Corticosteroid nasal sprays

The finding, which was published in the November 26 issue of the Archives of Internal Medicine, suggested that the current prescription patterns and guidelines flavoring the use of antihistamines to be the first-line treatment option for mild or moderate allergies need to be altered.

From Sciencedaily.com:

Antihistamines can block the actions of histamines if taken in advance but they have no impact on the late response. Intranasal steroids inhibit the late response and prevent priming.

“Antihistamines,” explained Naclerio, “taken once symptoms have already appeared, arrive too late to block the early response and have little effect on the late response. Corticosteroids taken when symptoms begin can prevent the late response and inhibit priming, which makes the patient more sensitive to subsequent contacts.”

“Our study,” he added, “demonstrates the greater importance of the late response compared to the immediate response.”

The authors emphasize that continuous medication use is more effective than sporadic use in response to symptoms but acknowledge that few patients comply with those instructions.

In light of their findings, they suggest revising the current guidelines so that “intranasal corticosteroids should become the first-line treatment for seasonal allergies. They should now be recommended for regular use in patients with severe disease,” said Naclerio, “and for as-needed use in patients with mild disease.”

Robert Naclerio, M.D., chief of otolaryngology-head and neck surgery at the University of Chicago and director of the study, remarked more people will be benefiting and health costs can be dramatically reduced by altering the present guidelines to match patient practice.

Inflammation measures were found to be considerably better for patients with hay fever and administered with fluticasone propionate than the combination of two anti-allergy drugs, according to Robert Naclerio, M.D., professor of surgery at the University of Chicago and director of the study.

The study was presented at the 58th annual meeting of the American Academy of Allergy, Asthma and Immunology.

From News.Bio-Medicine.Org:

“Because of the effect on inflammation, we prefer fluticasone,” he added, “but for patients, the choice may come down to cost and whether they would prefer a pill or a spray.”

Since one out of five people in the United States suffers from seasonal allergies, such preferences have financial implications. Antihistamines are prescribed three times as often, even though intranasal corticosteroids are less expensive than the non-sedating antihistamines. Combining loratidine with montelukast increases the cost difference.

A daily dose of Claritin, the leading antihistamine, costs $2.92 at the University of Chicago Hospitals pharmacy. Singulair, which works by blocking leukotrienes — substances that trigger inflammation — costs $4 per day. Flonase, the leading prescription nasal spray, costs $2.21 per day.

It was suggested during the study that use of nasal sprays result in less of patients’ nasal passages and those administered with steroid nasal sprays displayed signs of minimal side effects and lower levels of eosinophil cationic protein, an inflammation sign. It was remarked by Naclerio that fluticasone truly shows its worth because of its unmatched benefits and low cost.