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Nasal steroids reportedly superior to fight hay fever

Monday, November 26, 2001

CHICAGO -- Steroid nasal sprays are more effective than prescription antihistamines when used as needed to treat hay fever and other seasonal allergies, a study suggests.

The University of Chicago study compared two popular prescription drugs -- the antihistamine loratadine, sold as Claritin, and fluticasone nasal spray, sold as Flonase. The 88 participants were split into two groups, each using one of the drugs for four weeks when symptoms occurred, rather than continuously.

The steroid group experienced far less sneezing, runny nose and congestion than the group using pills. Lab tests also showed that, compared with Claritin patients, steroid patients had fewer cells called eosinophils, an inflammation marker.

The study appears in today's Archives of Internal Medicine. It was funded by GlaxoSmithKline, Flonase's manufacturer, and the National Institutes of Health.

Dr. Marianne Frieri, a spokeswoman for the American Academy of Allergy, Asthma and Immunology, said the results don't show whether Flonase or other nasal steroids are superior to other, newer antihistamines.

"They only compared it to one antihistamine. It really needs to be compared to others," said Frieri, director of allergy and immunology at Nassau University Medical Center in East Meadow, N.Y.

Revisions needed

The researchers said the findings suggest revisions are needed in guidelines recommending antihistamines as first-line treatment for allergies such as hay fever that affect at least 36 million people nationwide.

Steroid nasal sprays "should now be recommended for regular use in patients with severe disease and for as-needed use in patients with mild disease," said Dr. Robert Naclerio, the study's director and chief of otolaryngology at the University of Chicago.

Some doctors have been reluctant to prescribe steroid nasal sprays because of concerns about side effects, which include dry nose and nasal bleeding. More severe side effects associated with long-term use of other prescription steroids, such as cataracts and bone-thinning, also have raised concerns among doctors treating allergy patients, Frieri said.

The data don't include information on side effects, but co-author Dr. Fuad Baroody said they were minimal in both groups.

Frieri said the study results aren't surprising, since steroids generally have a stronger anti-inflammatory effect than antihistamines.


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