AzelastinE-News - 1/2010

Dear Reader,

Happy New Year! This is a time of new beginnings and good intentions! Like the rest of us, did you also start 2010 with many good resolutions? Perhaps you have resolved to embark on a new fitness regime? But how will your allergy symptoms test your resolve? The current issue of our patient newsletter focuses on the topic of quality of life of the allergy sufferer. We ask how can hay fever sufferers can avoid the undesirable symptoms of their rhinitis and conjunctivitis, and/or effectively treat them and thus still actively participate in everyday life despite their hay fever?

In this issue you also learn what specific immunotherapy is all about, and what it entails. Additionally, we inform you about the pollen count situation in the spring, and provide detailed information on a representative group of the early bloomers.

Regardless of whether you want to prevent hay fever symptoms or to counteract them actively in acute cases, our expert tips describe the different treatment options with their associated advantages and disadvantages.

With the information in the current issue you will extend your allergic rhinitis knowledge base, so that the quiz at the end of this newsletter should be a walk in the park!

We wish you a lot of fun whilst reading and puzzling!
Your "Rhinitis" Newsletter Team

Quality of life in focus:
remain active during hay fever episodes despite the presence of pollen and other antigens

Anyone who suffers from hay fever dreads the beginning of the pollen season every year anew. As with previous years, you can expect a red and running nose (Rudolph has nothing on you!), itchy eyes, and breathing difficulties. Those affected feel weak and tired and sleep poorly, all of which impact on how well one functions in the work place. In a nutshell, one's quality of life is restricted! As your allergy symptoms become bothersome again, the most important factor is to find the right therapy, so that the restrictions to everyday life do not gain the upper hand. Topically-effective antihistamines with the active ingredient azelastine can bring fast relief as needed. Annoying rhinitis and conjunctivitis symptoms disappear very quickly following azelastine therapy, with very good tolerance for up to 12 hours, leading to a true improvement in everyday quality of life.

Experts consider quality of life to be the degree of well-being which a person experiences. Many factors play an important role in it, such as material prosperity, education and occupational opportunities, but health is of central importance. For the World Health Organisation, quality of life, in terms of health, denotes the physical, psychic and social condition of an individual.

Every pollen allergy sufferer would agree that one's physical well-being, and thus one's quality of life, is severely restricted by hay fever. For weeks on end, sleeping becomes a nightmare in the truest sense of the word, learning becomes continually more strenuous due to lack of concentration, and spontaneous leisure time activities are increasingly neglected. For allergy sufferers the coming of spring no longer signals the time for long walks through flowering orchards or the time when winter boots are replaced by jogging shoes, but merely the beginning of the hay fever season.

Anyone who must involuntarily orient his or her activities to the pollen calendar suffers a decrease in quality of life; all those affected agree on this. In order to be able to remain active outdoors, allergy sufferers require an appropriate therapy, which is also immediately effective in acute cases. The topically effective antihistamine azelastine works three ways against hay fever: anti-allergically, anti-inflammatorily, and additionally by mast cell stabilization. This means that mast cells release substantially less histamine, a key substance in the allergic process. Azelastine starts working within 12 to 15 minutes after application, and maintains its action for up to 12 hours, regardless of whether it is used to treat rhinitis or the symptoms of accompanying conjunctivitis. Thus, azelastine must only be administered twice a day. A therapy which is well-tolerated, simple in application and fast-acting should improve the quality of life of its users.

Hay fever under control: Hyposensitisation – a glimmer of hope for allergy sufferers?

The dream of all allergy sufferers is to have their hay fever permanently under control. In addition to allergen avoidance and the use of appropriate medicinal therapy, specific immunotherapy (SIT), also known as hyposensitisation, is an important approach in the treatment of hayfever. The objective is to persuade the immune system to reduce its over-exuberant defensive reactions to certain substances by administering very low concentrations of these allergens regularly. But annoying allergic complaints, which have to be treated rapidly and effectively, also occur during this time-consuming therapy. Topically effective antihistamines with the active substance azelastine are particularly effective in such cases, and are also well-tolerated during hyposensitisation therapy.

The principle of hyposensitisation is simple. The allergy sufferer is given a very low concentration of an allergen until the body's reactivity to the allergen has been so reduced that the body ultimately becomes insensitive. The important thing in this context is to precisely identify the allergen that produces the allergic symptoms. In hyposensitisation, small quantities of the allergen are normally administered on a weekly basis. The dose is continually increased. After the maximum quantity has been reached, the patient is given additional doses every four to eight weeks so that the immune system does not unlearn the desired reaction.

Specific immunotherapy can be performed in various ways. In most cases the extract is injected (subcutaneous immunotherapy). However, for sensitive patients a sublingual immunotherapy, in which drops or tablets are administered, is also possible.

In order to avoid additional continuous confrontation with the allergen, and to slowly accustom the body to the administered allergen, the therapy should be initiated in autumn. The pollen load is at its lowest level at that time. When the pollen count again rises in the spring, the immune system is appropriately prepared. At that time the physician frequently interrupts the therapy until the following autumn to avoid an increased allergic load.

Good prospects for successful hyposensitisation exist for seasonal allergic rhinitis as well as for cases of mild to intermediate allergic asthma in response to grass pollen (rye pollen), birch pollen (hazel pollen, alder pollen), mugwort pollen, and house dust mite. Eight out of ten allergy sufferers respond to the treatment, and require less allergy medication or sometimes even none at all. Even an incipient allergic march, (i.e. asthma development as a consequence of a poorly treated allergy) can thus be prevented. Specific immunotherapy normally has a high efficacy in children and adolescents.

A great disadvantage of this treatment is that it is very tedious, and is normally conducted for three, sometimes even five, years. During this period, reactions which require treatment repeatedly occur. Fast, effective eye drops and nasal sprays with the active substance azelastine provide extremely rapid relief within 15 minutes and are well-tolerated during specific immunotherapy.

Profile: Common hazel (Corylus avellana)

Family: Birch family (Betulaceae)
Home: Europe and Asia Minor

The common hazel, also known as hazel bush and hazel nut bush, is a light-demanding, deciduous bush, which can grow to five meters high, and is primarily found at the edges of forests. The male catkins are conspicuous in the early spring due to their yellow colour. The common hazel is known for its edible hazelnuts, which have been used by humans for millennia.

The beginning of the flowering period is dependent on the temperature subsequent to the end of the main resting period (beginning of December), and occurs at temperatures from approximately 5oC. This can occur as early as the end of December, but the main flowering period is usually February/March.

Its allergenicity is considered to be moderate to high. Both the alder and the hazel have a definite cross-reaction with birch pollen. Highly sensitive sufferers of birch pollen allergy can experience discomfort very early in the year, which can be traced back to the closely related alder and hazel pollen.

There is something in the air – early bloomers start increasingly earlier

Meticulous pollen calendars have been kept in most European countries for many years. These calendars tell us what blooms when, how long for and with what intensity? In the last several decades a definite trend has become apparent; the flowering periods of those plants which are important for allergy suffers definitely begin earlier and last longer. Therefore, it is increasingly important for allergy sufferers to always have acutely effective and simply administered therapeutic agents to hand.

The pollen season begins with the early bloomers such as the alder, hazel, willow and elm. These early bloomers now start producing pollen and reach maximum pollen production on average three weeks earlier than previously recorded. A further important representative of the early bloomers is the birch, which normally causes severe complaints in April.

Grasses and rye follow the early blooming trees, with grass pollens inducing allergy symptoms up to July or August. Hay fever sufferers who in the past first expected sneezing attacks due to rye or wall pellitory in the middle to the end of May, are now frequently unpleasantly surprised as early as April. The grasses and rye period is followed by the weed period (e.g. mugwort or ragweed). Ragweed is closely related to mugwort, and is becoming increasingly more widespread due to a change in the vegetation.

In the Mediterranean region along the coast and in the Alps, allergy sufferers must adjust to a longer pollen season. In Central Europe this extension holds true for grasses and herbs, but also for trees such as birches, oaks, beeches, ashes, plane trees, and lime trees. The situation is aggravated by the fact that, in addition to the altered climatic circumstances, elevated emissions such as fine dust and soot particles contribute to increased pollen allergenicity. Moreover, pollen can be transported hundreds of kilometres by the wind, even across mountains. The consequence is that pollen from the Moroccan Atlas Mountains can be detected in Central Europe, and ragweed bloom in Hungary, Poland, the Czech Republic or the Ukraine can result in discomfort for allergy sufferers as far afield as Stockholm.

There is no doubt that unpredictable times lie ahead for allergy sufferers! Consequently, therapies which can be directly used in an acute case are all the more important. The state-of-the-art antihistamine azelastine is a fast-acting and effective therapy which exhibits an anti-inflammatory, anti-allergic and mast-cell-stabilizing action. The onset of action is within 15 minutes, and its effect lasts for up to 12 hours. Moreover, azelastine is very well-tolerated, and thus helps allergy sufferers to get through the pollen period with almost no symptoms.

Frequent questions from people suffering from allergies:

As an active person I do not want to completely abstain from activities (including outdoor activities) due to my hay fever. Are there any sports which are particularly appropriate for me and my fellow sufferers?

In order to avoid worsening of the symptoms of allergic rhinitis during outdoor activity it is important to know which activities are safe, and which are likely to trigger your allergy symptoms. For example, joggers and walkers should not do laps through the park at night, in the early morning hours or during extremely windy weather (particularly in the spring and summer when the pollen concentration in the air is at its highest). At these times, the pollen load is distinctly higher than at other times of the day. In contrast, after a heavy downpour, there is less pollen in the air. Areas of open water are also associated with a reduced pollen load. Thus, sailing, surfing, kite surfing and swimming are viable outdoor alternatives. All types of winter sports are normally not prohibited for pollen allergy sufferers. The same is true for all types of sports practiced in enclosed rooms and halls. Since there are excellent medicinal treatment options available today, you should always have a nasal spray to hand for acute attacks. In such cases, the fast-acting antihistamine azelastine has proven itself. Relief from symptoms can occur within a few minutes.
The editorial staff wishes you great fun in your athletic endeavours.

My partner suffers from hay fever. In my home his symptoms are frequently more severe than elsewhere. Are there supportive measures that I can take to ensure that my partner's symptoms don't get any worse?

There are measures that you can take to create a nearly allergen-free environment for your partner. Here are a few tips for around the house. Air your rooms after a rain shower, the pollen load in the air is lowest then. You should never dry your laundry outdoors, as this immediately contaminates it with pollen again. Clothing that has already been worn should ideally not be removed in the bedroom, as it can be a source of pollen. Regarding joint activities, it is best to leave the windows closed during car trips and to coordinate your joint leisure time according to your partner's needs (e.g., avoid long walks through flowering meadows). Your partner should always have fast-acting medication to hand as this will ensure rapid relief from annoying symptoms in acute cases.
The editorial staff wishes you every success with the implementation of your preventive measures.

Tips from experts – today:

Which medications are particularly appropriate for the treatment of hay fever?

• Mast cell stabilizers

  Mast cells release histamine, a key substance in the allergic process. Mast cell stabilizers block the release of this histamine from mast cells.

  Properties of preparations such as cromoglicic acid:

  • Onset of action only after several weeks of use. Thus, treatment must be initiated before the pollen season begins.
  • Effective only after continual, regular application.
    
    

• Antihistamines

  These agents block the action of histamine.

  Properties of innovative substances, such as azelastine, which are topically administered:

  • Fast action within 15 minutes in acute cases.
  • Long-lasting action for up to 12 hours.
  • Very well tolerated. No unpleasant side effects such as signs of fatigue.
    
    

• Decongestant nasal sprays

  These agents are used for the treatment of blood vessel constriction in the nasal mucosa.

  Properties of vasoconstrictors:

  • Nasal congestion is relieved, but all other symptoms remain.
  • Only short-term application for 2 to 3 weeks is advisable, in order to avoid damage to the nasal mucosa.
    
    

• Nasal sprays containing cortisone

  Cortisone is an autologous hormone which suppresses the immune response and thus the allergic reaction.

  Characteristics

  • Administration is recommended for severe symptoms which cannot be controlled with antihistamines.
  • Medicinal product subject to medical prescription.
  • To avoid damage to the nasal mucosa, it is normally advisable to avoid using these preparations for long periods of time.
    
    

Test your knowledge of allergies

Please circle the letter adjacent to the correct answer.

1. Which plant's pollen causes allergy sufferers particular discomfort in the spring?
   M. Hazel
   N. Ragweed
   
   
2. What helps in acute cases of sneezing attacks and congested nose?
   D. Cromoglicic acid
   E. Azelastine
   
   
3. Where does the common hazel predominantly grow?
   D. In Central Europe
   E. In Australia
   
   
4. When should patients with rhinitis participate in outdoor activities in spring and summer?
   B. In long drought periods
   A. After a rain shower
   
   
5. How long does a specific immunotherapy normally last?
   P. 3 to 5 years
   H. 1 to 2 years
   
   
6. Which different options for hyposensitisation exist?
   I. Trans-nasal and intravenous
   H. Sublingual and subcutaneous
   
   
7. How long should decongestant nasal sprays be used at the most?
   Z. 5 weeks
   A. 2 to 3 weeks
   
   
8. What contributes to the elevated allergenicity of pollen?
   R. Increased emissions, e.g. of fine dust
   S. Altered light conditions
   
   
9. What is the medical term for hay fever?
   M. Seasonal rhinitis
   N. Local arthritis
   
   
10. What type of car is appropriate for pollen allergy sufferers?
    E. A convertible which is predominantly driven with its top down
    A. A model with pollen filters
    
    

If you have correctly answered all the questions, the first letters of the correct answers result in the following word:

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