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Symptomatic treatment of pollen-related allergic rhinoconjunctivitis in children: randomized controlled trial

J B Wartna1, A M Bohnen1, G Elshout1

  • 1Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.

Allergy
|October 4, 2016
PubMed

Insights

Daily intranasal corticosteroids (INCS) were not better than on-demand INCS or oral antihistamines for allergic rhinoconjunctivitis (AR) symptom relief in children. On-demand INCS reduced corticosteroid exposure and costs.

Area of Science:

  • Pediatric Allergy and Immunology
  • Otolaryngology
  • Clinical Pharmacology

Background:

  • Allergic rhinoconjunctivitis (AR) affects 12% of children.
  • Current treatments include intranasal corticosteroids (INCS) and oral antihistamines, but optimal symptom relief remains unclear.
  • This study compares daily INCS, on-demand INCS, and on-demand oral antihistamines for pediatric AR.

Purpose of the Study:

  • To determine if daily intranasal corticosteroids (INCS) are superior to on-demand INCS or on-demand oral antihistamines in relieving allergic rhinoconjunctivitis (AR) symptoms in children.
  • To evaluate the efficacy of different treatment strategies for pollen-induced AR.

Main Methods:

  • A single-blinded randomized controlled trial involving 150 children (aged 6-18) with pollen-related AR.
  • Participants received daily INCS (fluticasone propionate), on-demand INCS, or on-demand oral antihistamine (levocetirizine) for 3 months.
  • Daily online symptom diaries tracked nasal and eye symptoms, with the primary outcome being the percentage of symptom-free days.

Main Results:

  • On-demand INCS resulted in 30% symptom-free days, compared to 22% for daily INCS (not statistically significant).
  • The on-demand antihistamine group achieved 15% symptom-free days (not statistically significant compared to daily INCS).
  • Children using on-demand INCS used 61% less fluticasone than those on daily INCS (P < 0.0001).

Conclusions:

  • Daily INCS were not superior to on-demand INCS or on-demand antihistamines for symptom-free days in pediatric AR.
  • An on-demand INCS strategy offers reduced corticosteroid exposure and lower costs.
  • This suggests on-demand INCS is a viable alternative for managing pediatric allergic rhinoconjunctivitis.
Abstract

Keywords:
RCTallergic rhinoconjunctivitisantihistamineschildrenintranasal corticosteroids

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