Former AAOA Heads Take on Allergic Rhinitis

TORONTO-An expert panel containing three former American Academy of Otolaryngic Allergy presidents recently provided a look at the future of allergic rhinitis, as well as a refresher on how best to treat it.

During the course of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting here, AAOA past presidents J. David Osguthorpe, MD; M. Jennifer Derebery, MD; Edwyn L. Boyd, MD; and moderator Berrylin J. Ferguson, MD, presented Allergic Rhinitis: What’s True About What’s New.

According to Dr. Osguthorpe, more than 50 million Americans suffer from allergic diseases. Allergy is said to be a causative factor in up to 50% of patients presenting at otolaryngology offices. Patients with perennial or seasonal nasal congestion and sneezing, or with chronic rhinosinusitis, as well as those in whom the role of allergy is not commonly considered, such as those with hoarseness, disordered sleep, and the sequelae of eustachian tube dysfunction, all fit within this description.

In his presentation, Dr. Osguthorpe covered what is currently available for the treatment of allergies, focusing on salient aspects that physicians should consider when selecting a therapy.

Asthma affects both physical and mental status-mostly it is a ‘presenteeism’ problem, he said. Allergic rhinitis, this IgE media phenomenon, sits in the middle of a number of diseases. Asthma, of course, has the same inflammatory type of underlying process, which is true for some of the others as well.

The most common treatments for allergic rhinitis have been avoidance or environmental modification, and pharmacotherapy.

Allergic rhinitis broadly affects how one feels about getting up in the morning, Dr. Osguthorpe said. It is worst at night…is bad in the early morning…and exacerbates sleep apnea.

If you look at people who are allergic, their productivity goes down as pollen count goes up. These people just aren’t up to speed.

click for large version

Figure. More than 50 million Americans suffer from allergic disease, which is a cause of up to 50% of office visits.

Omalazumab and Zileuton

Dr. Ferguson followed Dr. Osguthorpe, talking about uses for and efficacy of omalazumab (Xolair) and zileuton (Zyflo).

Omalazumab is a human monoclonal antibody that has been designed to bind to the FC-Epsilon receptor of the immunoglobulin E molecule where IgE will bind to a receptor in a mast cell. The antigen-specific portion of the immunoglobulin is not touched at all by omalazumab, Dr. Ferguson said, so it prevents the binding of IgE to the affector cells. The dosage is based on the weight of the patient, as well as his or her IgE level.