Search

This study examined the effects of low dose systemic corticoid (methylprednisolone, MP), standard dose antihistamine (terfenadine, TF) or the combination on response to out-of-season acute allergen challenge. We feel that a single dose challenge delivered to the nose may represent real disease imperfectly and in this study used two doses given 1 hour apart, hoping to approximate better the circumstances of natural allergen stimulation. The study used clinical endpoints only: measured nasal airway resistance (NAR), sneeze count, and weight of blown nasal secretions. Subjects showed similar NAR, sneezing, and secretion response to both challenges. With placebo treatment, NAR rose after the first allergen provocation and returned to baseline about 30 minutes later. Antihistamine pretreatment appeared to delay but did not prevent this rise; low dose corticoid partially inhibited it, and the combination totally ablated the response. All active treatments suppressed sneezing and secretion better than placebo. Combination corticoid/antihistamine treatment showed no greater effect on sneeze/secretion than did antihistamine alone; this differs from our findings in separate studies comparing analogous drug combinations in naturally-acquired ragweed hayfever.

Sixty ragweed-sensitive volunteers participated in a 2-week study that compared symptom profiles during treatment with antihistamine (loratadine, LOR) alone, topical corticoid (beclomethasone, BEC) alone, or the two drugs combined. For 5 days commencing shortly after the beginning of the ragweed bloom, patients took no treatment while we collected baseline data. They were then randomized to one of the three treatments, receiving that treatment for the balance of the 2-week study term. Twice each day they recorded the severity of congestion, eye symptoms, running and blowing, itching, and sneezing. At the end of the study they provided an estimate of overall symptom relief, which favored combined treatment (vs LOR P = 0.001, vs BEC P = 0.042). To gain an estimate of disease severity and treatment effectiveness over time, and to smooth out day-to-day variation, we divided symptom diary reports into three segments (days 2–4, 5–7, and 8–10) for analysis. Combined treatment controlled symptoms better than antihistamine alone in nearly all study segments. Corticoid alone or combined with antihistamine provided similar control of congestion, running and blowing, and eye complaints. Combination therapy controlled itching and sneezing better, especially through the study segments 1 and 2. Patient preference for combined treatment seems to relate to control of itching and sneezing and rapid onset of effect.