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

Mygind, Niels; Laursen, L. C.; Dahl, Morten

doi:10.1034/j.1398-9995.2000.00108.x

Cited by 65 publications

(35 citation statements)

References 18 publications

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“…The fact that such medications need to be administered for long periods of time makes potential side effects a major disadvantage. The same stands for the use of per os corticosteroids and should be pointed out that, although short courses of prednisolone are occasionally administered in poorly controlled pediatric AR, the few corresponding studies in adult seasonal AR implicate effectiveness only in high (30 mg/day) doses [72].…”

Section: Pharmacotherapymentioning

confidence: 99%

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

et al. 2013

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The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR) and asthma has led to the concept of 'united airways disease' or 'respiratory allergy', implying that allergy, in its widest sense, underlies this clinical syndrome. Progression from AR to asthma is frequent and part of the 'atopic march'. Since pediatric immune responses are more adaptable and therefore may be more amenable to treatment, interventions at early childhood are characterized by a higher chance to affect the natural history of respiratory allergy. Although current treatments are quite effective in alleviating respiratory allergy symptoms, it has proven much more difficult to confirm any influence on the progression of the disease. Much more promising is the field of specific allergen immunotherapy, where current evidence, although not yet of ideal robustness, points towards a disease-modifying effect. In addition, newer or emerging, possibly more effective or more targeted interventions are promising in the preventive sense.

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Section: Pharmacotherapymentioning

confidence: 99%

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

et al. 2013

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“…Reduction of cortisol levels lasting for up to three weeks were found after a single intramuscular corticosteroid injection [5,6]. Post-injection flare, facial flushing, and skin and fat atrophy are the most common side effects of injectable corticosteroids, whereas systemic complications are rare but do exist [7].…”

Section: Primum Non Nocerementioning

confidence: 99%

“…Post-injection flare, facial flushing, and skin and fat atrophy are the most common side effects of injectable corticosteroids, whereas systemic complications are rare but do exist [7]. The most common adverse event, tissue atrophy, has even been reported in children [5,[8][9][10][11]. Moreover, a more persistent and possibly greater effect on bones or eyes, lasting for weeks, cannot be excluded.…”

Section: Primum Non Nocerementioning

confidence: 99%

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Primum non nocere

Bousquet

2005

Primary Care Respiratory Journal

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“…Some GPs have argued that treating individuals with 1-2 depotsteroid injections annually is safe and effective [15]. Unsurprisingly, allergologists do not agree [16]. The disagreement has resulted in a stalemate, partly for ethical reasons related to potential randomization into high-dose corticosteroid therapy and partly because of difficulties acquiring funding for proper randomized, double-blinded, placebo-controlled trials.…”

Section: Editorialmentioning

confidence: 99%

Steroids vs immunotherapy for allergic rhinitis – out with the old, in with the new

Aasbjerg

Backer

2014

Expert Review of Clinical Immunology

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Treatment for seasonal allergic rhinitis induced by airborne allergens can be divided into two major groups: symptom-dampening drugs, such as antihistamines and corticosteroids, and disease-modifying drugs in the form of immunotherapy. It has been speculated that depot-injection corticosteroids given once or twice a year are a safe and patient-friendly alternative to the time-consuming immunotherapy. Our data indicate otherwise.It has been estimated that 20% of the population in western societies has allergic rhinitis triggered by airborne allergens [1]. The severity of rhinitis varies greatly between individuals, ranging from mild symptoms easily alleviated with oral antihistamines to severe rhinitis with systemic impairment, which is more difficult to manage. Treatment of rhinitis is a cumulative stepwise approach, beginning with antihistamines or topical steroids and progressing to specific immunotherapy; only in rare cases should short-term treatment (<7 days) with oral corticosteroids be considered [2]. Specific immunotherapy is the only disease-modifying treatment available and therefore also the only potentially curative treatment. All other treatment modalities, including antihistamines and topical corticosteroids, are purely symptom dampening.Specific immunotherapy is available in three forms: subcutaneous immunotherapy (SCIT; the traditional treatment available for most airborne allergens); sublingual allergen tablets (SLIT tablets; currently available to treat only grass pollen-induced allergic rhinitis) and sublingual allergen droplets (SLIT-droplets), a treatment likely to be gradually replaced by SLIT tablets, and which, accordingly, will not be discussed further here. SCIT treatment consists of increasing doses of allergens, initially administered weekly, and subsequently, with increasing time spans and allergen doses until a high maintenance dose is administered every 8 weeks for 3-5 years. By contrast, SLIT tablets give a fixed allergen dose administered daily as a sublingual tablet for 3-5 years, that is, a treatment period similar to that of SCIT. The efficacy and safety of SCIT [3] and SLIT [4] have been thoroughly investigated, and both treatments provide a 50-70% decrease in symptoms and a 30-60% reduction in rescue medication score (antihistamines and steroids). Recent data on the treatment of grass pollen-induced allergic rhinitis indicate that SCIT and SLITtablet treatments are similar in terms of efficacy [5]; however, safety is an issue. SCIT treatment has involved the loss of human life, and lessons have been learned. Nevertheless, the risk of experiencing a severe adverse event is minimal when SCIT is performed by a trained specialist [6]. In comparison, SLIT-tablet treatment with grass pollen looks very promising; the treatment seems safe and tolerable for most individuals and administration does not require the same level of expert training [7]. Consequently, SLIT tablets are seemingly the better option for monotreatment of grass pollen-induced allergic rhinitis [5]. KEYWORDS Edit...

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

Cited by 65 publications

References 18 publications

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

Primum non nocere

Steroids vs immunotherapy for allergic rhinitis – out with the old, in with the new

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