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Superiority of an Intranasal Corticosteroid Compared With an Oral Antihistamine in the As-Needed Treatment of Seasonal Allergic Rhinitis
Scott M. Kaszuba, MD;
Fuad M. Baroody, MD;
Marcy deTineo, BSN;
Lauran Haney, BSc;
Christopher Blair, BSc;
Robert M. Naclerio, MD
Arch Intern Med. 2001;161:2581-2587.
Background The daily use of either intranasal corticosteroids or histamine1 (H1) 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 H1 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 H1 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 (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.
From the Section of Otolaryngology–Head and Neck Surgery, Department
of Surgery, The Pritzker School of Medicine, University of Chicago, Chicago,
Ill.
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Superiority of an Intranasal Corticosteroid Compared with an Oral Antihistamine in the As-Needed Treatment of Seasonal Allergic Rhinitis
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