Use INCS alone, not with antihistamine tablets: experts


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A nasal spray alone may be more beneficial than adding an antihistamine tablet when treating hayfever, US experts suggest

The Joint Task Force on Practice Parameters, which comprises representatives of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), formed a work group to review evidence and provide guidance to health care providers on the initial pharmacologic treatment of seasonal allergic rhinitis in patients aged 12 years or older.

Many of the 14% of US adults who suffer from seasonal allergic rhinitis have already tried many OTC monotherapies without success by the time they seek help from allergy and immunology specialists, the authors write.

However, “no consensus exists about whether a particular medication should be used for initial treatment or about the benefit of using two or more medications concurrently for initial treatment”.

The group put together three key clinical questions as the focus of a systemic review of the literature.

They came up with three evidence-based guidelines to inform the treatment of these patients, and published them in Annals of Internal Medicine.

These include:

  1. For initial treatment of people 12 years old or older, the Joint Task Force recommends treatment with an intranasal corticosteroid alone, rather than in combination with an oral antihistamine. The Joint Task Force did not find evidence proving a benefit of adding an oral antihistamine to an intranasal corticosteroid and recognized that oral antihistamines, mainly first-generation, may cause sedation and other adverse effects.
  2. For initial treatment of people 15 years old or older, the Joint Task Force recommends treatment with an intranasal corticosteroid over a leukotriene receptor antagonist. The Joint Task Force found evidence clearly showing that an intranasal corticosteroid was more effective than a leukotriene receptor antagonist for nasal symptom reduction.
  3. For treatment of moderate to severe seasonal allergies in persons 12 years old or older, the clinician may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment, the Joint Task Force advises. The evidence showed that the addition of an intranasal antihistamine to an intranasal corticosteroid in patients with moderate-to-severe seasonal allergic rhinitis provides additional benefit, in contrast to combination therapy with an intranasal corticosteroid and an oral antihistamine.

“Overall, we judged the evidence as not proving a benefit of adding an oral antihistamine to an intranasal corticosteroid and recognised that oral antihistamines, mainly first-generation, may cause sedation and other adverse effects,” the authors wrote.

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