Healthcare Professionals
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Learn more about:
Allevia benefits
Fexofenadine is a second generation antihistamine that:1
Significantly improves early symptoms of allergic rhinitis such as sneezing, itchy, runny or blocked nose and itchy, red and watery eyes 2
Helps improve the overall quality of life in people experiencing symptoms 3,4
Significantly improves ability to take part in work and activity 3,4
*for verification email uk-medicalinformation@sanofi.com
How Allevia works for allergic rhinitis
The fexofenadine 120mg* in Allevia impacts on allergic rhinitis symptoms by acting as a non-sedating receptor blocker, explained Dr Glenis Scadding, Honorary Consultant Allergist and Rhinologist at the Royal National Throat, Nose and Ear Hospital in London and Honorary Associate Professor at University College London, in an interview.
Dr Scadding outlined the workings of fexofenadine against allergic rhinitis. She said: “The mechanism of action of fexofenadine is to selectively antagonise H1 receptors on the surface of cells on multiple different organ systems. It is a second-generation H1 receptor blocker and is non-sedating. Fexofenadine also affects inflammatory mediators. Fexofenadine does not cross the blood-brain barrier and thus does not cause drowsiness like other H1 blockers.”
Different allergy products can take between 15 minutes and up to a week to work, explained Dr Scadding. She said: “Nasal corticosteroids take a few days, up to a week, to exert their maximum effect. Antihistamines, such as Allevia, taken orally start working within an hour. Topical antihistamines to nose or eyes work within around fifteen minutes and are much faster if they’re put locally.”
A combination of eye and nose treatments together with an antihistamine will generally have a greater effect than using a single product alone, advises Dr Scadding. She said: “In my practice, I find that most patients who have eye symptoms also have nose symptoms as well. So for most of them I would say use the combination of antihistamine and chromone or use an intra-nasal corticosteroid plus a chromone. Rarely, there are patients who seem to have isolated eye symptoms and for them the chromones alone into the eyes should be enough.”
Topical treatments for hayfever
| Corticosteroid nasal sprays |
| Reduce the swelling in the nose, helping to relieve symptoms so are helpful for customers with nasal congestion (but they can take time to have full effect). |
| Decongestant nasal sprays |
|
Unblock the nose and can ease congestion. Decongestants should not be used for more than 7 days in a row. |
| Nasal barrier balms |
| Can help prevent pollen from coming into contact with the nasal cavity. |
| Eye drops |
|
Containing mast cell stabilisers - can help relieve itchy, red and watery eyes. Eye drops provide the fastest relief for eye symptoms. |
Customers may need to use a combination of products to effectively manage their symptoms, for example, using an oral antihistamine with eye drops.
Fexofenadine causes less side effects compared to first generation antihistamines, advises Dr Scadding. She said: “Second-generation antihistamines such as fexofenadine have less affinity for cholinergic and alpha-adrenergic receptors and therefore do not display the anticholinergic side effects that other antihistamines do. Fexofenadine can also inhibit other mechanisms such as mast cell, basophilic histamine, and inflammatory cell release.”
Fexofenadine can be considered for use by allergic rhinitis sufferers with symptoms affecting their eyes and nose, said Dr Scadding. She explained: “Antihistamines like fexofenadine are very effective against running, itching and sneezing. So patients in whom these are the predominant symptoms should respond well to an antihistamine. Congestion responds less well and patients with that as their major symptom should probably try an intra-nasal corticosteroid.”
Other products can be used together with fexofenadine, adds Dr Scadding. “Fexofenadine can be combined with eye drops such as chromones or it could be combined with nasal wash-out therapy such as saline. It could be combined with a nasal corticosteroid but actually that is not more effective than the nasal corticosteroid alone. However, it might be useful to use the combination because nasal corticosteroids take a while to work so the antihistamine might help while the nasal steroid is building up its effectiveness.”
Why recommend Allevia fexofenadine 120mg tablets
When it comes to choosing an antihistamine for allergic rhinitis symptoms, Dr Glenis Scadding, Honorary Consultant Allergist and Rhinologist at the Royal National Throat, Nose and Ear Hospital in London and Honorary Associate Professor at University College London, recommends users should look at sedation levels.
Speaking in an interview, Dr Scadding said: “When one chooses an antihistamine, it is important to choose the least sedating molecules and that is especially for people who are driving, working machinery, learning at school, doing exams. Fexofenadine does not cross the blood brain barrier and bind to H1 receptors in the brain. Some of the other second-generation molecules do so to a small extent, so my recommendation for non-sedation would be fexofenadine.”
Fexofenadine has lower levels of sedation, explained Dr Scadding. “Fexofenadine is an effective and safe antihistamine with practically no sedation even at nine times the usual dose. So I think it can be highly recommended for everyone with allergic rhinitis who also needs to remain alert and that includes, people who are driving, people who are studying, taking exams, working machinery, it can be widely recommended.”**
There are exceptions who should not use fexofenadine, warned Dr Scadding. “As yet it is available for those aged over twelve and it has not been well studied in pregnancy and lactation so I would not recommend its use under those circumstances.”
Different product formats take a range of amounts of time to work so users should read instruction leaflets carefully, explained Dr Scadding. She advised: “Tablets of antihistamines take about an hour to work but when they do work, they will work on nose and eyes and palate. If you use an antihistamine topically such as in the nose or in the eyes then the effect is faster but more localised. So nasal antihistamine works mainly on the nose although it gives a bit of eye protection and eye antihistamine works almost exclusively on the eyes. These products are only available through prescription in the UK.”
Supporting allergic rhinitis (e.g. hayfever) sufferers during the season
Hayfever sufferers have options to relieve symptoms but starting early makes a difference, advises Dr Glenis Scadding, Honorary Consultant Allergist and Rhinologist at the Royal National Throat, Nose and Ear Hospital in London and Honorary Associate Professor at University College London. Dr Glenis Scadding does not endorse any medicinal brand or product.
Speaking in an interview Dr Scadding said: “Across the world hayfever now affects over a billion people. Hayfever actually affects quality of life quite remarkably. People tend to dismiss it but in fact the symptoms are really difficult to live with, so it really needs treating seriously and properly.”
Planning ahead can made a significant impact, explained Dr Scadding. She said: “Seasonal sufferers tend to leave treatment until late, try something for a day or two only, then switch treatments, often just using the same class of drug, rather than selecting something more effective. Forethought, with an early start to treatment and avoidance of triggers makes for better control.”
Dr Scadding recommends hayfever sufferers are treated in line with an algorithm process devised by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA). She said: “The EUFOREA treatment algorithm takes into account different levels of severity and different patient types, but it starts for everybody with education, avoidance of allergen and other triggers like pollutants, cigarette smoke, bonfire smoke and the use of nasal saline.
It then goes on for patients presenting to the pharmacy or in primary care to suggest treatment with an antihistamine or possibly an intra-nasal corticosteroid. The algorithm then goes on to recommend what should be used if the patient has to visit their doctor or is not well controlled at the first level and that would start with a nasal corticosteroid if they haven’t already used it.
But if they have used it, they would go on to a combination molecule with nasal corticosteroid plus intra-nasal antihistamine. And then if that is still not controlling their symptoms, they probably need specialist referral and then other measures would be considered. Such as oral corticosteroids or allergen specific immunotherapy, which is the only treatment that can alter the course of disease.”
Pharmacists can support hayfever sufferers, according to Dr Scadding. She said: “Show patients the EUFOREA algorithm4, suggest avoidance measures and discuss their sites and level of symptoms to select appropriate medication. Tell them how and when to use it and what side effects might occur. Ask about asthma too, whether the patient is taking treatment and whether it is controlled. Hayfever tends to worsen asthma and an increase in asthma treatment may be sensible.”
Hayfever patients can self-manage the condition to avoid making their symptoms worse, according to Dr Scadding. She advises: “Grass pollen levels are high first thing in the morning when the pollen goes up as the air warms and they’re also high in the evening when the pollen comes down as the air cools. So avoiding being outside at those times of day is good. If you do have to go out, wrap-around sunglasses can keep the pollen out of your eyes and in these COVID times wearing a mask is actually extremely good protection against pollen as well.
One other simple measure is simply to wash the nose out with salty water or saline. You can buy sprays or you can make up your own and that does help to reduce symptoms considerably and reduces the amount of medication the patient needs to take. A very good point is to avoid using much alcohol during the hayfever season because it tends to make symptoms worse.”
Technology can be used by hayfever sufferers to track their symptoms, said Dr Scadding. “Allergic rhinitis control may be checked, after a new prescription or therapy adjustment, using the Mask air app5 which is free. I would love patients to put the Mask air app on their mobile phone, because that can help with recording symptoms, they can assess their control, they can look back and check what was happening last year and they can be primed to go to their GP if their control is too poor even if they’re taking regular medication. It is a very useful app, it includes not only the nose and the eyes but the chest as well and I would recommend it to all hayfever sufferers. The app itself is like a diary but it is electronic and so easier to use.”
Find out more
You can help customers and patients get allergy rhinitis relief with our range of products.
Understanding Allergies
Get information about allergies and advice on how to relieve symptoms before they take over you.
What is the blood brain barrier?
Learn all about the blood brain barrier and how it affects your body.
References
- McDonald K, Trick L, Boyle J. Sedation and antihistamines: an update. Review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol. 2008;23(7):555-570.
- Allevia ® 120mg Film-coated tablets contains fexofenadine. For the relief of symptoms associated with allergic rhinitis. SmPC: Allevia 120mg tablets - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)
- Meltzer, E. O., Casale, T. B., Nathan, R. A., & Thompson, A. K. (1999). Once-daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Annals of Allergy, Asthma & Immunology, 83(4), 311-317.
- Euforea | Allergic Rhinitis Pocket Guide https://www.euforea.eu/news/allergic-rhinitis-pocket-guide Last accessed June 2023
- Mask Air App https://www.mask-air.com/ Last accessed June 2023
*Fexofenadine 120mg is referred to as ‘fexofenadine’ throughout all articles.
**On the basis of the pharmacodynamic profile and reported adverse reactions it is unlikely that fexofenadine hydrochloride tablets will produce an effect on the ability to drive or use machines. In objective tests, Allevia 120 mg has been shown to have no significant effects on central nervous system function. This means that patients may drive or perform tasks that require concentration. However, in order to identify sensitive people who have an unusual reaction to medicinal products, it is advisable to check the individual response before driving or performing complicated tasks.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to the Sanofi drug safety department on 0800 0902314.
Allevia 120 mg tablets
Product Information
Presentation: Allevia (fexofenadine hydrochloride) 120mg film-coated tablets, containing equivalent to 112mg of fexofenadine. Indications: Relief of symptoms associated with allergic rhinitis in adults and children 12 years and older.
Dose and administration: Adults and Children ≥ 12 years: The recommended dose is one tablet (120mg) once daily taken before a meal. Children (<12 years old): Allevia should not be used in children under 12 years of age. Elderly; Renally or hepatically impaired patients: studies indicate that dose adjustment is not necessary, but Allevia should only be administered with care in these patients on the advice of a doctor. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and precautions: Patients with a history of or ongoing cardiovascular disease should be warned that antihistamines as a medicine class have been associated with adverse reactions such as tachycardia and palpitations and should use Allevia 120 mg only on the advice of their doctor.
Interactions: Fexofenadine is a P-glycoprotein (P-gp) and organic-anion-transporting polypeptide (OATP) substrate. Concomitant use of fexofenadine with P-gp inhibitors or inducers can affect the exposure to fexofenadine. Coadministration of fexofenadine hydrochloride with P-gp inhibitors, erythromycin or ketoconazole has been found to increase the level of fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval or an increase in adverse reactions compared to the medicinal products given singly. A clinical drug-drug interaction study showed that co-administration of apalutamide (a weak inducer of P-gp) and a single oral dose of 30 mg fexofenadine resulted in a 30 % decrease in AUC of fexofenadine. It is advisable to leave 2 hours between administration of fexofenadine hydrochloride and aluminium and magnesium hydroxide containing antacids. Pregnancy: Allevia should not be used during pregnancy unless on the advice of a doctor. Lactation: Allevia 120 mg is not recommended for mothers breast-feeding their babies. Breast-feeding women should only use Allevia 120 mg if advised to do so by a doctor. Adverse Reactions: The following undesirable effects have been reported in clinical trials, with an incidence similar to that observed with placebo. Common (≥1/100 and˂1/10): Headache, drowsiness, dizziness, nausea. Uncommon (≥1/1,000 and ˂1/100): Fatigue. The following undesirable effects have been reported in post-marketing surveillance. Frequency not known: Hypersensitivity reactions with manifestations such as angioedema, chest tightness, dyspnoea, flushing and systemic anaphylaxis, insomnia, nervousness, sleep disorders or nightmares/excessive dreaming (paroniria), tachycardia, palpitations, diarrhoea, rash, urticaria, pruritus, vision blurred. RRP (ex VAT): 30 tablets pack: £8.74, 15 tablets pack: £4.91, 7 tablets pack: £2.91. Legal category: GSL. Product Licence Number: PL 53886/0065. Product licence holder: Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK.
Further information is available from Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT. Email: uk-medicalinformation@sanofi.com Document number: MAT-GB-2300132 (v1.0) Date of preparation: June 2023.
The Product Information for our Nasal Spray is available on the Product Page.
MAT-XU-2300605 (V1.0) June 2023