Nasal Steroids in Allergic Rhinitis

In mild or moderate allergic rhinitis, endonasal steroids are advisedas they are effective and with no side effects. Most patients affected by this disorder present however also ocular allergic manifestations, at the same time, so physicians often use oral anti-histamines prepared for conjunctival use. Through a trial sponsored by pharmaceutical industry, 429 patients affected by seasonal allergic rhinitis have been treated with a mometasone-based spray (200 μg in an only daily sprinkling) or with a placebo spray for an overall of 15days. Compared to subjects treated with placebo, the ones using mometasone have presented a statistically significant improvement both in nasal symptomsand in ocular ones.

According to this trial (and to previous ones), intranasal use of cortisones is more effective than oral anti-histamines in relieving the symptoms of seasonal allergic rhinitis and it has a good efficacy on
ocular symptoms in the same way. We do not know well the explanation of this result, except for the hypothesis of an unknown nasal-ocular influence. In any case, since adding an oral anti-histamine does not improve the situation, the use of an endonasal cortisone in monotherapy seems to be the best solution for the treatment of seasonal allergic rhinitis, associated or not with ocular symptoms. Apart from the presence of cataract or glaucoma, this therapy has given evidence of sufficient safety of use.