From the Guidelines
Oral steroids should only be considered for severe, uncontrolled allergic rhinitis cases that significantly impact quality of life, and then only as a short course of 5-7 days. For mild to moderate symptoms, intranasal corticosteroids and oral antihistamines are preferred due to their better safety profile 1. Intranasal corticosteroids are typically the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, the 4 major symptoms of allergic rhinitis.
Some key points to consider when treating allergic rhinitis include:
- Intranasal corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis 1
- Oral antihistamines, such as loratadine, cetirizine, or fexofenadine, can be used to reduce symptoms of allergic rhinitis, but have little objective effect on nasal congestion 1
- A short course of oral steroids, such as prednisone at 20-40mg daily for 5-7 days, may be considered for severe, uncontrolled cases, but should only be used as a brief intervention during severe flare-ups, not as regular treatment 1
- Oral steroids carry significant side effects, including mood changes, increased blood sugar, fluid retention, and bone density loss when used long-term, and can cause problems in patients with diabetes, hypertension, or glaucoma 1
It is essential to consult with a healthcare provider before starting oral steroids for allergic rhinitis, as they can help determine the best course of treatment and monitor for potential side effects 1. After the short course, patients should transition to maintenance therapy with intranasal steroids and antihistamines to prevent symptom recurrence.
From the Research
Treatment Options for Allergic Rhinitis
- Oral steroids are not typically considered a first-line treatment for allergic rhinitis, as they can have significant side effects with long-term use 2, 3.
- Instead, treatment options for allergic rhinitis include:
- Oral and intranasal antihistamines
- Intranasal corticosteroids
- Oral and intranasal decongestants
- Oral and intranasal anticholinergics
- Leukotriene receptor antagonists
- Second-generation oral antihistamines and intranasal corticosteroids are often recommended as the mainstays of treatment, with intranasal corticosteroids being preferred for moderate to severe allergic rhinitis 2, 3, 4.
Efficacy of Intranasal Corticosteroids
- Intranasal corticosteroids have been shown to be effective in relieving symptoms of allergic rhinitis, including nasal congestion, itching, rhinorrhea, and sneezing 4, 5, 6.
- They are often preferred over oral antihistamines due to their ability to provide superior relief with fewer side effects 6.
- Combination therapy with intranasal corticosteroids and oral antihistamines may not provide additional benefits over intranasal corticosteroids alone 2, 6.
Role of Oral Steroids
- Oral steroids may be considered for short-term use in severe cases of allergic rhinitis, but their use is generally limited due to the risk of side effects 2, 3.
- There is limited evidence to support the use of oral steroids as a primary treatment for allergic rhinitis, and they are not typically recommended as a first-line treatment 2, 3, 4, 5, 6.