  The term “allergy” means that your body produces IgE–antibodies that cause the symptoms of allergy….sneezing, congestion, and hay fever.  If you don’t produce IgE you have Vasomotor Rhinitis or irritation.  Skin testing and blood testing for allergy measures the same thing: IgE antibodies lurking in your body just waiting to find pollen or dust. Here’s a cartoon of what IgE can do:

I'm a science geek...what can I say?

3.  Don’t get me wrong, patients with irritation can be just as miserable as those with allergy. 

4.  Is treatment any different?  YES

5.  Allergy treatment uses strict avoidance of the offending agent (dust, mold, animals).  Vasomotor rhinitis is more difficult to control with avoidance because there are so many irritants in the air & in your home.  Did anyone notice the ozone alerts in Tulsa?  That’s an irritant!

6.  Medications are similar between allergy and irritant nasal inflammation.  Be careful, however, if you are using antihistamines (Zyrtec, Benadryl, Loratadine, OTC) for vasomotor rhinitis (irritation).  If you don’t have allergy, antihistamines will only dry you out and won’t stop your runny nose!  It’s always helpful to find out if you have allergy or not, so you won’t spend money on OTC medications you don’t even need. 

7.  Allergy Immunotherapy (shots)–will cure your allergies, but do nothing for irritant rhinitis. 

8.  So….whether your sneezing is due to “allergy” or “irritant”, there is hope for you.

Allergy or Irritant--that is the question!

Want more info?–click the links for Allergic Rhinitis or Non-allergic (vasomotor) Rhinitis and enjoy the outdoors!