Keywords
Revisión sistemática
Corticoides nasales
Tratamiento
Calidad de vida Allergic rhinitis
Steroids
Adults
Fever
Systematic review
Quality of life
How to Cite
Abstract
Objective: to assess the effectiveness of nasal topic steroids in controlling global nasal symptoms in patients with allergic rhinitis as compared to placebo. Design: systematic revision and meta-analysis of the literature. Population: randomized controlled experiments comparing intranasal steroids versus placebo in adults suffering from allergic rhinitis. Interventions: topical nasal corticoids compared to placebo. Measuring: the principal outcome was the subject proportion that achieved a global improvement regarding four nasal symptoms. the secondary outcomes were the improvement in each of the nasal symptoms, the quality of life, and the frequency of adverse effects. Results: the search in literature databases, the manual search in non-indexed journals, in abstracts of scientific conferences, in literature databases and through contact with authors and pharmaceutical brands allowed the identification of 1,251 studies. two independent reviewers selected, evaluated quality, and extracted the data from 27 of them. Even though there was heterogeneity in the intervention and measuring methods of outcomes all the studies found a global improvement of the symptoms with a topical nasal steroid. A meta-analysis with a random effects model found a relative risk of 0.46 (CI95% 0.40, 0.54); these results were the same with the fixed model. the analysis of the funnel graph cannot rule out the publication bias. In the presence of heterogeneity a meta-analysis for each of the symptoms was not done. However, the punctual results of the studies were homogeneous toward the topical nasal steroids. only three studies evaluated quality of life and a meta-analysis with the fixed and random effects models did not find significant differences (weighted mean difference of -0.97 CI95% -2.35 - 0.40). Adverse effects more frequently reported were blood tinged nasal secretions, burning sensation in the nose, and nasal dryness. Conclusions: the results indicate that the use of topical nasal steroids reduces to a half the risk of not showing improvement, and that they favorably improve each of the individual symptoms. Differences regarding quality of life were not found, even though the number of studies that evaluated this outcome is small. these results must be interpreted cautiously due to the clinical heterogeneity and the methodology of the studies, and because of the probability of publication bias.
References
Bousquet J, Khaltaev N, Cruz A, Denburg J, Fokkens W, togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update. allergy 2008; 63 (Suppl. 86): 8-160.
English g. JB. In: otolaryngology. Lippincott Company. 1993; 34: 9-12.
Dikewics M, Fineman S, Skoner D, Nicklas R, Lee R, Bleesing-Moore J, et al. Diagnosis and Management of Rhinitis: Complete guidelines of the Joint task force on Practice Parameters in allergy, Asthma and Immunology. ann allergy asthma immunol 1998; 81: 478-520. https://doi.org/10.1016/S1081-1206(10)63155-9
Storms W. Pharmacologic approaches to daytime and night time symptoms of allergic rhinitis. J allergy clin immunol 2004; 114: S146-153. https://doi.org/10.1016/j.jaci.2004.08.045
Bousquet J, van Cawenberge P, Khaltaev N, Ait-Khaled N, Annesi-Maesano I, Ba-chert C, et al. Allergic Rhinitis and its impact on asthma ARIA workshop report. J allergy clin immunol 2001; 108: S147-336. https://doi.org/10.1067/mai.2001.118891
van Cauwenberge, Bachert C, Ciprandi g. Epidemiology of Allergic Rhinitis. the UCB Institute of Allergy. 2004.
Stanaland BE. once-daily budesonide aqueous nasal spray for allergic rhinitis: a review. clin ther 2004; 26:473-492. https://doi.org/10.1016/S0149-2918(04)90050-1
Peters-golden M, Henderson W. the role of leukotrienes in allergic rhinitis. ann allergy asthma immunol 2005; 94: 609-618. https://doi.org/10.1016/S1081-1206(10)61317-8
Ciprandi g, tosca MA, Milanese M, Schenone g, Ricca v. Antihistamines added to an antileukotriene in treating seasonal allergic rhinitis: histamine and leukotriene antagonism. allerg immunol (Paris). 2004; 36: 67-72.
Weiner J, Abramson M, Puy R. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: Systematic review of randomized controlled trials. BmJ. 1998; 317: 1624-1629. https://doi.org/10.1136/bmj.317.7173.1624
Ciprandi g, Canonica W, grosclaude M, ostinelli J, Brazzola g, Bousquet J. Effects of budesonide and fluticasone propionate in a placebo-controlled study on symptoms and quality of life in seasonal allergic rhinitis. allergy. 2002; 57: 586-591. https://doi.org/10.1034/j.1398-9995.2002.03228.x
Bathia S, Baroody FM, detineo M, Nacleiro RM. Increased nasal airflow with budesonide compared with desloratadine during the allergy season. arch otolaryngol Head neck surg. 2005; 131: 223-228. https://doi.org/10.1001/archotol.131.3.223
Benninger MS, Ahmad N, Marple BF. the safety of intranasal steroids. otolaryngol Head neck surg 2003; 129: 739-750. https://doi.org/10.1016/j.otohns.2003.10.001
Jeal W, gaulds D. triamcinolone acetonide. drugs. 1997; 53: 257-280. https://doi.org/10.2165/00003495-199753020-00006
Lund v, Black J. Efficacy and tolerability of budesonide aqueous nasal spray in chronic rhinosinusitis patients. Rhinology.2004; 42: 57-62.
Allen D. Systemic effects of intranasal steroids: An endocrinologist's perspective. J allergy clin immunol 2000; 106: S179-190. https://doi.org/10.1067/mai.2000.110038
galant P, Melamed I. Lack of effect of Fluticasone Propionate Aqueous Nasal Spray on the hypothalamic-pituitary-adrenal axis in 2 and 3 year old patients. pediatrics. 2003; 112: 96-100. https://doi.org/10.1542/peds.112.1.96
Kim K, Rabinovitch N. Effect of budesonide aqueous nasal spray on hypothalamic-pituitary-adrenal axis function in children with allergic rhinitis. ann allergy asthma immunol 2004; 93: 61-67. https://doi.org/10.1016/S1081-1206(10)61448-2
Moller C, Ahlstrom H. Safety of nasal budesonide in the long-term treatment of children with perennial rhinitis. clin exp allergy 2003; 33: 816-822. https://doi.org/10.1046/j.1365-2222.2003.01689.x
Schenkel El. Features of mometasone furoate nasal spray and its utility in the management of allergic rhinitis. expert opinion on pharmacotherapy. 2003;4: 1579-1591. https://doi.org/10.1517/14656566.4.9.1579
Juniper E. Measuring health-related quality of life in rhinitis. J allergy clin immunol 2007; 99: S742-749. https://doi.org/10.1016/S0091-6749(97)90000-2
Pullerits t, Praks L, Ristioja v, Lotvall J. Comparison of nasal glucocorticoid, antileukotriene, and combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. allergy clin immunol. 2002; 109: 949-955. https://doi.org/10.1067/mai.2002.124467
Egger M, Smith g, Altman D. Systematic reviews. BmJ Publishing group 2001; 15: 285-312.
Higgins JPt, green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]. In: the Cochrane Library, Issue 4, 2006. Chichester, UK: John Wiley & Sons, Ltd.
Palma s, Delgado M. Consideraciones prácticas acerca de la detección del sesgo de publicación. gac sanit. 2006; 20(Supl 3):10-6. https://doi.org/10.1157/13101085
Sterne J, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J clin epidemiol 2001; 54: 1046-1055. https://doi.org/10.1016/S0895-4356(01)00377-8
terrin N, Schimd C, Lau J. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J clin epidemiol 2005,58: 894-901. https://doi.org/10.1016/j.jclinepi.2005.01.006
Andersson M, Berglund R, greiff L, Hammarlund A, Hedbys L, Malcus I, et al. A comparison of budesonide nasal dry powder with fluticasone propionate aqueous nasal spray in patients with perennial allergic rhinitis. Rhinology. 1995; 33: 18-21.
Andersson, M, Lindqvist, N, Svensson, C, Ek, L, and Pipkorn, U. Dry powder inhalation of budesonide in allergic rhinitis. clinical otolaryngology and allied sciences. 1993; 18: 30-33. https://doi.org/10.1111/j.1365-2273.1993.tb00805.x
Bende, M, Carrillo, t, vona, I, Da Castel-Branco, Mg, and Arheden, L. A randomized comparison of the effects of budesonide and mometasone furoate aqueous nasal sprays on nasal peak flow rate and symptoms in perennial allergic rhinitis. ann allergy asthma immunol 2002; 88: 617-623.Comunicación personal con el autor. https://doi.org/10.1016/S1081-1206(10)61894-7
Bronsky E, Aaronson D, Berkowitz R, Chervinsky P, graft D, Kaiser HB, et al. Dose ranging study of mometasone furoate (Nasonex) in seasonal allergic rhinitis. ann allergy asthma immunol 1997; 79:51-56. https://doi.org/10.1016/S1081-1206(10)63084-0
Cordray S, Harjo J, and Miner L. Comparison of intranasal hypertonic Dead Sea saline spray and intranasal aqueous triamcinolone spray in seasonal allergic rhinitis. ear, nose and throat 2005; 84: 426-430. https://doi.org/10.1177/014556130508400713
Day J, Carrillo, t. Comparison of the efficacy of budesonide and fluticasone propionate aqueous nasal spray for once daily treatment of perennial allergic rhinitis. J allergy clin immunol 1998; 102:902-908. https://doi.org/10.1016/S0091-6749(98)70326-4
Dockhorn R, Paull B, Meltzer E, van As A, Weakle S, Woehler t, et al. once-versus twice-daily fluticasone proprionate aqueous nasal spray for seasonal allergic rhinitis. am J Rhinol 1993; 7: 77-83. https://doi.org/10.2500/105065893781976519
gross g, Boggs P, ginchansky E, Howland W, Munk Z, Weakley S, et al. A placebo-controlled double-blind comparison of topical versus systemic triamcinolone acetonide aqueous nasal spray in seasonal allergic rhinitis. am J Rhinol 1996; 10: 409-414.
Hebert J, Nolop K, Lutsky B. once-daily mometasone furoate aqueous nasal spray (Nasonex(tM)) in seasonal allergic rhinitis: An active- and placebocontrolled study. allergy: european Journal of allergy and clinical immunology 1996; 51: 569-576. https://doi.org/10.1111/j.1398-9995.1996.tb04670.x
Hughes K, glass C, Ripchinski M, gurevich F, Weaver t, Lehman E, et al. Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis. allergy 2003; 58: 380-385. https://doi.org/10.1034/j.1398-9995.2003.00093.x
Jen A, Baroody F, de tineo M, Haney L, Blair C, Naclerio R. As-needed use of fluticasone propionate nasal spray reduces symptoms of seasonal allergic rhinitis. J allergy clin immunol 2000; 105: 732-738. Comunicación personal con el autor. https://doi.org/10.1067/mai.2000.105225
Kammermeyer J, Rajtora D, Anuras J, Richerson H. Clinical evaluation of intranasal topical flunisolide therapy in allergic rhinitis. J allergy clin immunol 1977; 59: 287-293. https://doi.org/10.1016/0091-6749(77)90049-5
Kwaselow A, McLean J, Busse, W, Bush R, Reed C, Metzger W, et al. A comparison of intranasal and oral flunisolide in the therapy of allergic rhinitis. Evidence for a topical effect. allergy 1985; 40: 363-367. https://doi.org/10.1111/j.1398-9995.1985.tb00248.x
Meltzer E, orgel H, Bronsky E, Furukawa C, grossman J, LaForce C, et al. A dose-ranging study of fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis assessed by symptoms, rhinomanometry, and nasal cytology. J allergy clin immunol 1990; 86: 221-230. https://doi.org/10.1016/S0091-6749(05)80069-7
Munk Z, LaForce C, Furst J, Simpson B, Feiss g, Smith JA. Efficacy and safety of triamcinolone acetonide aqueous nasal spray in patients with seasonal allergic rhinitis. ann allergy asthma immunol 1996; 77: 277-281. https://doi.org/10.1016/S1081-1206(10)63320-0
Nathan R, Bronsky E, Fireman P, grossman J, LaForce C, Lemanske R Jr. once daily fluticasone propionate aqueous nasal spray is an effective treatment for seasonal allergic rhinitis. annals of allergy 1991; 67: 332-338. FLN203. www.gsk.com
Nathan R, Cook C, Westlund R, Reed K, Richard K. A review of data supporting the maintenance dose for fluticasone propionate aqueous nasal spray (FP). ann allergy asthma immunol 2000; 84: 139. FLtA4008. www.gsk.com
Norman P, Winkenwerder W. Suppression of hay fever symptoms with intranasal dexamethasone aerosol. J allergy clin immunol 1965; 36: 284-92. https://doi.org/10.1016/0021-8707(65)90087-0
Norman P, Creticos P, tobey R, Proud D, KageySobotka,A, Meyers D, et al. Budesonide in grass pollen rhinitis. annals of allergy 1992; 69: 309-316.
Pedersen B, Larsen B, Dahl R, Lindqvist N, Mygind N. Powder administration of pure budesonide for the treatment of seasonal allergic rhinitis. allergy 1991; 46: 582-587. https://doi.org/10.1111/j.1398-9995.1991.tb00627.x
Pedersen B, Larsen B, Dahl R, Hedbys L, Mygind N. Budesonide powder administration for the treatment of grass-pollen-induced allergic rhinitis. allergy 1994; 49: 855-860. https://doi.org/10.1111/j.1398-9995.1994.tb00787.x
Pipkorn U, Rundcrantz H, Lindqvist N. Budesonide - a new nasal steroid. Rhinology 1980; 18: 171-175.
Ratner P, Paul B, Findlay S, Hampel F Jr, Martin B, Kra, K, et al. Fluticasone propionate given once daily is as effective for seasonal allergic rhinitis as beclomethasone dipropionate given twice daily. J allergy clin immunol 1992; 90: 285-291. https://doi.org/10.1016/S0091-6749(05)80005-3
Settipane g, Korenblat P, Winder J, Lumry W, Murphree J, Alderfer v, et al. triamcinolone acetonide aqueous nasal spray in patients with seasonal ragweed allergic rhinitis: a placebo-controlled, double-blind study. clin ther 1995; 17: 252-263. https://doi.org/10.1016/0149-2918(95)80023-9
Stern M, Dahl R, Nielsen L, Pedersen B, Schrewelius C. A comparison of aqueous suspensions of budesonide nasal spray (128 micrograms and 256 micrograms once daily) and fluticasone propionate nasal spray (200 micrograms once daily) in the treatment of adult patients with seasonal allergic rhinitis. am J Rhinol 1997; 11: 323-330. https://doi.org/10.2500/105065897781446658
Stern, MA, Wade, Ag, Ridout, SM, and Cambell, LM. Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine. ann allergy asthma immunol 1998; 81: 354-358. https://doi.org/10.1016/S1081-1206(10)63128-6
the electronic Medicines Compendium (eMC). topical nasal corticoids. [Internet]. Cited 05-2008. Available from: http://www.medicines.org.uk/emc.
Drugs.com. Rhinocort Aqua official FDA information, side effects and uses. [Internet]. Cited 05-2008. Available from: www.drugs.com/pro/rhinocortaqua.html.
Rhinocort turbuhaler. 05-2008. Disponible en:www. astrazeneca.ca/documents/ProductPortfolio/RHINoCoRt%20tURBUHALER_PM_en.pdf
Drugs.com. Beconase Aq. [internet]. Cited 05-2008. Available from: www.drugs.com/pro/beconase-aq. html
Inhousepharmacy. Beconase Nasal Spray 0.5%. [Internet]. cited 05-2008. Available from: www. inhousepharmacy.biz/asthma-allergy/beconase. html.
Drugs.com. Nasarel official FDA information, side effects and uses. [Internet). Cited 05-2008. Available from: www.drugs.com/pro/nasarel.html.
Drugs.com. Nasonex official FDA information, side effects and uses. [Internet]. Cited 05-2008. Available from: www.drugs.com/pro/nasonex.html.
Drugs.com. Fluticasone, official FDA information, side effects and uses. [Internet]. Cited 05-2008. Available from: http://www.drugs.com/pro/fluticasone-nasal-spray.html.
Drugs.com. Nasacort AQ official FDA information, side effects and uses. [Internet]. Cited 05-2008. Available from: www.drugs.com/pro/nasacort.html.
Bernstein D, Scharf M, Bernstein C, Diener P, Qui C, garcía J, et al. Effects of triamcinolone acetonide aqueous on sleep microarousals in perennial allergic rhinitis: a pilot study. Proceedings of the American thoracic Society 2005; 2: A329. www.nasacorth.com(XRg5029C/4004)
Ciprandi g, tosca M, Cirillo I, vizzaccaro A. the effect of budesonide on the cytokine pattern in patients with perennial allergic rhinitis. ann allergy asthma immunol 2003; 91: 467-471. https://doi.org/10.1016/S1081-1206(10)61515-3
Lin R, Nahal A, Lee M, Menikoff H. Changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment. ann allergy asthma immunol 2000; 84: 618-622. https://doi.org/10.1016/S1081-1206(10)62413-1
Pullerits t, Praks L, Sjostrand M, Rak S, Skoogh BE, Lotvall J. An intranasal glucocorticoid inhibits the increase of specific IgE initiated during birch pollen season. J allergy clin immunol 1997; 100: 601-605. https://doi.org/10.1016/S0091-6749(97)70162-3
Ratner P, Wingertzahn M, van Bavel J, Hampel F, Darken P, Heltbardt S. Effectiveness of ciclesonide nasal spray in the treatment of seasonal allergic rhinitis (SAR). ann allergy asthma immunol 2006; 97: 657-663. https://doi.org/10.1016/S1081-1206(10)61097-6
Rosenthal R, Berger W, Bronsky E, Dockhorn R, Korenblat P, Lampl K, et al. tri-Nasal triamcinolone acetonide nasal spray 200 and 400 micrograms qd versus placebo and Nasacort triamcinolone acetonide nasal aerosol 440 micrograms qd in patients suffering from seasonal allergic rhinitis during the grass season. am J Rhinol 1998; 12: 427-433. https://doi.org/10.2500/105065898780707991
Sim t, Hilsmeier K, Alam R, Allen R, Lett-Brown M, grant J. Effect of topical corticosteroids on the recovery of histamine releasing factors in nasal washings of patients with allergic rhinitis. A doubleblind, randomized, placebo-controlled study. am Rev Respir Dis 1992; 145: 1316-1320. https://doi.org/10.1164/ajrccm/145.6.1316
Steensen H, Lindqvist N. treatment of grass pollen induced hay fever with intranasal budesonide. allergy 1981; 36: 245-249. https://doi.org/10.1111/j.1398-9995.1981.tb01570.x
Stuck B, Blum A, Hagner AE, Hummel t, Klimek L, Hoermann K. Mometasone furoate nasal spray improves olfactory performance in seasonal allergic rhinitis. allergy 2003; 58: 1195. Comunicación personal. https://doi.org/10.1034/j.1398-9995.2003.00162.x
tinkelman D, Falliers C, gross g, Segal A, Southern L, Welch M, et al. Multicenter evaluation of triamcinolone acetonide nasal aerosol in the treatment of adult patients with seasonal allergic rhinitis. annals of allergy 1990; 64: 234-240.
glaxoSmithKline. FLN270. [Internet]. Cited 05-2008. Available from: www.gsk.com
Berlin, J. M., golden, S. J., teets, S., Lehman, E. B., and Craig, t. J. Efficacy of flunisolide aqueous nasal spray compared with azelastine hydrochloride nasal spray in the treatment of perennial allergic rhinitis. treating allergic inflammation in rhinitis and urticaria: Symposium. allergy asthma Proc 2001; 22: 327-328.
Craig t, teets S, Lehman E, Chinchilli v, Zwillich C. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J allergy clin immunol 1998; 101: 633-6377. https://doi.org/10.1016/S0091-6749(98)70171-X
Ferguson B, Paramaesvaran S, Rubinstein E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. otolaryngol Head neck surg 2001; 125: 253-260. https://doi.org/10.1067/mhn.2001.117717
Nielsen L, Bjerke t, Christensen M, Pedersen B, Rasmussen tR, Dahl R. Assessment of the allergic reaction in seasonal rhinitis: acoustic rhinometry is a sensitive and objective method. clin exp allergy; 1996. 26: 1268-1275. https://doi.org/10.1046/j.1365-2222.1996.d01-285.x
gurevich F, glass C, Davies M, We, W, McCann J, Fisher L, et al. the effect of intranasal steroid budesonide on the congestion-related sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis. allergy and asthma proc 2005; 26:268-274.
Hadley J. Cost-effective pharmacotherapy for inhalant allergic rhinitis. otolaryngol clin n am. 2003: 825-836. https://doi.org/10.1016/S0030-6665(03)00054-9
Al Sayyad J, Fedorowicz Z, Alhashimi D, Jamal A. topical nasal steroids for intermittent and persistent allergic rhinitis in children. 79. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD003163. DoI: 10.1002/14651858.CD003163. pub4. https://doi.org/10.1002/14651858.CD003163
trangsrud A, Whitaker A, Small R. pharmacotherapy 2002; 22(11): 1458-1467. https://doi.org/10.1592/phco.22.16.1458.33692
Barnes N. J allergy clin immunol 1998; 101: S460-464. https://doi.org/10.1016/S0091-6749(98)70160-5