Specific immunotherapy can greatly reduce the need for systemic steroids in allergic rhinitis

Abstract

Worldwide, more than 400 million individuals have allergic rhinitis, which has a significant impact on the individual's general health. Most patients self-medicate with over-the-counter drugs, but severe cases need treatment with topical corticosteroids and/or immunotherapy (SCIT). Although the ARIA guidelines discourage the use of systemic corticosteroids, this treatment is often used by general practitioners. To investigate the use of systemic steroids to treat allergic rhinitis in Denmark and the role of SCIT as an alternative. A retrospective study based on Danish National Registry databases 1995-2009. Steroid use was defined as a minimum of one steroid injection during April-July for at least three consecutive years. SCIT treatment against grass (Phleum pratense), birch (Betula verrucosa) or both was included. Overall, 39173 individuals were treated with either SCIT or steroids; 93.1% received only steroids, and 6.9% received SCIT and/or steroids. The steroid-to-SCIT ratio was 14:1 (P<0.0001). The mean annual steroid injections were 1.6 in the steroid-only group and 1.0 in the SCIT group (P<0.0001). Of the SCIT-treated individuals, 84% did not need steroids after SCIT treatment (P<0.0001). The hazard ratios of receiving steroids after SCIT against grass, birch or both were 0.65, 0.83 and 0.72, respectively (P<0.0001), when compared with the steroids-only group. The maximum hazard reduction was obtained if patients responded well to SCIT treatment after one to 3years. Systemic steroid injections are still widely used to treat pollen allergy. Specific immunotherapy can greatly reduce the need for steroids.