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):
|
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):
|
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):
|
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):
|
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:
|
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):
|
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.