Quick facts!
- Allergic rhinitis (AR) takes approximately 2 years to develop, thus it’s rare in kids <2yo
- AR has bimodal peak onset in early school years and early adulthood
- AR is associated with a range of issues including allergic conjunctivitis, sinusitis, asthma, eczema, oral allergy syndrome, and eustachian tube dysfunction
- First-line treatment for AR is intranasal corticosteroids such as mometasone or fluticasone; second-line treatment is oral anti-histamines such as cetirizine or loratadine
- Consider montelukast in the presence of concomitant asthma
Exam findings!
Allergic shiners (subcutaneous venodilation) and Dennie-Morgan lines
New evidence!
A recent article in the Journal of Allergy and Clinical Immunology looked at the efficacy of fluticasone furoate nasal spray in terms of as-needed vs regular daily use in patients with allergic rhinitis (AR).
- Methods: single-blinded (physicians not patients) RCT in Thailand
- Participants: 108 adults with moderate-to-severe persistent AR
- 53 patients received 2 sprays in each nostril once daily for 1wk, followed by as-needed use (max 2 sprays per day) for 5 more weeks
- 55 patients received 2 sprays in each nostril once daily for 6 weeks
- Results:
- No significant differences between treatment groups in terms of symptom improvement or QOL
- The mean cumulative dose in the as-needed group was approximately 50% of the group with regular use
A few questions come to mind when thinking about this study:
- What’s the difference between fluticasone furoate (brand name: Veramyst) and fluticasone propionate (brand name: Flonase)?
- How do we define mild vs moderate-severe AR and intermittent vs persistent AR?
- How does AR impact QOL?
- How generalizable are the results? Will they change your practice?