Clinical comparison of systemic methylprednisolone acetate versus topical budesonide in patients with seasonal allergic rhinitis

Abstract

Thirty patients with seasonal allergic rhinitis entered a double blind study comparing budesonide (nasal spray, 400 micrograms/d) and i.m. injection of 80 mg methylprednisolone acetate. Symptoms were assessed over a "run in" period of 3-7 days followed by a treatment period of 3 weeks. Pollen counts were evaluated daily. Both the systemic and topical corticosteroid treatment resulted in a significant improvement of nasal and ocular symptoms and were accompanied by reduced antihistamine intake. A comparison of the two treatments in relation to the pollen count yielded statistically significantly fewer nasal symptoms, such as itching, secretion, and sneezing in the budesonide-treated group. Nasal blockage and ocular symptoms remained unchanged, but the use of eyedrops was significantly reduced in the methylprednisolone-treated group. Side effects of both treatments were mild and the incidence negligible. Methylprednisolone-treated patients had a significantly lower cortisol value after 7 days but still had a normal response to ACTH-stimulation. We conclude that the acute symptoms of allergic rhinitis are at least as well ameliorated by regular topical application of budesonide as by a single injection of methylprednisolone acetate. The accompanying allergic conjunctivitis may require additional treatment.

Short‐term growth in children with allergic rhinitis treated with oral antihistamine, depot and intranasal glucocorticosteroids

“…Topical and systemic glucocorticosteroids have been found to be superior to oral antihistamines in controlling the symptoms (1)(2)(3). Systemic glucocorticosteyoids are often given as a single injection of a long-acting depot steroid at the beginning of the pollen season (4)(5)(6). However, such treatment may be associated with a risk of serious side effects, such as suppression of longitudinal growth (2,6,7).…”

Glucocorticosteroids and rhinitis

“…The clinical efficacy of systemic GCSs, in the dosages used in the few chnical trials published, is comparable to that of a GCS spray (87,133). Higher doses are probably more effective, but they cannot be justified in rhinitis.…”

Clinical trial design, nasal allergen challenge models, and considerations of relevance to pediatrics, nasal polyposis, and different classes of medication

“…1,4,156,157 Although controlled-drug comparative studies are few, they have indicated that local treatment is at least as effective as systemic low-dose treatment. 158 ANTIHISTAMINES. Several comparative studies have shown that local treatment with an antihistamine is at least as effective as oral treatment.…”

“…Although systemic treatment is highly effective on nasal blockage, 184 limited data have indicated that local treatment is more effective on itching, sneezing, and rhinorrhea. 158 Systemic treatment can be given orally or as a depot injection. Consensus reports recommend oral treatment, 1,4 but there is no reason to assume that the therapeutic index is different.…”