December 2000
SEATTLE - Recent clinical studies indicate intranasal steroids are the most effective therapy and are more cost effective than other treatments for allergic rhinitis, according to speakers at the American College of Allergy, Asthma and Immunology's annual meeting here.
"Intranasal steroids demonstrate greater efficacy than antihistamines, decongestants and cromolyn in patients with allergic rhinitis," said William W. Storms, MD, clinical professor at the University of Colorado Health Sciences Center and Asthma and Allergy Associates in Colorado Springs, Colo. "They can be used alone or in combination with other therapies to achieve optimal overall improvement of symptoms in rhinitis."
"Although antihistamines are considered first-line therapy for allergic rhinitis, an increasing number of physicians are recognizing the benefit of first-line use of intranasal steroids. Clinical trials have shown the most common side effects of intranasal steroids, due to local irritation, are minimal when patients are instructed in the proper use of this class of drugs," he added.
Guidelines developed by a joint task force of allergists-immunologists recommend intranasal inhaled corticosteroids as the most effective medication class for controlling the symptoms of allergic rhinitis.
Although intranasal steroids have demonstrated efficacy in the management of nasal symptoms of seasonal and perennial allergic rhinitis, they are often considered second-line agents due to the perception that they are slow to act, according to James H. Day, MD, professor of medicine and head of the allergy unit at Kingston General Hospital in Kingston, Ontario, Canada.
"Studies demonstrate that with more precise methods of measuring onset of action, there is both subjective and objective evidence that selected nasal corticosteroids provide relief by seven hours with indications of even earlier response," Day said.
Medication selection is based on factors including duration of symptoms (persistent or intermittent); effectiveness to safety profile; patient preferences and which therapy is the most cost effective, Storms said.
Studies indicate noncompliance with prescribed therapy is a common and substantial contributor to treatment failure, and is affected by numerous factors.
"The primary reason for noncompliance in allergic rhinitis is convenience, and it has been suggested that treatment complexity may be the most important factor in determining patient compliance with prescribed therapy," Storms said.
"The ideal characteristics of an intranasal steroid are those that are likely to increase patient acceptance and compliance with therapy. Patients prefer odorless and tasteless formulations, with minimal amount of fluid in the nose and throat. With comparable safety and efficacy, factors such as simple dosing, pleasing formulation and lack of irritating recipients become key factors in defining the ideal intranasal steroid," Storms said.
Allergic rhinitis is the most common allergic disease, affecting more than 20 million Americans - making it the fifth most common chronic illness. It is the most prevalent chronic condition in children. About 3.8 million work and school days are lost annually due to allergic rhinitis. It adversely affects both physical and mental health statuses.
Symptoms of the disease include nasal congestion, sneezing, nasal discharge, itching of the nose, postnasal congestion and itchy, watery eyes. The presence of allergic rhinitis is a risk factor for developing asthma and can predispose to other conditions including sinusitis, otitis media, nasal polyps, respiratory infections, sleep disorders and orthodontic problems.
Treatment approaches include reducing exposure to suspected allergens and immunotherapy, which can often reduce or eliminate the need for medications.
The estimated annual direct cost of allergic rhinitis includes $1.1 billion for medical care use and more than $500 million spent on over-the-counter medications and more than $4 billion for prescription drugs.
For more information:
- Storms WW. Defining the ideal characteristic of intranasal steroid.
- Day JH. Onset of action of nasal steroids.
- Both presented at the Annual Meeting of the American College of Asthma, Allergy and Immunology. Nov. 3-8, 2000. Seattle.
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