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Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis.

Abstract

BACKGROUND

The daily use of either intranasal corticosteroids or histamine(1) (H(1)) receptor antagonists has proved to 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 H(1) receptor antagonists with that of intranasal corticosteroids in the treatment of seasonal allergic rhinitis.

METHODS

We performed a randomized, open-label, parallel-group study comparing the as-needed use of an H(1) receptor antagonist (loratadine) with 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 (r(s) = 0.70, P<.01).

CONCLUSION

As-needed intranasal corticosteroids reduce allergic inflammation and are more effective than as-needed H(1) receptor antagonists in the treatment of seasonal allergic rhinitis.

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  • Authors+Show Affiliations

    ,

    Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 S Maryland Ave, Mail Code 1035, Chicago, IL 60637, USA.

    , , , ,

    Source

    Archives of internal medicine 161:21 2001 Nov 26 pg 2581-7

    MeSH

    Administration, Intranasal
    Administration, Oral
    Adrenal Cortex Hormones
    Androstadienes
    Anti-Allergic Agents
    Eosinophils
    Fluticasone
    Histamine H1 Antagonists
    Humans
    Loratadine
    Nasal Lavage Fluid
    Nasal Provocation Tests
    Quality of Life
    Rhinitis, Allergic, Seasonal
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    11718589

    Citation

    Kaszuba, S M., et al. "Superiority of an Intranasal Corticosteroid Compared With an Oral Antihistamine in the As-needed Treatment of Seasonal Allergic Rhinitis." Archives of Internal Medicine, vol. 161, no. 21, 2001, pp. 2581-7.
    Kaszuba SM, Baroody FM, deTineo M, et al. Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Arch Intern Med. 2001;161(21):2581-7.
    Kaszuba, S. M., Baroody, F. M., deTineo, M., Haney, L., Blair, C., & Naclerio, R. M. (2001). Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. Archives of Internal Medicine, 161(21), pp. 2581-7.
    Kaszuba SM, et al. Superiority of an Intranasal Corticosteroid Compared With an Oral Antihistamine in the As-needed Treatment of Seasonal Allergic Rhinitis. Arch Intern Med. 2001 Nov 26;161(21):2581-7. PubMed PMID: 11718589.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis. AU - Kaszuba,S M, AU - Baroody,F M, AU - deTineo,M, AU - Haney,L, AU - Blair,C, AU - Naclerio,R M, PY - 2001/12/26/pubmed PY - 2002/1/5/medline PY - 2001/12/26/entrez SP - 2581 EP - 7 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 161 IS - 21 N2 - BACKGROUND: The daily use of either intranasal corticosteroids or histamine(1) (H(1)) receptor antagonists has proved to 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 H(1) receptor antagonists with that of intranasal corticosteroids in the treatment of seasonal allergic rhinitis. METHODS: We performed a randomized, open-label, parallel-group study comparing the as-needed use of an H(1) receptor antagonist (loratadine) with 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 (r(s) = 0.70, P<.01). CONCLUSION: As-needed intranasal corticosteroids reduce allergic inflammation and are more effective than as-needed H(1) receptor antagonists in the treatment of seasonal allergic rhinitis. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/11718589/full_citation L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/161/pg/2581 DB - PRIME DP - Unbound Medicine ER -