Drug Selection Based on the Lifestyle and a Questionnaire Survey in Patients Receiving Second-generation Antihistamines

Abstract

The incidence of allergic diseases has been increasing in recent years. Although sublingual immunotherapy and molecular-targeted drugs have emerged as treatments for allergic rhinitis in recent years, drug therapy is still the mainstay of treatment in Japan. Recently, new non-sedative antihistamine drugs that do not cross the blood-brain barrier have been introduced. Therefore, we conducted a questionnaire survey of patients to determine the patient satisfaction level with the prescribed drug, the drugs selected, and presence of subjective drowsiness, in order to devise an algorithm for selection of the appropriate drug based on patients’ lifestyle and needs for second-generation antihistamines. This survey was divided into two parts: a lifestyle and drug needs survey and a survey of the second-generation antihistamines actually taken.

In regard to the desires of the patients in respect of the antihistamine to be prescribed, such as “immediate effect,” “persistent effect,” “no serious side effects,” “inexpensive,” “infrequent oral use,” and “strong effect even with side effects,” the results showed that the former three were desired more frequently by the patients than the latter three. A comparison of the subjective drowsiness level between patients who took a drug that calls for avoidance of extra attention to be paid while driving and patients who took a drug that did not call for the above revealed that the subjective drowsiness level was statistically significantly higher in the former group (p=0.021: Chi-squared test).

In the future, in addition to the previously reported desire of patients to be prescribed drugs with “strong efficacy,” we believe that it is necessary to also develop new drugs focusing on the desires of patients for “immediate efficacy,” “persistence,” and “no serious side effects.”

Doctors will need to make drug selections tailored to the living conditions of each person. In addition, it is necessary to examine whether daytime sleepiness is secondary to the allergic symptoms or to antihistamines. Considering that impaired performance is reduced even when there is no drowsiness, it is necessary to improve the QOL while treating the allergic symptoms, by appropriately selecting drugs that would not interfere with learning and dangerous work, or pose obstacles in daily life. The above issues must be borne in mind while prescribing antihistamines in clinical practice.