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Hay fever is a seasonal allergy to plant pollen. The reaction to pollen occurs 10-20 minutes after exposure to the allergen and manifests as seasonal allergic rhinitis and conjunctivitis. In some patients, Hay fever contributes to the development of asthma. Sometimes pollen allergy is accompanied by urticaria, angioedema, and atopic dermatitis. Hay fever reduces the quality of life. Patients often complain of headaches, fatigue, and sleep disturbance, making studying and working difficult.

Hay fever is one of the most common types of allergies. In Russia, 10-30% of adults and 20-50% of children suffer seasonal pollen allergies. At the same time, over the past 30 years, the prevalence of hay fever has increased eight times.

Predisposition to allergies in 60% of cases is inherited. The occurrence of allergies depends on the climate, the allergenicity of plants, and the degree of environmental pollution. Residents of cities develop hay fever 4-6 times more often than residents of rural areas. Allergies usually first occur in preschool and school children but can also occur in adults. Hay fever often occurs in children and young people from 8 to 20 years.

Why Seasonal Allergies Occur

Hay fever occurs when the immune system overreacts to an allergen. Pollen gets on the mucous membranes of the nose and eyes. Pollen allergens pass through the epithelium, to which the immune system responds with the production of IgE antibodies. At high levels, IgE activates inflammatory immune cells. In patients predisposed to Hay fever, the production of IgE is increased, so contact with the allergen causes inflammation and allergic symptoms.

At the same time, in patients predisposed to Hay fever, the motor activity of the ciliated epithelium of the respiratory tract is impaired, and the production of IgA antibodies is also reduced. The primary function of IgA is to protect mucous membranes from infections.

All of this allows allergens to more easily enter the body, causing swelling of the mucous membranes, increased mucus production, and spasm of smooth muscles.

Often, with hay fever, the reaction occurs not only to pollen but also to foods and herbal remedies that contain the same molecules as the pollen that causes allergies. Therefore, hay fever symptoms can develop at any time of the year.

Three Periods Of Pollination Of Allergenic Plants In Russia

  • Spring period: birch, alder, hazel, oak, ash.
  • Early summer period (first half of summer) – cereals: hedgehog, timothy, fescue, ryegrass, bluegrass, foxtail, couch grass, broomstick, bent grass, feather grass, wheatgrass, rye, corn, wheat, barley, oats.
  • Late summer period (late summer and early autumn) – weeds: feather grass, wormwood, quinoa, nettle.

Treating Seasonal Allergies: ASIT, Antihistamines, Glucocorticoids

One of the methods of hay fever treatment is allergen-specific immunotherapy (ASIT). During ASIT, small doses of the allergen are injected into the patient to reduce the immune system’s response. However, if the patient has developed sensitivity to several allergens at once, ASIT is hard to use. Therefore, antihistamines and topical glucocorticoids are often prescribed to treat seasonal allergies.

Histamine is an allergy mediator that is involved in inflammatory reactions. In response to penetration into the body of the allergen, basophils and mast cells release histamine. Histamine increases capillary permeability, facilitating the migration of inflammatory immune cells to the site of allergen entry and promoting inflammation and tissue edema. Antihistamines block the histamine receptor, preventing allergic reactions.

Azelastine is one of the antihistamines used to eliminate eye symptoms of hay fever. Azelastine inhibits the release of histamine and other mediators of allergic reactions and has an anti-inflammatory effect. Azelastine is used to prevent and treat seasonal allergic conjunctivitis and rhinitis.

Topical glucocorticoids are also used in the treatment of seasonal allergies. Glucocorticoids suppress inflammation and resist tissue swelling. One of the glucocorticoids for the treatment of hay fever is betamethasone, considered the most effective topical glucocorticoid for treating allergic rhinitis.

Seasonal Allergy Treatment: Interferon-Alpha-2b and Betamethasone Combination

Interferon-alpha-2b (IFN) has antiviral and immunomodulatory effects and restores the mucous membranes’ protective functions. In addition, IFN-alpha-2b helps reduce the synthesis of IgE antibodies that stimulate allergic reactions.

The combined preparation of interferon-alpha-2b and betamethasone combines the action of two active substances and can treat ocular and nasal symptoms of seasonal allergies – allergic rhinitis and conjunctivitis.

Hay Fever Drugs Comparison

Russian scientists compared the effectiveness of azelastine and the combined preparation of interferon-alpha-2b with betamethasone.

The study involved 100 adult patients with moderate Hay fever. The symptoms interfered with work, study, sports and disrupted the patients’ sleep. Patients complained of itching of the eyelids, watery eyes, redness of the eyes, nasal discharge, nasal congestion, and impaired general condition. Patients were more likely to present ophthalmic symptoms of hay fever than rhinological.

Patients were divided into two treatment groups:

  • Group 1. 50 people took azelastine in the form of eye drops and nasal spray. In allergic rhinoconjunctivitis, azelastine was injected into the conjunctival sac of each eye, 1 drop 2 times a day. Intranasal application – 1 spray dose 2 times a day.
  • Group 2. 50 people took combined preparation of interferon-alpha-2b with betamethasone, nasal and eye drops. The drug was injected into the conjunctival sac of each eye 1 drop 2 times a day and instilled into each nasal passage 2 drops 3 times a day, followed by a decrease in the multiplicity depending on the therapeutic effect.

Both groups of patients received treatment for 14 days. Patients’ condition and drug tolerance were assessed on days 7 and 14 of treatment.

Treatment results on day 7

In both groups, nasal discharge stopped:

  • azelastine group – in 20% of patients;
  • interferon-alpha-2b group with betamethasone – in 36% of patients.

The treatment eliminated the itching of the eyelids:

  • azelastine group – in 16% of patients;
  • interferon-alpha-2b group with betamethasone – in 24% of patients.

Treatment reduced coughing and sneezing:

  • azelastine group – in 20% and 24% of patients;
  • interferon-alpha-2b group with betamethasone – in 24 and 36% of patients.

The redness of the conjunctiva has disappeared:

  • azelastine group – in 12% of patients;
  • interferon-alpha-2b group with betamethasone – in 24% of patients.

The swelling of the nasal mucosa has passed:

  • azelastine group – in 24% of patients;
  • interferon-alpha-2b group with betamethasone – in 52% of patients.

General well-being has been restored:

  • azelastine group – in 24% of patients;
  • interferon-alpha-2b group with betamethasone – in 36% of patients.

These results show that a quarter of patients in the azelastine group and one-third of patients in the interferon group with betamethasone improved during treatment.

Treatment results on day 14

Nose stuffiness is cleared up:

  • azelastine group – in 50% of patients;
  • interferon-alpha-2b group with betamethasone – in 70% of patients.

At the same time, by the end of the second week of treatment, patients in the interferon group had no nasal discharge, and in the azelastine group, nasal discharge was still present in 8% of patients.

The itching of the eyelids has completely stopped:

  • azelastine group – in 40% of patients;
  • interferon-alpha-2b group with betamethasone – in 64% of patients.

Disappeared lacrimation:

  • azelastine group – in 56% of patients;
  • interferon-alpha-2b group with betamethasone – in 72% of patients.

Stopped coughing and sneezing:

  • azelastine group – in 44 and 56% of patients;
  • interferon-alpha-2b group with betamethasone – in 64 and 72% of patients.

The treatment eliminated the redness of the conjunctiva:

  • azelastine group – in 80% of patients;
  • interferon-alpha-2b group with betamethasone – in 96% of patients.

The swelling of the nasal mucosa has passed:

  • azelastine group – in 48% of patients;
  • interferon-alpha-2b group with betamethasone – in 76% of patients.

Completely disappeared nasal, ocular, and respiratory symptoms:

  • azelastine group – in 50% of patients;
  • interferon-alpha-2b group with betamethasone – in 70% of patients.

Both drugs were well tolerated with no side effects.

Conclusion

Although both drugs reduced seasonal allergy symptoms, the efficacy of the interferon-alpha-2b combination with betamethasone was superior to that of azelastine on both days 7 and 14 of treatment. The preparation of interferon-alpha-2b with betamethasone significantly reduced ocular, nasal, and respiratory symptoms in patients with moderate hay fever.

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Reference

Comparative experience of using the combined drug interferon alfa-2b with betamethasone and azelastine in the treatment of hay fever

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