Purpose. The daily use of either intranasal corticosteroids or histamine 1 (H1) receptor antagonists has provedto be efficacious in the treatment of seasonal allergic rhinitis. Most patients, however, use these medications as needed. Our objective was to compare the effectiveness of as-needed use of H1 receptor antagonists with that of intranasal corticosteroids in the treatment of seasonal allergic rhinitis.
Study Population and Methods. We performed a randomized, open-label, parallel-group study comparing the as-needed use of an H1 receptor antagonist (loratadine) that of an intranasal corticosteroid (fluticasone propionate) in the management of fall seasonal allergic rhinitis in the fall of 1999. Subjects kept a diary of their daily symptoms and were examined at enrollment into the study and biweekly for 4 weeks during treatment. Outcome measures were the Rhinoconjunctivitis Quality of Life Questionnaire score, daily symptom diary scores, and the number of eosinophils and the levels of eosinophilic cationic protein in nasal lavage samples.
Results. Patients in the fluticasone-treated group reported significantly better scores in the activity, sleep, practical, nasal, and overall domains (P < .05) of the Rhinoconjunctivitis Quality of Life Questionnaire. The median total symptom score in the fluticasone-treated group was significantly lower than that in the loratadine-treated group (4.0 vs 7.0; P < .01). After treatment, the number of eosinophils was significantly smaller in the fluticasone-treated group compared with the loratadine-treated group (P = .001). Eosinophilic cationic protein levels followed the same pattern, with a significant correlation between the levels of eosinophilic cationic protein and the number of eosinophils (Rs = 0.70; P < .01).
Conclusion. As-needed intranasal corticosteroids reduce allergic inflammation and are more effective than as-needed H1 receptor antagonists in the treatment of seasonal allergic rhinitis.
Reviewer’s Comments. What would a study from this group be without nasal wash data? Everybody knows that most patients don’t use their allergy medicines just the way we tell them to. The results of this study are reassuring that patients can do well just by using their nasal corticosteroids as needed. I usually count on the fact that by instructing daily use of medications, most folks will use them every 2 or 3 days. If we suggest that patients use medications less frequently than that, they may not use them at all.
- Copyright © 2002 by the American Academy of Pediatrics