DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20182040

Assessment of cost effectiveness of antihistaminics in allergic rhinitis patients in rural region by Nasal cytology: a simple and inexpensive tool

Ganesh S. Pentewar, Ranjit J. Wagh, Aparna S. Chincholkar

Abstract


Background: This study was to assess the usefulness of nasal smear as a quick, easy and inexpensive diagnostic method for allergic rhinitis and for assessment of the cost effectiveness of antihistaminics.

Methods: This study was conducted in rural setting of tertiary care hospital. Nasal smears were taken from 52 patients with a clinical history of nasal allergy having nasal congestion score of at least 3 or more. Nasal smears were stained with Hematoxilin-Eosin and examined by pathologists.

Results: A total of 52 patients 13 in each groups of the age group 18 to 65 years (Mean age, 33.73±10.23 years); 48.08% are Female and 51.92% are Male were randomized and received either Cetirizine, Levocetirizine, Loratadine, or Fexofenadine over a period of one week. The association of eosinophil before and after the treatment was obtained using logistic regression analysis for each treatment separately. Eosinophil is marginally associated with Cetirizine before and after treatment.

Conclusions: Evaluation of eosinophils in nasal smear is an insensitive but cheaper test for the diagnosis of allergic rhinitis and use as a simple tool for comparison of cost effectiveness among commonly used oral antihistaminics. pharmacoeconomic analysis of present comparative clinical study shows that cetirizine is a better choice in comparison with levocetrizine, loratidine and fexofenadine due to its cost effectiveness.


Keywords


Allergic rhinitis, Antihistaminics, Cost effectiveness, Eosinophilia, Nasal cytology

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References


Bakhshaee M, Fereidouni M, Farzadnia M, Varasteh AR. The Nasal Smear for Eosinophils, Its Value, and Its Relation to Nasal Mucosal Eosinophilia in Allergic Rhinitis. Iranian Journal of Otorhinolaryngology. 2010 Jul 1;22(3):73-8.

Varney VA, Jacobson MR, Sudderick RM. Immunohistology of the nasal mucosa following allergen- induced rhinitis: Identification of activated T lymphocytes, eosinophils and neutrophils. Am Rev Respir Dis. 1992;146:170-6.

Chanda R, Aggarwal AK, Kohli GS, Jaswal TS, Gupta KB. Comparative study of nasal smear and biopsy in patients of allergic rhinitis. Indian J Allergy Asthma Immunol. 2002;16(1):27-31.

Canakcioglu S, Tahamiler R, Saritzali G, Alimoglu Y, Isildak H, Guvenc MG, et al. Evaluation of nasal cytology in subjects with chronic rhinitis: a 7-year study. 2009;30(5):312-7.

Lopert R, Lang DL, Hill SR. Use of pharmacoeconomics in prescribing research. Part 3: cost‐effectiveness analysis–a technique for decision‐making at the margin. Journal of clinical pharmacy and therapeutics. 2003 Jun 1;28(3):243-9.

Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. Journal of allergy and clinical immunology. 2008 Aug 1;122(2):S1-84.

Pentewar GS, Wagh RJ, Chincholkar AS. Pharmacoeconomic assessment and comparing efficacy between cetirizine, levocetirizine, loratadine and fexofenadine in allergic rhinitis patients. Int J Basic Clin Pharmacol. 2017;6:2684-9.

Wright AL, Holberg CJ, Martinez FD, Halonen M, Morgan W, Taussig LM. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics. 1994;94:895-901.

Meltzer EO. The prevalence and medical and economic impact of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997;99:805-28.

Dykewicz MS, Fineman S, Skoner DP. Diagnosis and management of rhinitis: Complete guidelines of the joint task force on practice parameters in allergy, asthma and immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol. 1998;81:478-518.

Howarth PH. Eosinophils and rhinitis. Clin Exp Allergy. 2005;5:55-63.

Lim MC, Taylor RM, Naclerio RM. The histology of allergic rhinitis and its comparison to cellular changes in nasal lavage. Am J Resp Crit Care Med. 1995;151:136-44.

Tveld CD, Garrelds IM, Koenders S, Vanwijk RG. Relationship between nasal hyperactivity, mediators and eosinophils in patients with perennial allergic rhinitis and controls. Clin Exp Allergy. 1996;26:903-8.

Jirapongsananuruk O, Vichyanond P. Nasal cytology in the diagnosis of allergic rhinitis in children. Ann Allergy Asthma Immunol. 1998;80(2):165-70.

Salib R, Lau L, Howarth PH. Nasal lavage fluid concentrations of eotaxin-1 in naturally occurring allergic rhinitis: Relationship to disease activity, nasal luminal eosinophil influx, and plasma protein exudation. Clin Exp Allergy. 2005;35(8):995-1002.

Wilson SJ, Lau L, Howarth PH. Inflammatory mediators in naturally occurring rhinitis. Clin Exp Allergy. 1998;28:220-7.

Pignatti P, Pala G, Pisati M, Perfetti L, Banchieri G, Moscato G. Nasal blown secretion evaluation in specific occupational nasal challenges. Int Arch Occup Environ Health. 2010;83(2):217-23.

Canakcioglu S, Tahamiler R, Saritzali G, Alimoglu Y, Isildak H, Guvenc MG, et al. Evaluation of nasal cytology in subjects with chronic rhinitis: A 7-year study. Am J Otolaryngol. 2009;30(5):312-7.

Gollash H. Zur kenntnis des asthmatischen sputums. Fortschritte der Medizin. 1889;7:361-5.

Eyermann CH. Nasal manifestation of allergy. Annals of Otology. 1927;36:808-15.

Malmberg H, Holopainen E. Nasal smear as a screening test for immediate-type nasal allergy. Allergy. 1979;34:331-7.

Kajosaari M, Saarinen UM. Evaluation of laboratory tests in childhood allergy. Total serum IgE, blood eosinophilia and eosinophil and mast cells in nasal mucosa of 178 children aged 3 years. Allergy. 1981;36(5):329-35.

Nowacki Z, Neuberg J, Strzałka K. Is prediction of the allergic march possible on the basis of nasal cytology? Pneumonologia i Alergologia Polska. 2010;78(4):263-70.

Miller RE, Paradise JL, Friday GA. The nasal smear for eosinophils. Its value in children with seasonal allergic rhinitis. Ame J of Dis of Childr. 1982;136(11):1009-11.

Vaidya KA, Pai S, Nagaraj TS. A study on utility of nasal smear examination in diagnosing allergic rhinitis and its histopathological correlation in allergic nasal polyps. Int J of B and App Med Scien. 2015;5(1):291-7.