title: Symptomatic treatment of pollen-related allergic rhinoconjunctivitis in children: randomized controlled trial.
abstract: BACKGROUND
  About 12% of children are affected by allergic rhinoconjunctivitis (AR). Although the main symptomatic treatments are intranasal corticosteroids (INCS) (daily or on demand) and oral antihistamines, it remains unclear which treatment provides the best relief of symptoms. Therefore, this study examines whether daily use of INCS is superior to on-demand use or to oral antihistamines on demand.
  
  
  METHODS
  A single-blinded randomized controlled trial in children (aged 6-18 years) with pollen-related AR. Patients received either INCS daily (fluticasone propionate), INCS on demand (fluticasone propionate) or oral antihistamine on demand (levocetirizine) for 3 months during the grass pollen season. A daily online symptom diary on both nose and eye symptoms was completed. The primary outcome was the percentage of symptom-free days.
  
  
  RESULTS
  A total of 150 children were randomized. The percentage symptom-free days was in favour of INCS on demand (30%) compared with INCS daily (22%), that is 8% difference (95% CI -5 to +21%; not significant). The antihistamine on-demand group had 15% symptom-free days, that is 7% difference compared to INCS daily (95% CI -6 to +19%;, not significant). Patients in the INCS on-demand group used on average 61% less fluticasone than patients in the INCS daily group during the study period (P < 0.0001).
  
  
  CONCLUSIONS
  This trial with three parallel treatment groups shows that INCS daily was not superior to INCS on demand or to antihistamine on demand regarding the number of symptom-free days. An on-demand INCS strategy has the advantage of a lower overall corticosteroid exposure and less costs.
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Wartna
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Bohnen
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Elshout
authors.affiliation: Department of Pediatrics, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: M W H
authors.initials: MW
authors.lastname: Pijnenburg
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: D H J
authors.initials: DH
authors.lastname: Pols
authors.affiliation: Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: R R
authors.initials: RR
authors.lastname: Gerth van Wijk
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: P J E
authors.initials: PJ
authors.lastname: Bindels
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003233:Conjunctivitis, Allergic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D011058:Pollen / Q000276:immunology; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents
keywords: 
  RCT
  ; allergic rhinoconjunctivitis; antihistamines; children; intranasal corticosteroids