Fluticasone Propionate or Loratadine

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Ragweed pollen allergies are very common in our population. Sufferers have to depend upon medication to help them manage the symptoms of irritated eyes and nasal passages. Topical intranasal corticosteroids have been a popular choice of medication for seasonal allergic rhinitis; the most recent of these is fluticasone propionate (Flovent).

This new drug is thought to be a safer choice of treatment because it has little effect on other body systems when it is given in doses of up to 16 mg daily. Thus it is seen as having a good safety profile and as being effective in controlling allergy symptoms. The study compared the effectiveness and safety of treating seasonal allergic rhinitis in adolescents using fluticasone propionate (Flovent) versus the use of loratadine tablets, another drug traditionally used in such therapy.

The authors compared the nasal and eye symptoms of 240 adolescents suffering from ragweed-induced allergies, half of whom received fluticasone propionate (Flovent) nasal spray at 200 g daily while the rest were given loratadine tablets, 10 mg daily. Loratadine is an antihistamine which demonstrates little sedative and dehydrating side effects. Patients were asked to record their nasal and eye symptoms on a daily basis.

Overall, fluticasone propionate provided more symptom-free days than did loratadine for nasal problems, but there was no difference between treatments in terms of relieving eye symptoms. Both drugs had the adverse side effects of headache and sore throat. An interesting observation was the diurnal variation in symptom levels, with the morning being the best time of the day for allergy sufferers, regardless of treatment.

Based on these findings, researchers have concluded that fluticasone propionate (Flovent) is an effective means of controlling the symptoms of this specific allergy, without extreme side-effects, and suggest that this treatment be recommended as a first choice for ragweed allergy sufferers.

Questions:

1. Do adolescent allergy sufferers differ from adults? Do allergies intensify with age?

In the case of allergic rhinitis, children and adults are affected in the same way. Allergies do increase with age, due to accumulated exposure to allergens – you can’t be allergic to something you’ve never been exposed to. Very young children tend not to have respiratory allergies (excluding asthma) – these often develop around age six or seven. Both the number of allergies and their intensity generally increase until age 20 or so, then may start to gradually subside. I’m referring to hayfever, not asthma. Of course, people can become allergic to anything at any age.

2. Are there any side effects associated with long-term use of topical intranasal corticosteroids?

Side effects are related to dosage: low doses are well tolerated, but higher doses can cause thinning skin and increased bruising in the elderly, and can interfere with growth in children. They may occasionally lead to yeast infections in the mouth. That’s why we keep patients on the lowest dose possible and follow them carefully. However, 95% of patients have no side effects at all.

3. Do you recommend that people take inhaled corticosteroids only when symptoms arise, or as a preventive measure?

We only prescribe them as needed, never preventively, and at the lowest possible level for effective symptom control.

Comment: I think the most useful development in hayfever treatment in the last 30 years has been the introduction of inhaled corticosteroids. Seasonal use for limited periods (one or two months at a time) is very safe, and the most effective way of keeping symptoms under control. In my practice, every patient who’s troubled by acute ragweed allergy symptoms will get inhaled corticosteroids. However, these must be combined with efforts to minimize exposure to allergens. In the case of ragweed, there’s nothing you can do while outdoors, but at home, keeping windows closed is very important. Air filters are useless if outside air full of pollen is continually coming in. Air conditioning may be needed, with the vents kept closed. This will not only reduce the pollen count, but also the humidity. More people in damp houses are affected by respiratory symptoms, because of increased mould and dust mites. Air conditioning helps both factors.