Oral antihistamine or nasal steroid in hay fever: a double‐blind double‐dummy comparative study of once daily oral astemizole vs twice daily nasal beclomethasone dipropionate

Abstract

Summary Seventy‐four patients with a well documented history of seasonal allergic rhinitis were randomly allocated to receive either astemizole 10 mg orally per day or beclomethasone 100 μg in each nostril twice daily on a double‐blind double‐dummy basis. The patients were studied in a general practice setting and were seen at entry, during the study and at the end of the study by a single observer, the author. Assessment was by diary card incorporating five 10 cm visual analogue scales related to the four symptoms of sneezing, rhinorrhoea, blocked nose and itchy eyes and an overall assessment of hay fever symptoms. Patients were asked if the medication had upset them in any way at each observer assessment. Symptom severity, as recorded by the visual analogue scales, was not significantly different for sneezing, rhinorrhoea, blocked nose or overall between the two groups but the symptom scores for itchy eyes were significantly better for the astemizole group. Adverse effects were minimal and of a minor nature only. There was no real difference between the two groups regarding adverse effects. The study suggests that oral astemizole is at least as good as nasal beclomethasone in the maintenance treatment of hay fever and that it offers the additional advantage of improved control of eye symptoms.

Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

“…Intranasal corticosteroids produced significantly greater relief of total nasal symptoms than did oral antihistamines (−0.42, −0.53 to −0.32). However, there was significant heterogeneity (χ 2 =26.8, P<0.001), with Wood12 showing greater (albeit not significantly) relief of symptoms with oral antihistamines than with intranasal corticosteroids.…”

Intranasal Mometasone Furoate Alleviates the Ocular Symptoms Associated with Seasonal Allergic Rhinitis: Results of a Post Hoc Analysis

“…According to a meta-analysis of randomized, controlled trials published between 1966 and 1997 comparing oral antihistamines and intranasal corticosteroids, only 2 of 11 studies in which ocular symptoms were evaluated found antihistamines to be superior to intranasal corticosteroids [10]. In both of those studies, the intranasal corticosteroid was beclomethasone [10, 14, 15]. …”

The cost of treating allergic rhinitis

“…The standardized mean differences for nasal symptoms, both in the individual studies and in the pooled data, consistently favored the INCS with the exception of sneezing in the study by Wood [18]. In Wood's study, the information was presented only in a visual graphic format, making it difficult to assign specific symptom scores.…”

“…The perception is that inhaled corticosteroids have a slower onset of action, frequently requiring days of therapy before clinical effectiveness is established. A recent review of the literature reveals that in studies designed to look at onset of action, the effect is noted within the first days [18]. If the onset of effect from INCS were several days, it would preclude the use of this class of medication for as-needed therapy.…”

“…This study was more inclusive, containing comparisons of both first-and second-generation antihistamines, nonapproved dosages in the study by Wood et al [18], and utilized both Medline and Embase. Sixteen randomized, double-blind, controlled trials comparing oral antihistamines with intranasal corticosteroids were identified from literature published between 1966 and 1997, and were included in this meta-analysis.…”