Twenty-four-hour duration of effect of intranasal corticosteroids for seasonal allergic rhinitis symptoms: clinical evidence and relevance.
BACKGROUND
Seasonal allergic rhinitis (SAR) symptoms are often most severe and/or disruptive during overnight and morning hours, resulting in cognitive/performance impairments and reduced quality of life throughout the following day. Surveys of allergy patients and health  care practitioners reveal a common perception that intranasal steroids (INSs), many of which are dosed q.d., fail to adequately relieve symptoms for a full 24 hours. This review assessed whether perceptions of the 24-hour duration of action of INSs correspond with duration of action documented  in clinical literature.


METHODS
SAR clinical trial literature of the last 5 years was reviewed to identify studies of INSs incorporating morning instantaneous (A.M. NOW) or instantaneous assessments of 24-hour duration of action.


RESULTS
In numerous  placebo-controlled trials of INSs in patients with SAR, treatment was associated with significantly greater improvements in A.M. NOW symptoms from baseline versus placebo. For congestion, this is noteworthy, because patients often cite this symptom, especially in the morning, as the most bothersome  symptom. Comparison of A.M. NOW and daily scores suggests minimal drop in efficacy at 24 hours postdose. In several studies, INS treatment was found superior to intranasal or oral antihistamines in A.M. NOW symptom improvement.


CONCLUSIONS
Once-daily INSs have potential  for effective 24-hour symptom relief; however, there is an apparent disconnect between these findings and patient/physician perceptions. This discrepancy may be explained, in part, by less-than-ideal treatment adherence among "real-world" patients versus subjects treated in clinical  trials. Proactive counseling can encourage proper INS use and help maximize treatment benefits.
Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine, Washington, DC, USA. ldubuske@aol.com
Lawrence M
LM
DuBuske
D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D006633:Histamine Antagonists / Q000008:administration & dosage; D006801:Humans; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D006633:Histamine Antagonists