New opportunities in the allergic rhinitis therapy

Allergic rhinitis (AR) is one of the most common allergic diseases, especially in economically developed countries, including Russia. The main goal of AR therapy is the control achievement over the disease symptoms, the minimizing of the future exacerbations risks and side effects. Antihistamines and glucocorticosteroids are the main classes of medicines used in all allergic diseases, including AR. According to the Federal Clinical Guidelines for Allergic rhinitis the use of the intranasal corticosteroids in combination with antihistamines is recommended on the second stage of therapy and higher. Both classes of medicines have a complementary effect on the allergic inflammation pathogenesis main stages. The intranasal corticosteroids and antihistamines using allows the delivery of the medicines to the allergic inflammation area directly. Modern intranasal corticosteroids have a high affinity that provides the high efficacy in the low concentrations using and the insignificant systemic bioavailability. The review presents the key characteristics of the olopatadine and mometasone furoate nasal spray in a fixed combination, which registered in the Russian Federation recently. This combination is recommend for use in adults and children over 12 y.o. with allergic rhinitis. The pharmacological characteristics of the nasal spray components including the action mechanism described. The main clinical studies results presented, that confirmed the high efficacy and safety of olopatadine/mometasone furoate combination in AR patients. The olopatadine and mometasone furoate fixed combination ensures the rapid onset and the long-lasting effect with minimal adverse events risks that increases compliance and leads to the control achievement over the AR symptoms.

The role of bacteriotherapy in the restoration of the nasal mucosa in patients with chronic rhinosinusitis

Topicality: Chronic rhinosinusitis is an polyetiological disease with shch basic complaints as nasal obstruction, nasal discharge, headache or facial pain and reduction of smell. The SNOT-22 questionnaire is widely used to detail patient complaints in various fields. Chronic rhinosinusitis is most often divided into chronic rhinosinusitis with polyps and without nasal polyps. Given the large number of phenotypes and endotypes of the disease, it is important to study further the mechanisms of pathogenesis and selec- tion of individualized treatment. Aim: to determine the role of topical application of Streptococcus salivarius 24SMBc and Streptococcus orals 89a in the form of nasal spray in improving the condition of the nasal mucosa in chronic rhinosinusitis and reducing the recurrence rate. Materials and methods: The study was conducted at the Department of Otolaryngology of National Medical University on the basis of KNP "Oleksandrivs’ka Clinical Hospital of Kyiv". It was attended by 82 patients (38 women and 44 men) aged 18 to 60 years, who were randomly divided into two groups. The 1st group (main, 43 patients) received treatment: irrigation therapy with isotonic saline, topical corticosteroid mometasone furoate in combination with a nasal spray, which contains autochthonous saprophytes (AC) – Streptococcus salivarius 89SMBc and Streptococcus orals 89a nasal mucus. The 2nd group (control, 39 patients) received nasal saline irrigation therapy, topical corticosteroid mometasone furoate in combination with topical antibiotic framicetin sulfate. Assessment was performed according to the VAS scale, SNOT-22 questionnaire (before treatment, on the 10th day of treatment and one month after the end of therapy) and determining the frequency of relapses in patients of both groups. Results: According to the obtained results, the indicators of patients of both groups before treatment and on the 10th day had no statistically significant difference (p>0.05). However a month later patients in the main group had better results (p<0.05) on the scale of VAS and the SNOT-22 questionnaire. So, topical use of Streptococcus salivarius 24SMBc and Streptococcus orals 89a as a nasal spray is effective and can be recommended for the treatment of patients with chronic rhinosinusitis in the acute stage.

Mometasone furoate in the treatment of allergic rhinitis: a complex therapeutic effect

The review examines the role of mometasone furoate (NSMF) intranasal spray (Nasonex) in the treatment of allergic rhinitis (AR). There is a wide prevalence of AR both among children and adults, its adverse effect on the quality of life of patients. It is emphasized that the main means of therapy for moderate and severe course in accordance with international and Russian recommendations for the diagnosis and treatment of AR are intranasal glucocorticosteroids (INGKS). The pharmacological features of the MF molecule that underlie its efficacy and safety, including the affinity, lipophilicity and viscosity of the drug, as well as low systemic bioavailability, are discussed in detail. The therapeutic effects of NSMF in the treatment of seasonal and perennial AR, its effect on nasal symptoms are discussed in detail. The beneficial effect of NSMF therapy on nasal congestion is emphasized separately. The beneficial effect of NSMF treatment on other clinical manifestations of AR, including ocular symptoms, effects on sleep, and olfactory function, has been noted. The safety issues of NSMF use are discussed in detail, including systemic effects, such as effects on adrenal function, eye, and growth retardation in children, and local adverse effects on the nasal mucosa; there is a high profile of local and systemic safety of long-term use of NSMF in the treatment of AR in both adults and children.

A Novel Approach to Assess the Potency of Topical Corticosteroids

The potencies of topical corticosteroid products have mainly been classified using clinical data but in some instances, the US Food and Drug Administration’s (FDA’s) vasoconstrictor assay (VCA) to assess the skin blanching response has also been used. However, the reported skin blanching response data were often based on a single visual reading and lack information on the dose (amount/quantity) or dose duration. Although several lists classifying potencies of various topical corticosteroid products have been published, the inherent potencies of topical corticosteroid raw materials used as active pharmaceutical ingredients (APIs) have not been investigated. The objective was to rank the inherent potencies of topical corticosteroid APIs and to standardize dosing such that the relevant compounds could be compared on a normalized molar basis. The potencies of clobetasol propionate, halcinonide, mometasone furoate, and fluocinolone acetonide were compared using the resulting Emax data following the fitting of the relevant response data to the Emax model where mometasone furoate > fluocinolone acetonide = clobetasol propionate > halcinonide. This ranking lists the respective inherent potencies of the APIs, which will facilitate the choice of a suitable candidate for incorporation into an appropriate topical corticosteroid product for a specific clinical indication.