Steroid and Anti-Histamine All-In-One Nasal Spray!

Meda Pharmaceuticals has announced a new nasal spray "Dymista" that contains both a steroid and an anti-histamine active ingredient. Why is this significant? It's because it's the first and only one to do so. Of course, it's not available yet until the FDA approves it, but at least it has shown effectiveness in Phase 3 clinical trials.

At this time, nasal sprays as it relates to nasal allergies come in two separate flavors:

1) Steroid Nasal Spray (flonase, nasonex, nasacort, rhinocort, veramyst, omnaris, etc, etc)
2) Anti-Histamine Nasal Spray (patanase, astepro, astelin)

This new combo nasal spray "Dymista" contains fluticasone and azelastine. Fluticasone is a steroid that is also found in flonase nasal spray whereas azelastine is an anti-histamine also found in astepro and astelin nasal sprays.

Clinical trials in the past have shown that using a steroid nasal spray and an anti-histamine nasal spray was more effective than using one or the other individually.

Similarly, Dymista has also been found to be better than either nasal spray alone, but with the convenience of using a single nasal spray.

Look for it in the near future! Let's just hope insurance will cover it however.

Read the press release here.

Reference:
Onset of Action of MP29-02 in the Treatment of Seasonal Allergic Rhinitis. J Allergy Clin Immunol 2011; 127; 2; Abstracts 199

MP29-02 in the Treatment of Nasal Symptoms of Seasonal Allergic Rhinitis. J Allergy Clin Immunol 2011; 127; 2; Abstracts 199

Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Annals of Allergy, Asthma and Immunology, 2008, vol. 100, no. 1, pp. 74 - 81.

Anti-Histamine Eye Drops

Allergies often cause eye symptoms of itching, swelling, redness, and tearing.

If other allergy symptoms are also present involving the nose and skin, it is best to try an oral anti-histamine as a first step.

This one oral drug may be able to resolve all these symptoms. As I am fond of telling patients, oral medications affect the whole body as the medication goes to the stomach after swallow, gets digested, and spreads to the big toe just as much as the skin, nose, and eyes.

However, if symptoms are limited to just the eye, it is best to use topical medications like eye drops rather than an oral medication which goes everywhere (where it is not needed).

There are in essence two anti-histamine eye drops available over-the-counter.

The first is the combination of naphazoline and pheniramine found in NaphCon-A and Visine-A (formerly called Ocuhist). Naphazoline is a decongestant that helps eliminate the red eyes whereas pheniramine is an anti-histamine to help eliminate itching. It can be used up to 4X per day for relief.

The other contains the active ingredient ketotifen and has 3 modes of action: anti-histamine, mast cell stabilizer, and eosinophil inhibition. All three actions in essence help resolve current as well as future allergy eye symptoms. It's also why it can be used only twice a day opposed to 4X per day required with naphazoline/pheniramine.

There are three main brands of ketotifen that basically are the same thing:

- Zaditor

- Alaway

- Zyrtec Eye Drops

- Claritin Eye Drops

The "zyrtec" and "claritin" eye drops names are quite misleading in that the eye drops do NOT contain the same ingredient as that found in the oral medication by the same name.

Personally, I prefer ketotifen over naphazoline/pheniramine due to longer-lasting relief per use, 2X per day dosing, and less risk (glaucoma and hypertension specifically). Ketotifen can be used from the age of 3 years (age 6 years for the other).

Of course, if these eye drops don't work, there are prescription antihistamine eye drops that work quite well including pataday/patanol (olopatadine), bepreve (bepotastine),  and lastacaft (alcaftadine). Of course, most insurance companies require trial of OTC eye drops first before they will authorize these prescriptions.

On a final note, there is one steroid nasal spray called Veramyst that has an FDA indication for eye allergies though I suspect all steroid nasal sprays can help similarly. As such, if a patient has only ocular and nasal allergy symptoms, it may be worth trying a steroid nasal spray, though I'm not sure how often this is practiced in reality.

New and Only Over-The-Counter Anti-Histamine Nasal Spray

Up until now, there has been three anti-histamine nasal sprays in the United States market available only by prescription... Astelin, Astepro, and Patanase.

However, in May 2011, Meda Pharma announced a new anti-histamine nasal spray Rhinolast Allergy that is available over-the-counter.

The active ingredient is azelastine, the same one as found in the prescription nasal spray Astelin and Astepro.

Azelastine has a triple mode of action: anti-histamine effect, m,ast-cell stabilizing effect, and anti-inflammatory effect. Azelastine has a rapid onset of action of 15 minutes.

It can be used from the age of 5 years.

This nasal spray can be used in combination with other over-the-counter anti-histamines medications taken orally like zyrtec, claritin, allegra, and benadryl.

Read more about this new nasal spray here.

Read more about allergy medications in general here.