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Allergic Rhinitis and its Impact

on Asthma (ARIA) Guidelines:
Classification of Allergic Rhinitis fluticasone furoate

The symptoms of allergic rhinitis include rhinorrhoea, nasal obstruction, nasal itching and sneezing,
which are reversible spontaneously or with treatment.

Allergic rhinitis is subdivided into intermittent and persistent disease. The severity of allergic rhinitis
can be classified as mild or moderate/severe.

Intermittent Persistent
symptoms symptoms
<4 days per week >4 days per week
Or <4 weeks And 4 weeks

Mild Moderate/Severe
No impairment of sleep One or more items
No impairment of daily Abnormal sleep
activities, sport, leisure Impairment of daily
activities, sport, leisure
No impairment of work
and school Impaired work and
school
No troublesome
symptoms Troublesome
symptoms

Reference: Aria guidelines (2008) "Management of Allergic Rhinitis and its impact on asthma" available at: http://www.whiar.org/docs/ARIA_PG_08_View_WM.pdf (accessed: 1/11/11).
Date of preparation: November 2011 IE/FF/0007a/11
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The ARIA Algorithm for the

Management of Allergic Rhinitis fluticasone furoate

Check for asthma

especially in patients
with severe and/or
persistent rhinitis
Recommendations
Patients with persistent rhinitis should
be evaluated for asthma
Diagnosis of allergic rhinitis Patients with persistent asthma should
be evaluated for rhinitis
Intermittent Persistent A strategy should combine the treat-
ments of upper and lower airways in
symptoms symptoms terms of efficacy and safety

Mild Moderate- Mild Moderate - severe

Not in preferred order
oral H1-blocker or
intranasal H1-blocker
Not in preferred order
and/or decongestant
or LTRA*
Severe
In preferred order
intranasal steroids (INS), H1-blocker or LTRA
oral H1-blocker or
intranasal H1-blocker review the patient after 2-4 weeks
and/or decongestant or
intranasal steroids (INS)
or LTRA (or cromone)

In persistent rhinitis Improved Failure

review the patient
after 2-4 weeks Review diagnosis
Step-down Review compliance
and continue Query infections
If failure: step-up treatment for or other causes
If improved: continue >1 month
for 1 month

Add or Itch/sneeze: Rhinorrhoea: Blockage:

increase add H1-blocker add ipratropium add decongestant
INS dose or oral INS
(short term)

Failure
surgical referral

Allergen and irritant avoidance may be appropriate

If conjunctivitis is present/persistent
Add
oral H1-blocker
or intranasal H1-blocker
or intraocular cromone
(or saline)

* Leukotriene-Receptor Antagonist Therapy Consider specific immunotherapy

Adapted from Bousquet J et al. Allergy 2008;63(Suppl 86):8160.
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Avamys Prescribinig Information

fluticasone furoate

Abridged Prescribing Information (see SPC for full prescribing information).

Trade name:
AVAMYS 27.5 micrograms/spray nasal spray suspension
Quantity of active ingredient per unit dose:
Each spray actuation delivers 27.5 mcg of fluticasone furoate.
Therapeutic indications:
Adults, adolescents (12 years and over) and children (6 11 years)
Treatment of the symptoms of allergic rhinitis
Posology and method of administration:
By the intranasal route only. Regular usage is recommended. Onset of action has been observed as early as 8 hours after initial
administration. However, it may take several days of treatment to achieve maximum benefit. The duration of treatment should be
restricted to the period that corresponds to allergenic exposure.
Adults and Adolescents (12 years and over) The recommended starting dose is two sprays in each nostril once daily (total daily dose,
110 mcg fluticasone furoate). Once adequate control is achieved, dose reduction to one spray in each nostril may be effective for
maintenance. The dose should be titrated to the lowest effective dose required to maintain control of symptoms.
Children (6 to 11 years of age) The recommended starting dose is one spray in each nostril once daily (total daily dose, 55mcg fluticasone
furoate). Patients not responding to one spray in each nostril once daily may use two sprays in each nostril once daily (total daily dose,
110 mcg). Once control of symptoms is achieved, dose reduction to one spray in each nostril once daily is recommended.
Children under 6 years of age: Safety and efficacy in this group has not been well established (see SPC for further information).
Elderly Patients and Renal Impaired Patients: No dose adjustment required.
Hepatic Impaired Patients: No dose adjustment required in mild to moderate hepatic impairment. There are no data in patients with
severe hepatic impairment.
Administration: Shake the device before use. Prime the device by pressing the button for six sprays actuations. Re-prime if the cap is
left off for 5 days or the device has not been used for 30 days. Clean after use and replace the cap.
Contraindications: Hypersensitivity to any of the ingredients.
Special warnings and precautions:
Systemic effects may occur, particularly at high doses prescribed for prolonged periods. Treatment with higher than recommended doses
may result in clinically significant adrenal suppression. The total systemic burden of corticosteroids should be considered whenever
other forms of corticosteroid treatment are prescribed concurrently.
Growth retardation has been reported in children receiving some nasal corticosteroids at licensed doses. The height of children receiving
prolonged treatment should be monitored. If growth is slowed, therapy should be reviewed.
If adrenal function is impaired, care must be taken when transferring patients from systemic steroid treatment to fluticasone furoate.
Caution is advised when treating patients with severe liver disease.
Concomitant administration with ritonavir is not recommended.
Close monitoring is warranted in patients with a change in vision or a history of increased intraocular pressure, glaucoma and/or
cataracts.
Avamys contains benzalkonium chloride which may cause irritation of the nasal mucosa.
Drug interactions:
Concomitant administration with ritonavir is not recommended. Caution is recommended when co-administering fluticasone furoate
with potent CYP3A4 inhibitors.

Pregnancy and lactation:

Fluticasone furoate should be used only if the benefits to the mother outweigh the potential risks to the foetus or child.
Side effects:
Respiratory, thoracic and mediastinal disorders: Epistaxis (very common), Nasal ulceration (common). Immune system disorders: Hy-
persensitivity reactions including anaphylaxis, angioedema, rash, and urticaria (rare).
PA number: EU/1/07/434/003
Name and address of PA holder:
Glaxo Group Ltd, Greenford, Middlesex, UB6 0NN, United Kingdom
Legal category: POM
For further information please contact: GlaxoSmithKline (Ireland) Ltd, Stonemasons Way, Rathfarnham, Dublin 16.
API job number: IE/FF/0009/11
Date of API preparation: May 2011