Efficacy of daily intranasal fluticasone propionate on ocular symptoms associated with seasonal allergic rhinitis

Ratner, Paul H.; Bavel, Julius van; Mohar, Dale; Jacobs, Robert L.; Hampel, Frank C.; Howland, William C.; Karwal, Ritu

doi:10.1016/j.anai.2014.11.012

Cited by 35 publications

(15 citation statements)

References 14 publications

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“…Although not readily explained, the improvement in eye symptoms associated with improvements in rhinitis may be attributable to suppression of a common underlying inflammatory pathophysiology. This phenomenon has been supported by other studies; for example, a randomized double‐blinded placebo‐controlled medication trial demonstrated significant improvement in ocular symptoms of AR with use of only intranasal fluticasone …”

Section: Discussionsupporting

confidence: 63%

Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study

2019

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Objective To assess the efficacy and safety of cryoablation of the posterior nasal nerve (PNN) for treatment of chronic rhinitis. Methods This was a prospective single‐arm trial of 98 adult patients at six U.S. centers with chronic allergic and nonallergic rhinitis. PNN cryoablation was performed in‐office under local anesthesia using a handheld device. Patients discontinued use of intranasal ipratropium 3 days prior to treatment and throughout the study period. Reflective Total Nasal Symptom Score (rTNSS) was measured at pretreatment baseline and posttreatment at 1 month, 3 months, 6 months, and 9 months. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was completed at pretreatment and 3 months posttreatment. Adverse effects and postprocedure medication usage were recorded. Results Ninety‐eight procedures (100%) were successfully completed. rTNSS significantly improved over pretreatment baseline (6.1 ± 1.9) at 1 month (2.9 ± 1.9, P < 0.001), 3 months (3.0 ± 2.3, P < 0.001), 6 months (3.0 ± 2.1, P < 0.001), and 9 months (3.0 ± 2.4, P < 0.001) postprocedure. Nasal congestion and rhinorrhea subscores improved significantly at all time points (P < 0.001). Both allergic and nonallergic rhinitis subcohorts showed improvement (P < 0.001), with a comparable degree of improvement between groups. RQLQ significantly improved over pretreatment baseline (3.0 ± 1.0) at 3 months (1.5 ± 1.0, P < 0.001), and all RQLQ subdomains demonstrated improvement. Of 54 patients using intranasal medication at baseline, 19 (35.2%) were able to discontinue use. Twenty‐nine adverse effects were reported, including headache, epistaxis, and sinusitis. Conclusion Cryoablation of the PNN for chronic rhinitis is safe and can result in relief of nasal symptoms and improvements in quality of life. Level of Evidence 4 Laryngoscope, 130: 1877–1884, 2020

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Section: Discussionsupporting

confidence: 63%

Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study

2019

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“…37-50 Fluticasone propionate was associated with an intermediate risk ratio of 1.36 (95% CI, 1.00-1.85; I 2 = 0%; Figure 7 ). 17,48,51-65…”

Section: Resultsmentioning

confidence: 99%

Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta‐analysis

Harris

Babcock

et al. 2019

Otolaryngol.--head neck surg.

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Objective Intranasal corticosteroids (INCSs) are widely utilized for the treatment of allergic rhinitis. Epistaxis is a known adverse effect of INCSs, but it is not known if the risk of epistaxis differs among INCSs. Data Sources Systematic review of primary studies identified through Medline, Embase, Web of Science, PubMed Central, and Cochrane databases. Review Methods Systematic review was conducted according to the PRISMA standard. English-language studies were queried through February 1, 2018. The search identified randomized controlled trials of INCSs for treatment of allergic rhinitis that reported incidence of epistaxis. An itemized assessment of the risk of bias was conducted for each included study, and meta-analysis was performed of the relative risk of epistaxis for each INCS. Results Of 949 identified studies, 72 met the criteria for analysis. Meta-analysis demonstrated an overall relative risk of epistaxis of 1.48 (95% CI, 1.32-1.67) for all INCSs. The INCSs associated with the highest risk of epistaxis were beclomethasone hydrofluoroalkane, fluticasone furoate, mometasone furoate, and fluticasone propionate. Beclomethasone aqueous, ciclesonide hydrofluoroalkane, and ciclesonide aqueous were associated with the lowest risk of epistaxis. Conclusions about epistaxis with use of budesonide, triamcinolone, and flunisolide are limited due to the low number of studies and high heterogeneity. Conclusions While a differential effect on epistaxis among INCS agents is not clearly demonstrated, this meta-analysis does confirm an increased risk of epistaxis for patients using INCSs as compared with placebo for treatment of allergic rhinitis.

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“…Systemic anti‐inflammatory drugs are only exceptionally used to overcome a difficult period in selected cases of severe forms. The ocular effects of nasal anti‐inflammatory drugs are considered beneficial in the short term in cases of allergic rhinoconjunctivitis (ARC) but their long‐term use has not been validated . The allergist can suggest allergen immunotherapy, in particular in cases of SAC or PAC for which symptomatic treatment is not sufficient to ensure satisfactory quality of life when IgE‐mediated allergy and involvement of an allergen have been formally identified.…”

Section: Treatmentmentioning

confidence: 99%

Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective

Fauquert

2019

Pediatric Allergy Immunology

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Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE‐mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non‐IgE‐mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non‐pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second‐line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third‐line treatment is reserved for severe forms. Short‐lasting local steroid therapy can control flare‐ups of allergic keratoconjunctivitis, which should have specialized follow‐up. Cyclosporine is a disease‐modifying treatment, which is both effective and well tolerated.

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Efficacy of daily intranasal fluticasone propionate on ocular symptoms associated with seasonal allergic rhinitis

Cited by 35 publications

References 14 publications

Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study

Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study

Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta‐analysis

Diagnosing and managing allergic conjunctivitis in childhood: The allergist’s perspective

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