Purchase this article with an account.
C. Origlieri, L. Bielory; Intranasal Corticosteroids & Ocular Symptoms of Allergic Rhinitis: A Literature Review. Invest. Ophthalmol. Vis. Sci. 2008;49(13):420. doi: https://doi.org/.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the impact of intranasal corticosteroids (INS) on ocular signs and symptoms of allergic rhinitis (OSAR).
Recent trials suggest that INS may help to alleviate OSAR in addition to nasal symptoms. In this study, clinical trials published since 1973 documenting INS treatment were evaluated to determine the effectiveness of this medication in alleviating OSAR. A search was conducted of English-language articles through MEDLINE and PUBMED of the keywords intranasal, corticosteroid, allergic, rhinitis, conjunctivitis, rhinoconjunctivitis, ocular, eye, beclomethasone, triamcinolone, flunisolide, fluticasone, mometasone, budesonide, and ciclesonide. In addition bibliographies of all articles were evaluated for relevant publications.
295 published clinical trials out of 663 search results were found having data on INS treatment for allergic rhinitis compared to placebo (n=112), oral antihistamines (n=29), intranasal antihistamines (n=6), mast cell stabilizers (n=9), leukotriene receptor antagonists (n=5), systemic corticosteroids (n=6), other INS (n=83), multiple agents (n =15), other agents (n=11), or no control group (n=19). All studies had subjects rate nasal symptoms throughout treatment, yet fewer than half (n=122) required monitoring of OSAR as well. These 122 trials scored OSAR on a Likert scale (n=108), most commonly a scale of 0 to 3, or a visual analog scale (n=8); OSAR were either scored individually (n=66) or pooled into an overall ocular score (n=56). Rescue medications, including antihistamine eye drops, were prohibited in only 18 trials. Statistically significant differences were found between INS and controls in trials since 2004 that forbade rescue medications and scored OSAR individually rather than pooled. Specifically in studies of patients with seasonal allergic rhinitis, differences between INS and placebo were undetectable while subjects were allowed to take rescue medications (p<0.01).
Data prior to 2004 suggests that study design precludes the ability to detect statistically significant differences in OSAR between INS and control groups. Pooling of symptoms and permitting rescue medications are associated with an inability to detect differences between treatment arms. More recent trials scoring OSAR individually and forbidding rescue medications have shown an effect of INS on OSAR, therefore additional trials of such design should be conducted to generate more data. If patients with allergic rhinitis can control both nasal symptoms and OSAR with a single agent, then compliance and therefore clinical outcome may improve.
This PDF is available to Subscribers Only