Key takeaways:
- Sufferers obtained prednisolone or ebastine each day for 7 days throughout tree pollen season.
- Day by day symptom scores and drugs use have been comparable.
- High quality of life scores additionally noticed comparable enhancements.
Prednisolone and antihistamine tablets offered comparable ranges of aid for sufferers with allergic rhinitis throughout tree pollen season, in response to a examine revealed in Medical and Translational Allergy.
These findings underscore the advantages of individualized therapies for sufferers with tree pollen allergy, Carl Skröder, PhD scholar, division of ear, nostril and throat illnesses, division of medical science, intervention and expertise, Karolinska Institutet, and colleagues wrote.
Knowledge have been derived from Skröder C, et al. Clin Transl Allergy. 2024;doi:10.1002/clt2.70017.
The interventional, single-center, double-blind, randomized trial included 18 adults (9 ladies; imply age, 30 years) receiving a 20 mg pill of prednisolone and 16 adults (eight ladies; imply age, 29 years) receiving a 20 mg pill of ebastine every day for 7 days through the finish part of the 2018 tree pollen season.
There have been no vital variations between the teams in each day symptom scores (dSS), each day treatment scores (dMS) or each day mixed symptom and drugs scores (dCSMS), the researchers mentioned.
Imply areas underneath the curve (AUCs) for signs included 17.2 (95% CI, 11.7-22.7) for the prednisolone group and 17.2 (95% CI, 13.7-20.5) for the ebastine group.
Imply AUCs for using rescue treatment included 16.8 (95% CI, 12.3-21.2) for the prednisolone group and 15.5 (95% CI, 10.2-20.8) for the ebastine group, which didn’t characterize a big distinction both, the researchers mentioned.
Moreover, imply AUCs included 34 (95% CI, 24.5-43.4) for the prednisolone group and 32.6 (95% CI, 25.6-39.7) for the ebastine group in dCSMS scores, which the researchers referred to as a 4% discount in contrast with the prednisolone group.
Each teams skilled vital decreases in imply 22-item Sino-Nasal Consequence Check scores between days 1 and 21, with a fall from 1.65 to 1.14 (P = .03) for the prednisolone group and from 1.5 to 1.2 (P = .04) for the ebastine group.
At baseline, imply whole SNOT-22 scores included 36.3 for the prednisolone group and 33 for the ebastine group, which the researchers referred to as average. These means fell to 25.1 for the prednisolone group and 26.5 for the ebastine group, with each indicating enchancment, the researchers mentioned.
Imply Juniper Rhinoconjunctivitis High quality of Life Questionnaire (RQLQ) scores considerably fell for each teams between days 1 and 21 as nicely, together with a drop from 2.61 to 1.78 (P = .02) for the prednisolone group and from 2.39 to 1.69 (P = .01) for the ebastine group.
By the top of the examine interval, there have been no vital variations in high quality of life between the 2 teams, which the researchers mentioned may very well be because of decreased pollen counts because the tree pollen season progressed.
Each teams skilled predominantly gentle antagonistic occasions — mostly sneezing, nasal blockage, nasal drip and itching within the nostril and eyes — with no critical antagonistic occasions.
Based mostly on these findings, the researchers concluded that prednisolone didn’t yield any vital discount in signs or treatment use in contrast with antihistamines through the 2018 tree pollen season.
The researchers additionally mentioned these findings present how evidence-based practices and patient-centered care needs to be prioritized in managing allergic rhinitis, with individualized therapy methods tailor-made to affected person preferences and tolerability.
Perspective
The findings are fairly attention-grabbing, though oral corticosteroids are usually not a first-line therapy alternative for allergic rhinitis, even throughout symptomatic durations of pollen publicity, ie, seasonal allergic rhinitis (SAR).
We do know from real-life research in Europe that, in distinction with a randomized managed examine (RCT) comparable to this one, treatment adherence of allergic rhinitis sufferers to oral and/or intranasal treatment throughout pollen seasons shouldn’t be optimum, round 30%, growing solely when the management of rhinitis decreases. This implies that SAR sufferers typically don’t use treatment every single day however slightly on an as-needed foundation.
That’s a attainable rationale for the authors of this examine to match a brief interval (7 days) of oral medicines within the preliminary part of a tree pollen season to guage the management of signs and the necessity for added medicines. Someway surprisingly, and opposite to the authors’ preliminary speculation, a broad anti-inflammatory drug (corticosteroids) performs no higher than a selective anti-H1 histamine inhibitor, additionally a clearly safer treatment. This helps the information that mast cell activation (by means of IgE) and histamine launch are the important thing drivers of the acute allergic response and the signs on the ocular and nasal surfaces after pollen allergen publicity.
In my private expertise, I might say {that a} SAR affected person will exceptionally want a brief interval of oral steroids to regulate symptom exacerbations in season. With a correct eviction plan, following native pollen counts, a topical fastened mixture of an intranasal antihistamine (INAH) with an intranasal corticosteroid (INCS), ultimately with co-medication with an oral antihistamine (for example, in case of great ocular signs), will management most circumstances.
After all, affected person schooling to comply with pollen counts and native exposures and to make use of a correct inhalation approach to optimize the intranasal therapy are essential to keep away from the background state of affairs of this examine: “a secondary therapy choice when topical therapies fail.”
If in a extremely managed state of affairs, comparable to this double-blind RCT, a brief 7-day course of a once-daily oral corticosteroid pill carried out no higher than one among a safer second-generation non-sedative H1-selective antihistamine (which even obtained a 4% decrease discount of signs and rescue treatment use), there isn’t a supporting proof to make use of this therapy technique (short-term oral corticosteroids) in uncontrolled allergic rhinitis.
Of be aware and steerage, a current meta-analysis reported that intranasal therapies (each INCS, INAH or INCS + INAH fastened mixtures) are more practical than oral therapies (together with OAH) at enhancing nasal signs in addition to high quality of life in SAR.
Additionally, a current community meta-analysis put ahead the proof that, evaluating intranasal SAR medicines, INAH plus INCS mixtures have been discovered, amongst drug courses, to be the highest-ranked interventions for all outcomes wherein they have been assessed.
Utilizing the identical analysis state of affairs and protocol of this revealed RCT, it will be fairly attention-grabbing to match the efficacy of a brief interval of the once-a-day mixture of the used OAH plus oral corticosteroid with an INAH plus INCS intranasal fastened mixture, on each the entire ocular and nasal signs scores and high quality of life within the preliminary part of a tree pollen season.
References:
Sousa-Pinto B, et al. Allergy. 2024;doi:10.1111/all.16384.
Sousa-Pinto B, et al. Clin Exp Allergy. 2025;doi:10.1111/cea.70004.
Torres MI, et al. J Allergy Clin Immunol Pract. 2024;doi:10.1016/j.jaip.2024.09.001.
Luis Delgado, MD, PhD, FAAAAI
Professor of Immunology, Division of Pathology, School of Drugs, College of Porto
Disclosures: Delgado studies no related monetary disclosures.
