Steroid nasal sprays are more effective than antihistamines in treating seasonal allergies, according to an article in the November 26 issue of the Archives of Internal Medicine, a member of the JAMA family of journals.Allergic rhinitis affects about 20 percent of the U.S. population; its incidence continues to increase. Billions of dollars are spent every year on treatment; that number is expected to increase as the number of people with allergic rhinitis increases.
Guidelines recommend antihistamines as the first-line treatment of mild disease, while more severe disease is usually treated with daily steroid nasal spray.
Robert M. Naclerio, M.D., from the University of Chicago Pritzker School of Medicine and colleagues studied 88 people with fall seasonal allergic rhinitis. They compared the effectiveness of as-needed use of histamine1 (H1) receptor antagonists (loratadine) with that of intranasal corticosteroid (fluticasone propionate) in managing the allergy.
Patients in the fluticasone-treated group reported significantly better scores on the Rhinoconjunctivitis Quality of Life Questionnaire. The median total symptom score in the fluticasone-treated group was significantly lower than in the loratadine-treated group.
The responses to the questionnaire were supported by the measures of eosinophil counts. (Eosinophils are white blood cells that are part of the body's protective system against allergens).
"The rationale for these recommendations is that H1 receptor antagonists have a rapid onset of action (within hours) and are, thus, suitable for as-needed treatment when the patient is seeking immediate relief of symptoms.
"Fluticasone propionate nasal spray, an intranasal corticosteroid, has an onset of action within 12 hours and a peak effect that occurs after several days," the authors write. "We questioned the logic of these guidelines based on our understanding of the pathological features of seasonal allergenic rhinitis. "Our data support the efficacy of fluticasone propionate nasal spray in the treatment of seasonal allergic rhinitis and the superiority of its as-needed use compared with that of an as-needed H1 receptor antagonist."
The study was supported in part by grants from Glaxo Wellcome Inc., Research Triangle Park, N.C., and from the National Institutes of Health.
(Reference: Arch Intern Med. 2001;161:2581-2587)
28-Nov-2001
