Dr. Blaiss: Adherence to medication is a real problem for allergic rhinitis—the main reason is that patients don't understand that this is a chronic condition; that they need to take the medication not just when they're having symptoms, but in fact to prevent them from having symptoms.
Now, physicians sometimes contribute to the patients' poor adherence in allergic rhinitis, because many times we may be prescribing complex regimens, where we have patients taking two or three different medications for their allergic rhinitis. Another problem we have is failing to explain to our patients the benefits of taking the medication, and therefore we get poor adherence. We have to make sure that patients understand that it doesn't matter how great a medication is—in fact, if they don't use it, the patient is not going to get relief. Some other problems I think we have to deal with is not understanding the patient's lifestyle, and working with the patient so that in fact they can be more adherent to their treatment. And we always have to be cognizant of the cost of medications.
I do think one of the major problems we have with adherence with allergy treatments are in fact the side effects associated with them, and especially the formulation of the medications.
Narrator: Under current guidelines, intranasal corticosteroids are considered the most effective first-line therapy to improve allergic rhinitis symptoms and burden of disease.1 Although the various approved intranasal corticosteroids appear to be equivalent in terms of reducing disease burden, the method in which these agents are delivered to a patient has significant impact on the treatment’s overall success.2
Dr. Blaiss: Now, in allergic rhinitis, we commonly use nasal sprays because they're so effective, but many patients just don't like the taste or the smell [of the nasal spray]; they don't like the drip of the spray out of their nose or down the back of their throat. And in fact in the Allergies in America survey, we found that the spray dripping down the back of the throat was one of the major problems that stopped patients from using their spray on a daily basis.3 And the Nasal Allergy Survey Assessing Limitations reported that one-third of patients with allergic rhinitis named dripping down the throat as a bothersome side effect that was associated with the use of aqueous intranasal corticosteroid formulations.4
So how do we improve adherence—and therefore improve outcomes—in our patients with allergic rhinitis? I think the first thing we have to do is educate the patient about their condition, that it is a chronic condition, and understand the benefits of the treatments that we're using.
Now, no one dies from allergic rhinitis, but in fact there is significant morbidity, with decreased productivity at work or at school. We also know patients have a very poor quality of life and poor sleep associated with their condition. As I mentioned previously, we have to gear the treatment to the patient's lifestyle. So what may work for a middle-aged female, as far as their allergic rhinitis, may be quite different than if we were treating a teenage boy. [I should note] very importantly is once-a-day dosing works the best, and to use as few medications as possible. And if we're using nasal sprays, to minimize the side effects associated with taste, smell, and volume.