Worldwide, between 10 to 30% of the population is affected by allergic rhinitis (AR) . The prevalence of confirmed AR in adults in Europe range from 17% to 28.5% .
Allergic rhinitis is an inflammation of the nasal mucosa in response to airborne allergens such as pollen or house dust mites. Leading symptoms include sneezing, nasal itching, nasal obstruction, runny nose with clear secretion and other non-nasal symptoms such as red, itchy and watery eyes. In recent decades, air pollution has been associated with an increased incidence of AR worldwide. Diesel Exhaust Particulate (DEP) is an essential component of air pollutants. They can interact with allergens and worsen the allergic reaction . DEP particles infiltrate airway epithelial cells, inducing inflammation and cytotoxicity . In addition, it has been observed that the interaction of DEP with allergens can enhance allergen induced responses, up to 50-times more than allergens alone .
Fexofenadine new evidence in AR symptoms aggravated by DEP
Their allergic rhinitis symptoms (i.e. runny nose, sneezing, itchy nose, nasal congestion) were scored up to 12 hours. Primary endpoints were the area under the curve (AUC) of the TNSS (total nasal symptom score: sum of runny nose, sneezing, itchy nose) from basal to twelve hours (AUC0–12) in periods 1 and 2, and from two to twelve hours (AUC2–12) in the treatment period 3.
Looking at the first two periods of the study, a significant increase in TNSS AUC was seen in subjects exposed to both ragweed pollen (allergen) and DEP compared to those exposed to ragweed pollen alone (Fig. 1, p<0.0001). In the third period of the study, fexofenadine HCl 180 mg significantly reduced the air pollutant-aggravated AR symptoms compared to patients receiving placebo (p=0.0148) (Fig. 2). The mean percent symptoms reduction compared to placebo related to the individual symptoms was as follows: sneezing (39.2%), rhinorrhoea (28.8%), watery eyes (27.5%), blocked nose and red or burning eyes (24.8%), nasal itching and itchy eyes (23.0%), ear, palate or throat itching (18.6%).
Fig. 1. Symptoms of allergic rhinitis due to ragweed pollen were significantly stronger with the simultaneous presence of DEP. Adapted from Ellis et al., 2021 .
Fig. 2. The fexofenadine group showed significantly fewer symptoms of allergic rhinitis than the placebo group after allergen exposure with the simultaneous presence of DEP. Adapted from Ellis et al., 2021 .
Air pollutants such as DEP can aggravate AR symptoms . Fexofenadine-HCl 180 mg showed an improvement of SAR symptoms aggravated by DEP. Sneezing is particularly reduced, important for AR sufferers during the COVID-19 pandemic for when early mild COVID-19 symptoms may be confused with or co-occurrent with AR and, as uncontrolled hay fever may increase the risk of viral dissemination.
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Conflict of interest: M. Volonte and M. Murrieta-Aguttes are employees of Sanofi.
Disclosures: Medical Writing and Publication funded by Sanofi-Aventis Deutschland GmbH.