Allergy plays a key role in asthma, both by leading to the onset of the disease and by triggering exacerbations. Learn about the key action steps clinicians should consider in the diagnosis and management of patients with respiratory symptoms suggesting asthma.

As a pulmonologist you tend to see a more difficult patient with asthma who has other co-morbidities that make their disease more complicated and difficult to control. In this slide presentation, we discuss the role of allergy in a pulmonologist’s practice. We hope you find this presentation helpful in the treatment of your patients.

Target Audience: Pulmonologists

Presented by
Dr. Donald Rollins
Associate Professor of Medicine, Pulmonary Division,
Department of Medicine, National Jewish Health

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The following PowerPoint presentation presents points of clinical consensus arrived at by participants in a closed meeting held at National Jewish Health in Denver, Colorado, on October 8, 2009, on the role of intranasal antihistamines in the management of allergic rhinitis. The following represents a summary of the experts' presentations, discussions and recommendations.The Consensus Panel held at National Jewish Health focused on the topic - Rethinking the Treatment of Allergic Rhinitis: The Role of Intranasal Antihistamines: 'Me Too Drugs" or a Novel Class?

The project was chaired by Dr. Rohit Katial, Professor of Medicine, Program Director, Allergy and Immunology, and Director, Weinberg Clinical Research Unit, National Jewish Health. The objectives of this symposium were to: 1) describe the patient's perspective of the burden of allergic rhinitis and unmet needs, 2) discuss the new place of intranasal antihistamines as first-line therapies and compare and contrast this class of medication to the traditionally available medications, 3) discuss the potential for intranasal antihistamines to provide relief superior to second-generation oral antihistamines, and 4) explain how intranasal antihistamines fit into the latest guidelines.

National Jewish Health was honored to have the preeminent leaders in the field contributing to a supplement based on this symposium, including: Rohit Katial, MD; Phil Lieberman, MD; Eli O. Meltzer, MD; Paul H. Ratner, MD; William E. Berger, MD; Michael A. Kaliner, MD; Charles J. Siegel, MD; Don A. Bukstein, MD; Carman A. Ciervo, DO; and Bradley Marple, MD. The supplement will be published in the Annals of Allergy, Asthma, & Immunology in the Fall of 2010.

In addition to providing a historical perspective of allergic rhinitis, an overview of histamine mechanism of action, and reviews of current allergic rhinitis therapies, the monograph will also include updated suggested approaches to patient management.

Dr. Katial has also prepared a slide kit which covers the same topic and sections. This information is available for your presentation use. If you have questions contact the Office of Professional Education at 800.444.2305 or 800.423.8891, extension 1000.

Disclosure: The Consensus Panel, and the resulting Consensus Statement and journal supplement were funded through an educational grant from Meda Pharmaceuticals Inc. The commercial supporter was not involved in the content development.

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Patients seen in the clinican’s office with symptoms suggesting asthma likely have allergy playing a role in their illness. While the “hygiene hypothesis” suggests that asthma risk is decreased with childhood exposure to certain environmental antigens, the IgE-mediated allergic response is both a progenitor and sustainer of airway inflammation leading to acute and chronic asthma symptoms in both children and adults. New National Asthma Education and Prevention Program (NAEPP) guidelines encourage evaluation of our patients with persistent asthmatic symptoms with allergy testing to help identify factors responsible for aggravating and fomenting underlying airway inflammation. Immunoassay testing for the presence of antigen-specific IgE antibodies in asthma patients is now available in the office or hospital setting and should play an important diagnostic role in patient evaluation. In addition to the use of inhaled corticosteroids, the confirmation of allergy by in vitro testing may support the use of specific medications to reduce mast cell mediator cytokine release or cell signaling in the allergic cascade (cromolyn, nedocrimil, zyleuton, monteleukast), or use of anti-IgE therapy (omalizumab). Most importantly, knowledge of a patient’s allergic predisposition, or atopy, encourages the physician to stress preventative environmental exposure reduction and provide the patient with practical advice on how to accomplish this in their home and lifestyle as a complementary and important part of their treatment program.

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