Allergic rhinitis is a high-cost, high-prevalence disease. In the 12 months ending March 31, 1997 $3.1 billion was spent in the United States for medications to manage this illness.
Allergic rhinitis affects quality of life and interferes with work productivity. Nonsedating
antihistamines are the most common and most expensive
therapy for this condition. This study reviewed 13 randomized studies in which blinded investigators compared management of
allergic rhinitis by means of intranasal
steroids to management by means of nonsedating
antihistamine. Evidence tables demonstrated that in all studies in which total nasal symptoms and
nasal obstruction were recorded, the nasal
steroid was statistically superior to the nonsedating
antihistamine. For
nasal blockage the nonsedating
antihistamines did not perform better than placebo. For all other nasal symptoms the intranasal
steroid was statistically superior in most reports and equal or numerically better in the remaining papers. When these data are linked to those from cost analysis and quality-of-life studies, the evidence strongly suggests that nasal
steroids should be first-line
therapy for
allergic rhinitis. In four reports on the combination of a nonsedating
antihistamine compared to a nasal
steroid alone, there was no significant difference between these two treatments. Like
asthma,
allergic rhinitis is an inflammatory disease and should be managed with anti-inflammatory medication. Making such a change in the management of
allergic rhinitis should increase efficacy and decrease costs.