A Salute to Allergic Rhinitis

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
Allergic salute (transverse nasal crease)
Cobblestoning (lymphoid hyperplasia) of nasopharyngeal mucosa
Blue/gray discoloration of nasal mucosa in 2nd/3rd pictures compared to normal mucosa in 1st picture
Hypertrophy of nasal turbinates in 2nd/3rd pictures compared to normal nasal turbinate in 1st picture

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: 

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