Intranasal Corticosteroids Underperform in Allergic Rhinitis

Look for Options with Long-Term Efficacy

SAN DIEGO—Intranasal corticosteroids are widely prescribed for the treatment of moderate-to-severe symptoms of allergic rhinitis, but available agents are not providing sustained symptom relief, according to survey results presented at the American Academy of Allergy, Asthma & Immunology annual meeting.

“Allergies in America: A Survey of Nasal Allergy Sufferers” polled 400 treating physicians and healthcare providers, as well as 2500 patients with allergic rhinitis, about the efficacy of intranasal corticosteroids and the relationship between efficacy and patient satisfaction.

About one half (48%) of the patients said their currently prescribed nasal spray did not provide 24-hour symptom relief. The majority (87%) reported that these agents begin to lose their effectiveness within 15 hours after administration.

Many of the responding clinicians agreed. Some 37% of primary care physicians, 48% of otolaryngologists, 25% of allergists, and 29% of nurse practitioners/physician assistants said that intranasal steroids do not provide 24-hour symptom relief.

Lead investigator Eli Meltzer, MD, of the University of California, San Diego, said, “The patients’ perception is that intranasal corticosteroids lose effectiveness over time. So we need to reevaluate how we are managing these patients.”

Dr Meltzer said the majority of clinicians also reported that intranasal corticosteroids lose efficacy over time, even when taken as prescribed. This was cited by patients and clinicians as one of the reasons patients were dissatisfied with nasal allergy medications.

About 66% of patients and 50% of clinicians rated long-lasting symptom relief as one of the most important attributes of these treatments.

“These findings are a wake-up call for physicians,” Dr Meltzer told IMWR. “We need to better evaluate the duration of action of a medication, the persistence of that efficacy, and to see if it is continuously effective.”

He suggested that physicians “need to either add on other medications, or find a medicine that does last 24 hours as a monotherapy. Patients are not fully satisfied with their treatment, and these findings suggest undertreatment due to lack of durability of a medication contributes to this dissatisfaction.”