Nasal steroids more effective than immunotherapy for rhinoconjunctivitis

NEW YORK (Reuters Health) – In a head-to-head comparison, nasal steroid therapy won out over short-course specific immunotherapy in reducing symptoms of seasonal rhinoconjunctivitis, Scandinavian researchers report.

Dr. Sabina Rak, from Sahlgrenska University Hospital, Gצteborg, and colleagues studied 41 patients who were allergic to birch pollen. Twenty-one of the patients had rhinoconjunctivitis, and 20 had rhinoconjunctivitis and asthma. The researchers randomly assigned patients to budesonide 400 µg/day or preseason birch-specific immunotherapy.

In the last 2 weeks of the 6-week pollen season patients receiving budesonide had significantly less increase in rhinoconjunctivitis symptoms compared with patients who were treated with specific immunotherapy (p = 0.03), the researchers found.

Only patients receiving nasal steroids showed a significant decrease in seasonal peak expiratory flow (p = 0.01), but these patients did experience a significant increase in seasonal bronchial hyperresponsiveness (p = 0.0001), Dr. Rak's team reports.

However, in the asthmatic patients, specific immunotherapy prevented a seasonal increase in seasonal bronchial hyperresponsiveness and in eosinophil number, eosinophil cationic protein, and eosinophil chemotactic activity, according to the report in the December 2001 issue of The Journal of Allergy and Clinical Immunology.

Use of rescue medication, i.e., beta-agonists, was similar in the two treatment groups, the investigators add.

Dr. Rak and colleagues conclude that their findings indicate that "the mechanisms underlying bronchial hyperresponsiveness developing after heavy allergen exposure in patients with rhinitis and basically healthy airways might be partially different from those operating in patients with asthma

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