Smarter management

of allergic rhinitis

Background
Allergic and non-allergic rhinitis is the most common non-communicable chronic disease nowadays with
serious implications for the individual’s own respiratory health. Acute and chronic nasal symptoms seriously
affect the quality of life for sufferers causing a high direct and indirect economic cost. Allergic rhinitis also ranks
as the number one risk factor for development of asthma.

The nose is the gatekeeper of the lungs: it is the first filter to catch some of the dust particles contained
in the atmosphere and conditions it for an easy entry into the bronchi. Scientific studies have demonstrated
that there is connection between upper and lower airways, meaning that any physical changes in the nasal
mucosa could reflect negatively on the organs in the chest. Generally, the nasal mucosa, which is the first line
of resistance against foreign objects, plays a leading role in the sensitization to allergens and inflammatory
reactions. These surpass the relatively small area of the nasal cavity and the paranasal sinuses and may affect
the human organism as a whole. Keeping the nose free of inflammation is a prerequisite for a healthy lung and
life free of allergies.

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 The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative was started
at the beginning of the century with the publishing of a detailed guideline on the
diagnosis, classification, prevention and treatment of rhinitis disorders and their
link to asthma and other pathologies [1]. ARIA is constantly evolving, setting out a
practical platform for allergic rhinitis management putting together in a structured
way all the knowledge, which has emerged as a result of decades of research
(Figure 1).

An important message coming

from ARIA states that all patients with
allergic rhinitis should be instructed to
try to avoid allergens. Preventing the
contact between the nasal mucosa and
the harmful agents in the atmosphere
which attack it (allergens, irritants,
microorganisms) is the simplest and
most natural approach to prevent nasal
symptoms. This can be achieved by
hiding in places free of the air borne
irritants, which is not possible for people
leading an active life. Alternatively, so
called ‘barrier-enforcing’ measures can
Figure 1. Diagnosis and management of allergic rhinitis (ARIA 2008) [2]. be implemented, which directly protect
the nasal mucosa and block the contact
with noxious substances, allergens and particulate matter. In this context, barrier-enforcing measures may be
viewed as a means to achieve allergen avoidance and all patients may be recommended to use such an approach
[3]. Ideally, if implemented properly, this strategy could make unnecessary any other therapeutic action. In a real
world, though, rhinitis symptoms tend to recur again and again, making it necessary to resort to therapeutic
means to reduce them and to suppress the underlying mucosal inflammation by means of appropriate drugs
(many of them applied intranasally) in line with the ARIA document. In a recent review some of the leading
authors of ARIA have reviewed the newest therapeutic options for treatment of allergic rhinitis and have listed
among the latest pharmaceutical and biological preparations, cellulose derived powders [4]. The latter present
a smart treatment option which is now available and is beneficial as both a barrier enforcing measure and as a
vehicle to enhance the effect of nasally applied drugs in line with the ARIA recommendations.

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 Nasaleze: the ‘smart barrier’ approach:
Nasaleze, an inert proprietary grade of micronized cellulose powder, is composed of fine particles of inert
cellulose that are applied to the inside of the nose via a patented delivery system. Nasaleze is clinically proven
to deliver fast, effective protection against hay fever caused not only by pollen, but also by other allergens
such as dust mites and pet dander. It also effectively protects against other airborne harmful objects attacking
the airways such as: germs, substances from occupational hazards. A novel patented method ensures uniform
delivery of an effective dose in the nasal cavity. Relief from symptoms can occur in minutes for many patients or
within less than 3 hours for others. Over 20 positive clinical trials with statistically significant results have been
conducted on Nasaleze [5-12]. The product is proven to effectively relieve symptoms such as sneezing, runny/
stuffy/itchy nose. Our studies have proven that many sufferers can reduce their allergy drug intake and control
their symptoms with Nasaleze alone with no side effects.

The reason to call Nasaleze a ‘smart barrier’ comes from its mechanism of action. It gets to work when
the cellulose powder meets the fluid lining the nasal mucosa and forms a protective gel-like layer. This barrier
prevents contact between airborne allergens and the mucosa, thereby preventing an excess of possible
preventable events leading to irritation. Once triggered, inflammation can spill over the lungs, so cutting short
the vicious circle of pathological processes at the site of origin would protect also against asthma.

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 The ‘smart combination treatment’ approach

On the other side of the coin, if Nasaleze is applied after a drug is instilled in the nose, the subsequent gel
barrier holds it in place by prolonging its contact with the nasal mucosa enhancing its therapeutic effect. This
has been demonstrated in studies involving nasally applied decongestants, antihistamines and corticosteroids
significantly enhancing the treatment results, while reducing the overall need for medication [13,14]. Thus, not
only can severe rhinitis sufferers use Nasaleze along with their regular nasal drug treatment, but they can derive
extra benefit by combining different components and achieve the maximum synergy between the two after
sealing the applied mix with a puff of the powder. As opposed to fixed dose combinations like the commercially
available Dymista (nasal antihistamine & nasal corticosteroid), Nasaleze empowered combinations may have
more than two components, which can be subsequently discontinued sequentially ensuring treatment flexibility
and personalized approach.

Interestingly, in these studies the obtained symptom improvement carried over for a week after
discontinuation of Nasaleze, implying a possible ‘healing’ effect on its own.

Psychological aspects for potential Nasaleze users

Many rhinitis sufferers are looking for something new. Even ‘non-drowsy’ antihistamines can have a
hangover effect and long term use of steroids is loathed by users with ‘corticophobia’. Some sufferers will already
be taking medication for other reasons and will not want to add on more systemic drugs. Pregnant or breast
feeding women and parents of school age children will want to abstain from oral drugs. Achieving symptom
control by such individuals by a natural treatment would sound quite appealing.

Nasaleze: key messages:

1. Nasaleze is a cellulose derivative powder with a patented drug delivery system.

2. Nasaleze provides unique benefits in two directions:
- Mucosal barrier enforcing measures
- Enhancement of the effects of nasally applied drug treatment(s).
3. Nasaleze on its own provides relief of asthma symptoms in many patients.
4. Nasaleze may possess a ‘healing’ on top of its ‘avoidance’ effect.
5. Nasaleze has a very favourable safety profile.
6. Nasaleze can be used to enhance the effect of nasally applied drugs.
7. Nasaleze can combine under its seal different drugs ensuring synergistic
effects.
8. Nasaleze allows personalized and flexible treatment through combining drugs.

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 A note about the author…

Prof. Todor A. Popov, MD (BG)

Todor (Ted) Popov graduated medicine in 1978 at the Medical University in Sofia, Bulgaria. He started his
academic career in 1980 in the Clinical Centre of Allergology in Sofia. He acquired specialties in Internal Medicine
in 1984, and in Clinical Allergology in 1992. He defended his PhD Thesis on airway responsiveness and cough
in 1991. He spent 2 years as visiting professor at McMaster University in Canada, working with the team of F.E.
Hargreave in methods to induce and examine sputum. Since 1997 he holds the position of associate professor
at the Clinic of Allergy and Asthma at the Medical University in Sofia. Areas of Interest: asthma diagnosis and
treatment, non – invasive methods for evaluation of airway inflammation, bronchial reactivity and cough reflex
measurements, urticaria, food allergy, epidemiology. He has authored and co-authored more than 170 articles,
contributed to different monographs, owns several Bulgarian and international patents. He is member of the
editorial board of a number of medical journals, of Bulgarian and international societies: president of the Union
of the Bulgarian Medical Societies, general secretary of the Bulgarian Society of Allergology, past president of
INTERASMA, former vice president of European Academy of Allergology and Clinical Immunology, International
distinguished member of the American College of Allergy, Asthma and Immunology.

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