Nasal spray sufficient for allergic rhinitis in Japanese patients

Intranasal corticosteroid sprays can be administered as a first-line treatment for Japanese patients with seasonal allergic rhinitis, without the need to use systemic corticosteroid drugs, suggest study findings.

In the first direct comparison between an intranasal corticosteroid spray, mometasone furoate (MF), and a systemic oral corticosteroid, betamethasone valerate (BV), there were no significant differences in the effects of the two treatments among patients with Japanese cedar pollinosis, the most common form of allergic rhinitis in Japan.

In almost all areas in Japan, this condition is characterized by acute and severe symptoms that persist for about a month, explain Masayuki Karaki (Kagawa University) and colleagues. When treatment is chosen based on side effects, topical therapies are more commonly selected than systemic ones. However, systemic treatment has previously been thought to have a greater and more instantaneous therapeutic effect than that of topical corticosteroids.

The current open-label study included 72 patients, aged a mean of 40.8 years.

Individuals were allocated to receive once-daily loratadine (10 mg) single therapy (noncorticosteroid group), loratadine plus two 50 µg MF sprays per nostril each day (topical group), or loratadine plus 0.25 mg BV twice daily (systemic group) over a period of seven days.

Evaluation of changes in symptoms using the Japanese Guideline for Allergic Rhinitis showed there were significant reductions from baseline in individual and total symptom scores for sneezing, nasal obstruction, watery nasal discharge, and nasal itching among both the topical and systemic treatment groups compared with the noncorticosteroid group.

Furthermore, there was no significant difference in therapeutic effects found between the topical and systemic corticosteroid groups.

"This suggests that MFNS [MF nasal spray] may sufficiently improve nasal symptoms in patients with symptomatic seasonal allergic rhinitis without the administration of systemic corticosteroids," write Karaki et al in Auris Nasus Larynx.

The researchers also report that there were no major adverse events such as moon face, diarrhea, or anthema experienced during the study. However, the treatments were only used for seven days, which may explain why no major drug-related complications occurred. It has previously been reported that significantly more adverse events are experienced by patients treated with BV than in those treated with MF, they say.

"Given the side effects of systemic corticosteroid treatment, treatment with intranasal spray is more strongly recommended than systemic oral treatment," suggest the team.

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