A Comparison of Three Injectable Corticosteroids for the Treatment of Patients with Seasonal Hay Fever

Abstract

Three injectable corticosteroids, betamethasone dipropionate, beta-methasone disodium phosphate and betamethasone acetate, and methylprednisolone acetate, were compared for onset and duration of action in patients with severe seasonal allergic rhinoconjunctivitis. The sixty patients who were entered into the trial had been well-studied in our allergy clinic. They were assigned, on the basis of a random number code, to treatment with one of the corticosteroids. Following a single intramuscular injection with one of the preparations, plasma cortisol and blood glucose concentrations also were compared at days 1, 2--3, 5--7 and 14. All three preparations improved the nasal symptoms. There were no individual differences with respect to onset or to duration of action. However, there were some differences in the effects on endogenous cortisol production and on blood glucose levels. Two of the preparations, betamethasone dipropionate and methylprednisolone acetate, suppressed endogenous cortisol for more than 14 days, while betamethasone phosphate/acetate did not suppress cortisol beyond 12 days. Beta-methasone dipropionate produced a moderate increase in blood glucose concentrations for the first two days after administration; betamethasone phosphate/acetate caused an increase for one day and methylprednisolone acetate had no effect.

Systemic corticosteroid treatment for seasonal allergic rhinitis:a common but poorly documented therapy

“…These open comparisons between different IMCS preparations have not shown any definite advantage of one preparation over the others ( 12, 17, 18). As a pure slow‐release formulation has shown a relatively quick onset of action within a few days, it is theoretically difficult to find a rationale for adding a quickly absorbed compound.…”

“…Ohlander et al ( 12) gave, in a random order, a single injection of three IMCS preparations (betamethasone dipropionate 5 mg, betamethasone phosphate 3 mg plus betamethasone acetate 3 mg, or methylprednisolone acetate 40 mg) to 60 patients with severe SAR. Betamethasone dipropionate and methylprednisolone acetate reduced endogenous cortisol production for at least 14 days, while betamethasone phosphate/acetate did not suppress plasma cortisol beyond 12 days.…”

“…Thus, studies have shown reduced plasma cortisol levels after an IMCS injection. The effect is maximal after 3 days and disappears within 3 weeks (2–4 weeks) ( 10–13). These published data do not support the fear of a long‐lasting suppression of HPA function from a single IMCS injection.…”

“…Ohlander et al ( 12) gave, in random order, to 60 patients with severe SAR, a single injection of three IMCS preparations: 1) betamethasone dipropionate 5 mg, 2) betamethasone acetate 3 mg plus betamethasone phosphate 3 mg, or 3) methylprednisolone acetate 40 mg. All three preparations improved nasal symptoms, and there were no differences with respect to onset, degree, or duration of action.…”

Treatment of Allergic Rhinitis: Anticholinergics, Glucocorticotherapy, Leukotriene Antagonists, Omalizumab and Specific-Allergen Immunotherapy

“…These injections were administered to 60 patients with significant AR, who were divided into 3 groups depending on the type of injection (Ohlander et al, 1980) Methylprednisolone and beclomethasone dipropionate (BDP) reduced the production of endogenous cortisol for at least 14 days, while the combination of phosphate and betamethasone acetate did not suppress plasma cortisol in 12 days. Glycaemia increased in the 3 groups in the first two days following the injection.…”