Guidelines recommend intranasal corticosteroids for seasonal allergic rhinitis

New recommendations issued by the 2017 Joint Task Force on Practice Parameters support intranasal corticosteroid as monotherapy rather than in combination with an oral antihistamine for treatment of seasonal allergic rhinitis in people aged 12 years or older, according to guidelines published in Annals of Internal Medicine.

“Seasonal allergic rhinitis, which affects up to 14% of the U.S. adult population, is managed by clinicians and patients using a combination of prescription and over-the-counter medications,” Dana V. Wallace, MD, from Nova Southeastern University, and colleagues wrote. “Most patients who consult an allergy and immunology specialist have already tried many over-the-counter monotherapies without success and are seeking more effective treatment. No consensus exists about whether a particular medication should be used for initial treatment or about the benefit of using two or more medications concurrently for initial treatment.”

Comprising experts from American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology, the Joint Task Force developed evidence-based guidance to help clinicians treat seasonal allergic rhinitis in patients aged 12 years and older. Researchers examined clinical databases between July 2012 and July 2016 to identify studies that addressed efficacy and adverse effects of single or combination pharmacotherapy for seasonal allergic rhinitis.

The Joint Task Force advises:

initially treating patients aged 12 years or older with an intranasal corticosteroid alone, rather than in combination with an oral antihistamine;

initially treating patients aged 15 years or older with an intranasal corticosteroid vs. with a leukotriene receptor antagonist; and

clinicians may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine for treating moderate-to-severe seasonal allergies in those aged 12 years or older.

The evidence showed that adding an oral antihistamine to an intranasal corticosteroid did not benefit patients aged 12 years or older, and that oral antihistamines may cause sedation and other adverse effects. Researchers found that an intranasal corticosteroid was more effective compared to a leukotriene receptor antagonist for nasal symptom reduction. Adding an intranasal antihistamine to an intranasal corticosteroid in patients with moderate-to-severe seasonal allergic rhinitis provided further benefit compared to combination therapy with an intranasal corticosteroid and an oral antihistamine.

“When treating patients with seasonal allergic rhinitis, clinicians need to use their expertise to assist patients in evaluating the best treatment choice through shared decision making,” Wallace and colleagues wrote. “Consider the potential for benefit as well as the potential for harm, the burden, and the cost of combination therapy; and allow patients to express their values and preferences and participate in the decision-making process.” – by Savannah Demko

Disclosures: Wallace reports personal fees from Meda Pharmaceuticals and Mylan. Please see the study for all other authors’ relevant financial disclosures.