Lipworth BJ, Stewart K, Kuo CR, Chan R. J Allergy Clin Immunol Pract. 2024 Jun;12(6):1434-1435. doi: 10.1016/j.jaip.2024.01.024.EDITORIAL
Current guidelines advocate using regular treatment with intranasal corticosteroid/antihistamine (CS/AH) combination sprays as step-up therapy for adolescent and adult patients with moderate to severe persistent allergic rhinitis (AR) where there is suboptimal control with intranasal CS alone.1
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Rationale for using low-dose intranasal corticosteroid/antihistamine (CS/AH)
combination as on-demand anti-inflammatory reliever therapy for allergic rhinitis (AR).
Patients would escalate and de-escalate the dose according to symptoms,
prevailing triggers, and attendant disease severity. |
The therapeutic rationale here is that the CS component is effective at suppressing symptoms attributable to type 2 (T2) inflammation mediated by eosinophils, whereas the AH provides additional activity on T2 symptoms mediated by IgE and mast cells. The evidence from clinical studies shows superior clinical efficacy based on symptom scores when comparing twice-daily CS/AH combination versus twice-daily CS alone, demonstrating additivity of response for the 2 moieties.2,3 Moreover, CS/AH exhibits a faster onset compared with CS alone due to the effect of AH moiety.4 The more rapid onset of symptom relief with CS/AH might conceivably result in improved adherence due to patients perceiving a more pronounced benefit on their disease control...
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