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. Author manuscript; available in PMC: 2020 Jun 10.
Published in final edited form as: Int Forum Allergy Rhinol. 2018 Feb;8(2):108–352. doi: 10.1002/alr.22073

TABLE IX.B.2.b.

Evidence for the role of corticosteroid injections in the management of allergic rhinitis

Study Year LOE Study design Study groups Clinical endpoint Conclusion
Yang et al.1262 2008 1b Randomized, placebo-controlled single-blind trial Patients with PAR received intraturbinate injections (n = 39):
  1. Onabotulinum toxin A (25 units in each turbinate);

  2. Triamcinolone (20 mg, 1 mL in each turbinate);

  3. Isotonic saline (1 mL in each turbinate)

Symptoms of rhinorrhea, nasal obstruction, sneezing and itching at 1, 4, 8, 12, 16, and 20 weeks after injections onabotulinum toxin A controlled nasal symptoms for the longest time after injection. Steroid injection was better than placebo but the duration of action was shorter than onabotulinum toxin A.
Laursen et al.1253 1988 1b Double blind, double dummy, placebo controlled, study SAR during season (n = 30):
  1. Intranasal beclomethasone dipropionate (400 μg daily) for 4 weeks;

  2. IM injection of 2 mL betamethasone dipropionate/betamethasone disodium phosphate at start of season

Rhinoconjunctivitis symptom scores IM injection significantly more effective than placebo or intranasal preparation.
Borum et al.1254 1987 1b Double-blind, placebo controlled, parallel study during 2 consecutive pollen seasons SAR during 2 consecutive allergy seasons (n = 24):
  1. IM injection of 80 mg methylprednisolone given either at the beginning of the season or at peak pollen count;

  2. Placebo

Number of sneezes and nose blowing during the day. Symptom scores of sneezing, rhinorrhea, nasal blockage, eye itching recorded at the end of the day. IM injection was efficacious against nasal congestion with less pronounced effects against rhinorrhea and sneezing in active vs placebo treatment irrespective of timing of administration.
Laursen et al.1252 1987 2b Randomized, double-blind comparative SAR during season (n = 37):
  1. Oral prednisolone 7.5 mg PO daily × 3 weeks;

  2. Single IM injection of 2 mL betamethasone dipropionate/betamethasone disodium phosphate at start of season

Nasal peak flow and symptom scores. ACTH test performed at 3 weeks. IM and oral steroid resulted in a significant reduction of nasal/ocular symptoms during season. Significant suppression of adrenal function with oral steroid treatment only.
Ohlander et al.1251 1980 2b Prospective, randomized, parallel group SAR during season (n = 60). Received 1 of 3 long-acting IM injections:
  1. Betamethasone dipropionate (5 mg);

  2. Betamethasone disodium phosphate (3 mg)/acetate (3 mg);

  3. Methylprednisolone acetate (40 mg)

Scores of rhinorrhea, congestion, and ocular symptoms at 1, 2, and 4 weeks after injection. Cortisol and glucose blood levels in 38 subjects. All treatments led to significant reductions in nose and eye symptoms during season; no difference between groups. All preparations suppressed endogenous cortisol; 2 out of 3 injections caused increases in blood sugar levels.
Kronholm1250 1979 2b Prospective, parallel, randomized, open label SAR during season. IM injection at season onset (n = 42):
  1. 2 mL betamethasone dipropionate/betamethasone phosphate (5 and 2 mg/mL);

  2. 2 mL methylprednisolone acetate (40 mg/mL)

Weekly nasal and ocular symptoms for 5 weeks Both preparations led to a significant reduction of nose and eye symptoms; betamethasone combination was more effective.
Aasbjerg et al.1255 2013 4 Retrospective study of Danish National Registries between 1995 and 2011 Patients receiving IM steroid injections in April–July or immunotherapy against grass or birch pollen (n = 47,382) Incidence and relative risk of osteoporosis, diabetes, tendon rupture, and respiratory tract infection Relative risk and incidence of osteoporosis and diabetes were higher in individuals receiving at least 1 depot corticosteroid injection vs those receiving immunotherapy.

ACTH = adrenal corticotropic hormone; IM = intramuscular; LOE = level of evidence; PAR = perennial allergic rhinitis; PO = per os (medication taken orally); SAR = seasonal allergic rhinitis.

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