According to the WAO (World Allergy Organization), prevalence estimate for allergy on a global rate ranges between 10%- 40% (WAO, 2017). This prevalence is on an increasing trend every year. Therefore, increased cases act as a major driving factor for the allergy diagnostics and treatment market. Furthermore, the prevalence of Asthma in India has motivated the anti-allergy drug development companies to develop a new and effective range of prescribed drugs (White et al., 2018). According to a report by WHO, (2015) asthmatic drugs comprised approximately 30% of the overall drugs market. However, allergic cases such as drug hypersensitivities, food hypersensitivities, skin allergies, and others; lack a significant market share in spite of their rising prevalence.
Classification of the asthmatic drug market
The pharmaceutical drug market is classified into diagnostics and treatment (drug based and personalized therapeutics) market. The same remains in case of allergy drug market (WebMed, 2019). The major treatment type for most of the allergies is medications that are consumed orally (Acute Market Report, 2017). These oral medications hold a large proportion of the allergy drug market in India, an estimated 60%. Unlike India, USA has majority users of allergic drugs as orally and nasally (American Academy of Allergy, Asthma & Immunology, 2018).
On the basis of the treatment types for different kinds of anti-allergy drugs prevailing in India and USA, the market is divided into:
- mast cell stabilizers,
- leukotriene inhibitors and,
- nasal anticholinergics.
However, another category of allergy treatment has become prevalent in recent years, AYUSH. Similarly, ayurvedic treatment for allergy based on the bodily functions instructs the usage of ‘Ama’ or ‘Amavisha’ based products (Suja et al., 2017). However, homoeopathy uses various active compounds like:
- Aconitum napellus,
- Apis and others (Banerjee et al., 2017).
On the other hand, Unani medication for skin allergies prescribes usage of ‘Luaab-e- behdana’ or Quince and/or ‘Sheera-e- sandal’ or Indian sandalwood (Kawoosa & Allaqaband, 2017). AYUSH based treatment methods for allergies in the USA remains juvenile and will take over a decade to gain popularity.
Prevalence of asthma and drugs in India and USA
Asthma is the most common type of allergy on a global scale. 20%- 30% of the Indian population suffers from Asthma (Chandrika, 2017). The prevalence of allergic asthma in India is rising dramatically and it is more common in children than in adults (Rathi & Sharma, 2017). In the year 2011, 17.23 million people were reported with cases of Asthma, which increased to 20.69 million in 2015 and in 2018 approx. 23 million (Koul & Patel, 2015). On the other hand, Asthma and Allergy Foundation of America, (2018), indicated that a mere 7% of the American population have allergic asthma. Over 100 brands of prescribed drugs are available in India, whereas, USA market has approximately 50 different brands of asthmatic prescribed drugs (Asthma and Allergy Foundation of America, 2018; Acute Market Report, 2017). It is hypothesized that increased allergic or disease prevalence motivates the pharmaceutical companies in increasing sales of its drugs.
The following table presents the list of drugs for each of the most common allergies in India and USA. Furthermore, the table also represents various AYUSH based treatment methods in India.
|Type of medication||Name of drugs||Common names (India)||Common names (USA)|
|Allopathic||Inhaled Corticosteroids||FOMTIDE Inhaler,
FOMTIDE CFC Inhaler
|Long-Acting Bronchodilators||Advair, Dulera, Symbicort|
|Anti-Leukotriene Drugs||Montelukast, Zafirlukast||Montelukast, Zafirlukast|
|Oral Corticosteroids||Volitras tablets||Fevipiprant|
|Vitamin D supplements|
|AYUSH||Ayurveda||Kerala Ayurveda Vasarishtam|
|Homoeopathy||Dr. Reckeweg R43 Asthma Drop|
|Unani||Combination of leaves of Arusa, Filfil Daraz (Pipal), roots of Kutki, Zufa (Hyssop), and seeds of Kataan (Flaxseeds)|
|Naturopathy||Lobelia, Astragalus membranaceus (Huang-qi)|
Impact of the rising prevalence of asthma on drug sales in India
According to the patent data accessed from the International Patent Classification (IPC), a total of 7 asthmatic drugs has been patented since 2009. Sun Pharmaceuticals, (2017) reported in their annual reports, the sales of their allergic asthma drugs FOMTIDE Inhaler, COMBITIDE 250 Inhaler, and AQUAMET 0.05% Nasal Spray has increased in the past couple of years. The case of increased prevalence has made Sun Pharmaceutical in increased production and distribution of asthma based categories of drugs and meet the healthcare needs.
Patented drugs show the highest degree of sales amongst other forms of drugs (Grabowski et al., 2017). On the other hand, according to the report of Acute Market Report, (2017), the rate of an asthmatic drug sale in India has increased by 20%. Another report by HindustanTimes, (2017) indicated that the sales of anti-asthma medicines in India went up by 43% between 2014 and 2017. Thus, it may be implicated that the number of drug sales for asthmatic conditions have increased.
Impact of the rising prevalence of asthma on drug sales in the USA
Asthmatic conditions in the USA have increased in the past decade. According to a report by the CDC, (2017) 11.5 million American people with asthma was reported as in 2016. It is also forecasted that the prevalence may increase by 20 million by 2020. This might be the reason for reported new developments of asthmatic drugs such as Fevipiprant by Novartis (White et al., 2018).
Novartis in the USA, too have reported increased sales of SEQUADRA Inhalers, LIQUIDIX SR 75mg Tablets, Singulair. Advair Diskus have reported being the highest selling asthmatic drugs. The sales of asthma drug in the USA has generated around 15 billion USD in 2017 from 11 billion USD in 2011.
An increased prevalence of asthmatic conditions has motivated the drug company’s sales. The rising causes have led to rapid production and distribution of drugs. Therefore, the increased prevalence of asthma has challenged the pharma companies in meeting the demands of the market.
Impact of increasing prevalence asthma on the popularity AYUSH
Majority of people in India, still believe in allopathic medications over AYUSH based medications for asthma. Little known fact that AYUSH treatment for any disease condition is more effective than allopathic medications but time taking (Brooks, 2018). AYUSH treatments comprise different naturalistic methods of disease treatment.
For example, in Ayurveda, some may prefer the use of herbs such as Tulsi, Adoosa, Mulethi, Kooth, Bala and Banafsha for reducing anti-inflammatory in asthmatic conditions. Whilst, others may use pepper, ginger, cayenne, mustard, ma huang, and apricot seeds (Soni et al., 2018). The same process of using naturistic products is followed in Unani and Homeopathy. Yoga mainly uses different forms of respiratory exercises to comfort a patient.
Furthermore, in the past decade, 69% of households in 2015 in India use some form of ayurvedic or AYUSH based treatment. The same has also risen in 2017 to 77% according to AYUSH, (2017). Moreover, the AYUSH treatment market was valued at USD 3.4 billion in 2015 and is expected to rise by USD 10 billion by 2020.
Another report by AYUSH, (2017) indicated that 19% of AYUSH patients get treatment for asthma. Although the majority of the patient suffer from co-morbid conditions, asthma has been found to be the third largest treatment condition and has increased from 15% in 2014. This might be the reason for increased sales from AYUSH treatments.
- Acute Market Report. (2017). Allergy Diagnostics and Treatment Market Trends, Key Players, Competitive Strategies And Forecasts, 2017 To 2025. Retrieved October 16, 2018, from https://www.linkedin.com/pulse/allergy-diagnostics-treatment-market-trends-key-players-david-brown.
- American Academy of Allergy, Asthma & Immunology. (2018). Retrieved January 29, 2019, from https://www.aaaai.org/.
- Asthma and Allergy Foundation of America. (2018). Asthma Facts and Figures. Retrieved January 29, 2019, from https://www.aafa.org/asthma-facts/.
- AYUSH, 2017. National Ayush Mission. Retrieved January 29, 2019, from http://ayush.gov.in/sites/default/files/4197396897-Charakasamhita%20ACDP%20%20english_0.pdf
- Banerjee, K., Mathie, R. T., Costelloe, C., & Howick, J. (2017). Homeopathy for allergic rhinitis: a systematic review. The Journal of Alternative and Complementary Medicine, 23(6), 426-444.
- Brooks, L. A. (2018). Epistemology and Embodiment: Diagnosis and the Senses in Classical Ayurvedic Medicine. Asian Review of World Histories, 6(1), 98-135.
- Chandrika, D. (2017). Allergic rhinitis in India: an Overview. Int J Otorhinolaryngol Head Neck Surg, 3(1), 1–6. https://doi.org/10.18203/issn.2454-5929.ijohns20164801.
- Garfield, A. S., & Lowell, B. B. (2013). Was It Something I Ate? Cell Metabolism, 18(6), 769–770. https://doi.org/10.1016/j.cmet.2013.11.010.
- Grabowski, H., Brain, C., Taub, A., & Guha, R. (2017). Pharmaceutical patent challenges: company strategies and litigation outcomes. American Journal of Health Economics, 3(1), 33-59.
- HindustanTimes. (2017). World Asthma Day: India chokes, sales of medicines rise 43% in 4 years. Retrieved January 29, 2019, from https://www.hindustantimes.com/health/world-asthma-day-india-chokes-sales-of-medicines-rise-43-in-4-years/story-mt5V9Kdqv4yGF062ZOmC6I.html.
- Jensen-Jarolim, E., Jensen, A. N., & Canonica, G. W. (2017). Debates in allergy medicine: Molecular allergy diagnosis with ISAC will replace screenings by skin prick test in the future. World Allergy Organization Journal, 10(1), 33.
- Kawoosa, S. H., & Allaqaband, S. M. (2017). Effect of Unani medicine on irritant contact dermatitis: case study. International Journal of Scientific Reports, 3(10), 277-279.
- Koul, P. A., & Patel, D. (2015). Indian guidelines for asthma: Adherence is the key. Lung India: official organ of Indian Chest Society, 32(Suppl 1), S1.
- Paramesh, H. (2002). Epidemiology of asthma in India. Indian Journal of Pediatrics, 69(4), 309–312. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12019551.
- Rathi, A., & Sharma, S. (2017). Changing Allergy Patterns in India. Commentary Article Mathews Journal of Immunology & Allergy (Vol. 1).
- Soni, K. K., Kori, V. K., & Patel, K. (2018). Role of Shwasahara Dashemani in the Management of Tamakashwasa (bronchial asthma)-A single case study. International Journal of AYUSH Case Reports, 2(2), 19-24.
- Suja, K. P., Jose, L., Lakshmanan, D., Vidya, A. G., Reshmi Nair, R. J., & Kumar, R. A. (2017). Isolation and Characterization of Antimycobacterial Compounds from Fruits of Aegle marmelos (L.) Correa. J. Commun. Dis, 49(4), 4.
- Sun Pharmaceuticals. (2017). Annual Reports 2017-2018. Retrieved January 29, 2019, from http://www.sunpharma.com/investors/annualreports.
- WAO. (2017). World Allergy Organization. Retrieved October 16, 2018, from http://www.worldallergy.org/wao_societies/aboutwao.php.
- White, C., Wright, A., & Brightling, C. (2018). Fevipiprant in the treatment of asthma. Expert opinion on investigational drugs, 27(2), 199-207.
- WHO. (2015). Asthma. Retrieved January 29, 2019, from https://www.who.int/news-room/fact-sheets/detail/asthma.