מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – The intranasal corticosteroid fluticasone is superior to the oral antihistamine loratadine in the treatment of all seasonal allergic rhinitis, according to a report in the Archives of Internal Medicine for November 26.
Guidelines for seasonal allergic rhinitis treatment usually recommend histamine1 (H1) receptor antagonists as first-line treatment for mild disease and intranasal corticosteroids as treatment for severe disease, the authors of the report note. These recommendations are based on the onset of action of these different medications–a few hours for antihistamines and 12 hours for intranasal corticosteroids.
"We questioned the logic of these guidelines based on our understanding of the pathophysiological features of seasonal allergic rhinitis," Dr. Robert M. Naclerio and colleagues from the University of Chicago write.
Dr. Naclerio's team randomly assigned 88 subjects to fluticasone or loratadine for 4 weeks during the fall of 1999. Subjects in the trial kept a symptom log and were examined biweekly.
Patients in the fluticasone group had significantly better scores on the Rhinoconjunctivitis Quality of Life Questionnaire for activity, sleep, practical, nasal and overall domains compared with patients receiving loratadine (p < 0.05), the researchers report.
Compared with those receiving loratadine, patients receiving fluticasone also had significantly lower median symptom scores (7.0 versus 4.0, p < 0.005). The number of eosinophils, after treatment, was also significantly lower in the fluticasone group compared with the loratadine group (p = 0.001), Dr. Naclerio's team found.
"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 investigators note.
Dr. Naclerio's group adds that fluticasone is less expensive then loratadine, which "suggests that the cost-benefit ratio favors intranasal corticosteroids. A change in guidelines would benefit more patients and reduce healthcare costs," they conclude.
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