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Wise et al.

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loratadine 10 mg daily alone, loratadine with intranasal mometasone furoate (200 μ g once daily), or loratadine with oral betamethasone 0.25 mg twice daily for 1 week. The groups receiving some form of steroid in addition to loratadine had significantly lower symptoms of sneezing, rhinorrhea, and nasal obstruction compared to loratadine alone, with no significant difference between the intranasal and oral preparations. The oral steroid was more effective than the INCS in controlling allergic eye symptoms. The above data suggest that oral corticosteroids are effective for the treatment of AR. However, given the significant systemic adverse effects related to using oral corticosteroids for prolonged periods of time these agents are not recommended for the routine treatment of AR. • Aggregate Grade of Evidence: B (Level 1b: 5 studies; Level 2b: 1 study; Level 4: 3 studies; Table IX.B.2.a). • Benefit: Oral corticosteroids can attenuate symptoms of AR. • Harm: Oral corticosteroids have known undesirable adverse effects. These include effects on the hypothalamic-pituitary axis, growth and musculoskeletal system, gastrointestinal system, hypertension, glycemic control, mental/ emotional state, and others. • Cost: Low. • Benefits-Harm Assessment: The risks of using oral corticosteroids outweigh the benefits when compared to similar symptom improvement with the use of INCS. • Value Judgments: In the presence of effective symptom control using INCS, the risk of adverse effects from using oral corticosteroids for AR appears to outweigh the potential benefits. • Policy Level: Recommendation against the routine use of oral corticosteroids for AR. • Intervention: Although not recommended for routine use in AR, certain clinical scenarios warrant the use of short courses of systemic corticosteroids after a discussion of the risks and benefits with the patient. This may include patients with significant nasal obstruction that would preclude penetration of intranasal agents (INCS or antihistamines). In these cases, a short course of systemic oral corticosteroids could improve congestion and facilitate access and efficacy of the topical agents. IX.B.2.b. Injectable corticosteroids.: Corticosteroids have been injected intramuscularly or into the turbinates for management of AR. The evidence evaluating deep intramuscular injections will be reviewed first. Overall, several early studies 1250-1254 demonstrated clinical effectiveness in improving allergic symptoms; however, the safety outcomes demonstrated the risk of undesired systemic corticosteroid adverse effects. More recent evidence 1255 confirms the increased risk of endogenous cortisol suppression along with other corticosteroid-related adverse effects such as osteoporosis and hyperglycemia (Table IX.B.2.b).

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.