Prof Claudia Gray, a paediatrician with specialised accreditation in allergology and paediatric pharmacology, recently presented a webinar on the interplay between allergic rhinitis (AR) and asthma. Sponsored by Inova, the webinar aimed to enhance education, awareness, and support for these conditions.
Prof Claudia Gray, a paediatrician with specialised accreditation in allergology and paediatric pharmacology, part-time consultant at the Allergy and Asthma clinic at Red Cross Children’s Hospital, and an Associate Professor in Paediatrics at the University of Cape Town, recently presented a webinar on the interplay between allergic rhinitis (AR) and asthma. The webinar was sponsored by Inova in the interest of education, awareness, and support.
AR, often known as hay fever, extends beyond being a mere seasonal inconvenience. It manifests when the immune system reacts excessively to harmless substances, resulting in symptoms like itching, sneezing, congestion, and eye irritation.
Despite sometimes being trivialised, AR can significantly impact both physical and emotional well-being, causing discomfort and reducing functionality in daily life.
Understanding the immune response involved in AR reveals the formation of specific immunoglobulin E antibodies upon initial allergen exposure. Upon subsequent encounters, these antibodies trigger mast cells to release various mediators, leading to symptoms like itching, sneezing, and congestion. Additionally, cytokines released during this process can perpetuate inflammation, worsening symptoms over time. Traditional classification focused on seasonal versus perennial AR, but newer guidelines prioritise symptom duration and severity. The Allergic Rhinitis and its Impact on Asthma guidelines categorise AR into intermittent and persistent forms, with further subdivisions based on impact on quality of life (QoL). AR, especially when moderate to severe, disrupts sleep, hinders work or school performance, and interferes with leisure activities. It is vital to recognise AR's substantial impact beyond inconvenience and address it comprehensively to improve patients' QoL, stressed Prof Gray. Early testing for environmental allergies in children is feasible and beneficial, helping differentiate between infections and allergies for appropriate treatment.
Myths and misconceptions
Correcting misconceptions about AR is crucial for accurate diagnosis and treatment. Differentiating between allergies and infections can be challenging due to overlapping symptoms, but allergy testing is instrumental in proper classification.
A prevalent myth is that allergy medications should only be taken when symptoms are present. In reality, proactive medication use can be more effective as allergic inflammation can occur before symptoms emerge, noted Prof Gray.
Furthermore, the belief that using only one brand of allergy medication leads to tolerance build-up lacks evidence. Dispelling these myths can lead to better-informed treatment decisions and improved patient outcomes, she stressed.
Managing allergic rhinitis
Managing AR involves minimising allergen exposure and utilising pharmacological interventions tailored to individual needs. Intranasal corticosteroids and antihistamines are mainstays in treatment, with newer formulations offering improved efficacy and reduced side effects.
According to Prof Gray, antihistamines capable of inhibiting both histamine and platelet-activating factor hold a theoretical advantage for alleviating allergic AR symptoms, particularly nasal congestion - a benefit that many antihistamines lack. Furthermore, combination nasal sprays containing intranasal antihistamine corticosteroids offer an advantage by providing multiple benefits in a single device.
Recognising the interconnectedness of AR and asthma and adopting a proactive approach to treatment is essential for optimal disease control, she concluded.
Conclusion
Comprehensive management of AR requires understanding its pathogenesis, tailoring treatment, and considering the latest advancements in pharmacotherapy. Addressing both symptom relief and underlying inflammation is key to enhancing outcomes and improving patients' QoL.
