依情况需要而使用鼻用类固醇治疗过敏性鼻炎优于H1阻滞剂

专家建议改变过敏性鼻炎的治疗方针以使病人受益,减少花费

  2001年12月7日── 12月26日的Archives of Internal Medicine.上的一篇报导显示,采用鼻内用类固醇治疗季节性过敏性鼻炎,要比采用H1受体拮抗剂更有效。

  来自芝加哥大学Scott M. Kaszuba医师,以及合著者写道:「看来鼻内应用皮质类固醇,作为治疗季节性过敏性鼻炎的一线药物是合理的。

  在此次随机化开放平行组研究中,88位季节性过敏性鼻炎患者,记录了他们每天的症状,并且在入选时以及治疗的四周内,每两周进行一次检查。

  采用fluticasone治疗的患者,在鼻粘膜炎生活质量问卷的行为、睡眠、习惯、总体和全部症状的得分,都优于采用loratadine治疗的患者。

  治疗后fluticasone治疗组鼻粘膜嗜酸性粒细胞的数目,以及嗜酸性粒细胞阳离子蛋白的水浓度,都明显低于loratadine治疗组。

  H1-受体拮抗剂的销售量,高于鼻内用类固醇,二者的销量比为3:1,作者建议:「成本-效益比支持使用鼻内用类固醇。指导方针的变化,可以使更多的病人受益,同时可降低卫生保健的费用。」

  Glaxo Wellcome药厂提供了此次研究的部分资金。

  

PRN Nasal Steroids Better Than H1 Blockers for Allergic Rhinitis

Experts Suggest Guideline Changes to Benefit Patients, Reduce Cost

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Dominique Walton Brooks, MD, MBA

Dec. 7, 2001 -- As-needed intranasal steroids are more effective in treating seasonal allergic rhinitis than as-needed H1 receptor antagonists, according to a report in the Nov. 26 issue of Archives of Internal Medicine.

"It would seem logical to use intranasal corticosteroids as first-line treatment for seasonal allergic rhinitis," write Scott M. Kaszuba, MD, and coauthors from the University of Chicago.

In this randomized, open-label, parallel-group study, 88 patients with seasonal allergic rhinitis kept a diary of their daily symptoms and were examined at enrollment and biweekly for four weeks during treatment.

Patients treated with fluticasone did significantly better than those treated with loratadine in the activity, sleep, practical, nasal, overall, and total symptom subscores of the Rhinoconjunctivitis Quality of Life Questionnaire.

After treatment, nasal lavage showed significantly smaller number of eosinophils and eosinophilic cationic protein levels in the fluticasone-treated group compared with the loratadine-treated group.

While H1-receptor antagonists outsell intranasal steroids three to one, the authors suggest that "the cost-benefit ratio favors intranasal corticosteroids. A change in guidelines would benefit more patients and reduce health care costs."

Glaxo Wellcome, Inc., provided partial funding for the study.

© 2001 WebMD Corporation. All rights reserved.

    
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