Study: Steroid Spray Beats Antihistamine Pill for Hay Fever

Sniffing medication curbs increased sensitivity to pollen

FRIDAY, Dec. 21, 2001 (HealthDayNews) -- Taking an antihistamine may quickly ease sneezes and a runny nose, but using a steroid spray may be more effective in the long run to reduce sensitivity to pollen, a new study shows.

Doctors typically prescribe antihistamines to relieve the runny nose and sneezing of allergic rhinitis -- hay fever -- when patients have a mild allergic reaction to pollen. They usually suggest steroid sprays when the allergy is more severe, but that treatment ignores the fact that your first snort of pollen sensitizes the nasal linings and makes them more prone to allergies, the researchers say.

The clue to which medication will be more effective can be found in how an allergic person reacts to pollen, says lead study author Dr. Robert Naclerio, professor and chief of Otolaryngology-Head and Neck Surgery at the University of Chicago Pritzker School of Medicine.

"People with allergic rhinitis have two events which take place when they sniff pollen," he says. "The first event is the release of histamines from the mast cells within the lining of the nose, and that reaction begins the sneezing, the runny and stuffy nose. When that's over, there's a second event. Cells from the bloodstream come into the nasal mucosa and cause changes, leading to a sensitivity to the next exposure of pollen."

The culprits in increasing allergic sensitivity are eosinophils, a type of white blood cell that is part of the body's protective system against allergens. The researchers theorized that a steroid spray would prevent the infiltration of eosinophils into the nasal lining, preventing what they call "allergic priming."

To figure out which medicine was more effective, Naclerio divided 88 patients with an allergy to ragweed into two groups. The first group was instructed to dose themselves with one tablet of Claritin daily if they felt an allergic reaction coming on; the other group could use two sniffs of a steroid spray called fluticasone in each nostril.

"What happened is what we predicted," Naclerio reports. "The group taking Claritin got lots of eosinophils, and the group taking steroids didn't. The group using the steroid spray however reported fewer symptoms -- less sneezing and running nose -- than those taking the antihistamine."

Naclerio also asked both groups to rate their quality of life. "Did they sleep better, were they more emotionally happy? And that was significantly better among those taking steroids. The major message from our study relates to guidelines for treating seasonal allergic rhinitis. Our data supports the usefulness of steroid spray in the treatment of allergies," Naclerio says.

The findings were reported in the Archives of Internal Medicine.

Don't worry about side effects from a steroid spray, Naclerio says. "Steroids do have known side effects when taken by mouth, such as thinning of the skin, puffiness or growth retardations. But topical steroids are used in the spray, and topical steroids do not cause these kind of systemic side effects." Steroid sprays occasionally may cause some minor bleeding or irritation, he says.

Doctors still need to consider all the current therapies available to offer relief to allergy sufferers, says Dr. Gail Shapiro, president-elect of the American Academy of Allergy, Asthma and Immunology.

"There are many factors to consider when prescribing treatments for rhinitis, which often include a combination of therapies. Antihistamines act quickly to reduce rhinitis symptoms," she says. "Intranasal corticosteroids take longer to provide initial relief and are meant to be used as part of an ongoing treatment plan. It is very important to assess and monitor a patient's reaction to any one medication or to combinations of medicine."

What To Do: For more information on nose sprays, antihistamines and allergic rhinitis, see the American Academy of Allergy, Asthma and Immunology or the National Institute of Allergy and Infectious Diseases.

SOURCES: Interviews with Robert Naclerio, M.D., professor and chief of Otolaryngology-Head and Neck Surgery, University of Chicago Pritzker School of Medicine; Gail Shapiro, M.D., president-elect, American Academy of Allergy, Asthma and Immunology, Milwaukee; Nov. 26, 2001, Archives of Internal Medicine
Consumer News