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Corticosteroid spray used as-needed for treating perennial allergic rhinitis

Published online: October 10, 2020

Moderate-to-severe allergic rhinitis is still a problem worldwide because of troublesome symptoms. Corticosteroid spray used daily is the standard treatment of moderate-to-severe perennial allergic rhinitis (PAR). However, the majority of patients use their medications as-needed when their symptoms are well controlled or partially controlled. The as-needed use of corticosteroid spray has never been studied in patients with PAR.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Thongngarm and colleagues conducted a randomized clinical trial in which the participants with moderate-to-severe persistent perennial allergic rhinitis received 6 weeks of treatment with either regular daily corticosteroid spray (regular group) or 1 week of daily corticosteroid spray, followed by 5 more weeks of as-needed corticosteroid spray (as-needed group). The primary outcome was the improvement in the total nasal symptom score (TNSS) between the 2 groups over the 6-week treatment period.

Thongngarm and colleagues reported that both “as-needed” and “regular” use of corticosteroid spray had similar improvement in nasal symptoms and quality of life. The treatment effect was less sustained with as-needed use. The cumulative dose of corticosteroid spray in the as-needed group was half that of the regular group. Adverse events were mild and comparable in both groups.

The researchers concluded that as-needed corticosteroid spray, at half of the total dose exposure, was similar to regular use in improving nasal symptoms and quality of life. They suggested that patients with moderate-to-severe persistent perennial allergic rhinitis should be treated with regular corticosteroid spray until symptoms are well-controlled, then the as-needed use could be a step-down treatment to keep a balance between acceptable symptom control versus long-term side effects and cost of treatment.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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