Nasal spray beats antihistamine for allergy: study

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Nasal spray beats antihistamine for allergy: study

By Amy Norton

NEW YORK, Nov 28 (Reuters Health) - Using a steroid nasal spray to quash

allergy symptoms may work better than antihistamine pills, new research

suggests.

Investigators say that when used on an " as-needed " --rather than

daily--basis, the nasal spray fluticasone (Flonase) relieves allergy

symptoms such as runny nose, sneezing and congestion more effectively

than the antihistamine loratadine (Claritin).

The results of their study, funded in part by Flonase maker Glaxo

Wellcome, are published in the November 26th issue of the Archives of

Internal Medicine.

Although patients with seasonal allergies are advised to take their

antihistamines or steroid nasal sprays daily, " most patients are

probably not compliant, " according to Dr. M. Naclerio and his

colleagues at the University of Chicago in Illinois.

They note that little research attention has gone to how well these

treatments work when patients take them " as needed " --after their

allergies begin to bother them.

Fluticasone is a corticosteroid preparation that fights allergy symptoms

by reducing the inflammation that occurs in the nose when a person is

exposed to an allergy trigger such as pollen or dust mites.

Antihistamines block the effects of histamine, a compound released from

immune system cells during allergic reactions.

According to Naclerio's team, although antihistamines counter the early

stages of the allergic response, they have not been shown to fight the

" late response " to allergens. This stage is marked by the influx of

inflammatory immune cells and an increase in the nasal reaction to

further exposure to allergy triggers. Steroid nasal sprays, the

researchers write, have " profound inhibitory effects " on this late

response.

So the investigators studied whether fluticasone would be more effective

than loratadine in treating allergy symptoms after the first signs of an

allergic reaction. They had 88 patients with ragweed allergies take

either medication for 4 weeks during ragweed season. The patients were

instructed to use the medication as needed.

Within 5 days, the nasal-spray patients were reporting fewer allergy

symptoms and by the end of the study showed greater improvements in

quality of life.

" To our knowledge, " the researchers write, " the present study is the

first to demonstrate the superiority of as-needed intranasal

corticosteroid use compared with as-needed (antihistamine) use. "

While numerous studies have shown antihistamines ease seasonal

allergies, the authors add, " we question the efficacy of intermittent

use of (antihistamines) when taken after exposure (to an allergen). "

Moreover, Naclerio's team asserts, the lower cost of the steroid nasal

spray, along with its effectiveness, suggest it would be " logical " to

use the spray as the first-line treatment for seasonal nasal allergies.

But an allergy expert not involved in the study told Reuters Health that

" logical " may not be the right term. Instead, these findings suggest it

is possible to use a steroid nasal spray as a first-line treatment,

according to Dr. Lanny Rosenwasser, head of allergy and immunology at

National Jewish Medical and Research Center in Denver, Colorado.

He said the significance of the findings is that they show the sprays

can help allergic patients when used only intermittently.

Still, the results " wouldn't convince me to change the way I treat

patients, " Rosenwasser said, noting that factors such as patients'

symptoms, environmental exposures and drug side effects guide allergy

treatment decisions.

The different side effects of antihistamines and steroid nasal sprays

are a key issue, Rosenwasser stressed. Antihistamines can cause

significant sedation, for example. And the nasal sprays sometimes cause

nasal dryness and nose bleeds, while in children there is the potential

for the corticosteroids to hinder bone growth over time.

SOURCE: Archives of Internal Medicine 2001;161:2581-2587.