Allergy, Immunology, and ENT

Seasonal allergic rhinitis is a disease characterized by sneezing, nasal congestion, rhinorrhea, and itching, conventionally treated with intranasal corticosteroids and antihistamines. The leukotriene receptor antagonist montelukast (Singulair, Merck) recently gained FDA approval for the treatment of seasonal allergic rhinitis. While studies have shown the efficacy of montelukast in the treatment of seasonal allergic rhinitis, there are no published clinical efficacy trials to date to support the use of montelukast alone or in combination with antihistamines as a superior therapy to intranasal corticosteroids in the management of seasonal allergic rhinitis. When combined with current economic considerations, the primary role of montelukast appears to be as an adjunct agent in patients whose seasonal allergic rhinitis symptoms cannot be controlled with intranasal corticosteroids or nonsedating antihistamines alone.

Omalizumab appears effective in patients with poorly controlled allergic asthma.

Corticosteroid therapy is an effective treatment for asthma sufferers, but the use of systemic corticosteroids is known to increase the risk of osteoporotic fractures. A recent study published in the Journal of Allergy and Clinical Immunology suggests that moderate doses of inhaled corticosteroids (ICs) carry less risk than traditional oral corticosteroid (OC) therapy with respect to reduction of bone mineral density (BMD) in postmenopausal women. This assertion is based on the premise that the lowest daily dose of IC sufficient to control the patient's asthma is used.

New indications: Leukotriene blocker approved for treatment of seasonal allergic rhinitis

NME: First biologic treatment approved for psoriasis

Glaxo-SmithKline (GSK) has advised prescribers of salmeterol (Serevent) about rare, but potentially serious, respiratory adverse events in patients with asthma.

Alefacept (Amevive) is the first immunosuppressive agent directed specifically at inhibiting the activation of, and possibly killing, T cells, which are involved in the cascade of events leading to psoriatic plaque formation and inflammation. In May, an FDA advisory committee recommended alefacept for approval as a first-line therapy against moderate to severe plaque psoriasis. The authors of this Focus article review the clinical characteristics of alefacept as well as make comparisons with other systemic drugs currently used to treat chronic psoriasis and the likely biologic competitors etanercept and infliximab.

Last month the FDA's Nonprescription Drugs Advisory Committee unanimously supported loratadine's (Claritin, Schering-Plough) switch from prescription to over-the-counter status for treatment of chronic idiopathic urticaria, moving the drug one step closer to full OTC status (see significant event timeline in sidebar).

An array of both existing and investigational biologic agents are showing efficacy in clearing psoriasis and may prove useful for long-term psoriasis management. So suggests a collection of studies presented at the 60th annual meeting of the American Academy of Dermatology, held recently in New Orleans.

New indication: Broader allergy indication, new hives indication for nonsedating antihistamine

NME: Topical nonsteroid for second-line eczema Tx

NME: Loratadine successor for symptoms of seasonal allergic rhinitis

New Formulations/Combinations: Pediatric-specific albuterol formulation; fixed-dose bronchodilator combination