A Comparative Study of Intranasal Steroids with Intranasal Antihistamines Sprays v/s Intranasal Steroids Sprays Alone in Management of Allergic Rhinitis
Fellowship in Paediatric Otorhinolaryngology, Department of ENT, Children’s Airway and Swallowing Centre, Manipal Hospitals, Bangalore, Karnataka, India
*Corresponding Author: Deepa Shivnani, Fellowship in Paediatric Otorhinolaryngology, Department of ENT, Children’s Airway and Swallowing Centre, Manipal Hospitals, Bangalore, Karnataka, India.
May 11, 2022; Published: June 09, 2022
Background: Allergic rhinitis is the most common form of rhinitis, worldwide, affecting close to 10% to 30% of the global population. Heredity and environmental exposures may contribute to a predisposition to allergies. Pharmacotherapy along with effective allergen avoidance measures forms the mainstay of management of Allergic Rhinitis. The evidence indicates that intranasal corticosteroids are more efficacious than are antihistamines in the control of Allergic Rhinitis symptoms. This "superiority" is principally related to their effect on nasal obstruction. The numbers of studies done to know the efficacy of combination sprays over steroidal sprays alone are very few and provide insufficient insight.
Objectives: The purpose of this study was to ascertain whether the combination nasal sprays should be prescribed as a standard medical management for allergic rhinitis or not, as to achieve better quality of life after treatment with maximum improvement in Total Nasal Symptom Score (TNSS).
Methods: 100 subjects were taken up for this study, 50 in each group after fulfilling the inclusion and exclusion criteria. Subjects were allocated in two groups according to consultant’s preference. Subjects were evaluated for Total Nasal Symptom Score (TNSS) and score of Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) before and after the treatment initiation.
The study was conducted in two groups based on drug given and both the groups were evaluated after 2 weeks and 4 weeks of medication on the basis of TNSS and MiniRQLQ score.
Results: Allergic Rhinitis was found to be more common in younger age group. Both the drugs were effective in reducing the Total nasal symptom scores (TNSS) and score of MiniRQLQ significantly (p < 0.001). However, Combination Nasal Sprays (Intra-nasal corticosteroids with intranasal antihistamines) were found to be statistically superior when compared to only intranasal steroid sprays.
Interpretation and Conclusion: Combination Nasal Sprays are highly efficacious and statistically better to steroid nasal sprays hence this study confirms the superiority of combination nasal sprays and recommends combination nasal sprays as first line of treatment for allergic rhinitis.
Keywords: Allergic Rhinitis; Total Nasal Symptom Score; Intranasal Corticosteroids; Intranasal Corticorsteroids with Intranasal Histamines; MiniRQLQ; Quality of Life
- Greiner AN., et al. “Allergic rhinitis”. Lancet9809 (2012): 2112-2122.
- Hadley JA., et al. “Comorbidities and allergic rhinitis: not just a runny nose”. Journal of Family Practice 61 (2012): S11-S15.
- Nathan RA., et al. “The prevalence of nasal symptoms attributed to allergies in the United States: findings from the burden of rhinitis in an America survey”. Allergy and Asthma Proceedings 29 (2008): 600-608.
- Asthma and Allergy Foundation of America. Allergy facts and figures.
- Leynaert B., et al. “Quality of life in allergic rhinitis and asthma. A population-based study of young adults”. American Journal of Respiratory and Critical Care Medicine 162 (2000): 1391-1396.
- Meltzer EO., et al. “Quality of life and rhinitis symptoms: Results of a nationwide survey with the SF-36 and RQLQ questionnaires”. The Journal of Allergy and Clinical Immunology 99 (1997): S815-S819.
- Dykewicz MS., et al. “Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology”. Annals of Allergy, Asthma and Immunology5 Pt 2 (1998): 478-518.
- Khanna P and Shah A. “Categorization of patients with allergic rhinitis: a comparative profile of "sneezers and runners" and "blockers"”. Annals of Allergy, Asthma and Immunology1 (2005): 60-64.
- Brozek JL., et al. “Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision”. The Journal of Allergy and Clinical Immunology3 (2010): 466-476.
- Bousquet J., et al. “Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA (2)LEN and AllerGen)”. Allergy86 (2008): 8-160.
- Scadding GK., et al. “Patient and physician perspectives on the impact and management of perennial and seasonal allergic rhinitis”. Clinical Otolaryngology 6 (2000): 551-557.
- Wallace DV., et al. “The diagnosis and management of rhinitis: an’ updated practice parameter”. The Journal of Allergy and Clinical Immunology2 (2008): S1-S84.
- Hindmarch I and Shamsi Z. “Antihistamines: models to assess sedative properties, assessment of sedation, safety and other side-effects”. Clinical and Experimental Allergy 29 (1999): 133-142.
- Simons FE. “Advances in H1-antihistamines”. The New England Journal of Medicine21 (2004): 2203- 2217.
- Meltzer EO., et al. “Comparative outdoor study of the efficacy, onset and duration of action, and safety of cetirizine, loratadine, and placebo for seasonal allergic rhinitis”. The Journal of Allergy and Clinical Immunology 97 (1996): 617-616.
- Olsson P., et al. “Prevalence of self-reported allergic and non-allergic rhinitis symptoms in Stockholm: relation to age, gender, olfactory sense and smoking”. Acta Otolaryngology123 (2003): 75-80.
- Rydén O., et al. “Disease perception and social behaviour in persistent rhinitis: a comparison between patients with allergic and nonallergic rhinitis”. Allergy59 (2004): 461-464.
- Meltzer EO., et al. “MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fl uticasone propionate) in the treatment of seasonal allergic rhinitis: a randomized, double-blind, placebocontrolled trial of efficacy and safety”. Allergy and Asthma Proceedings 33 (2012): 324-332.
- Frank C Hampel., et al. “Double-blind, placebo-controlled study of azelastine and fluticasone in a single nasal spray delivery device”. Annals of Allergy, Asthma and Immunology2 (2010): 168-173.
- Romieu I., et al. “Improved biomass stove intervention in rural Mexico: impact on the respiratory health of women”. American Journal of Respiratory and Critical Care Medicine 180 (2009): 649-656.
- Smith-Sivertsen T., et al. “Effect of reducing indoor air pollution on women's respiratory symptoms and lung function: the RESPIRE Randomized Trial, Guatemala”. American Journal of Epidemiology 170 (2009): 211-220.