Specific immunotherapy can greatly reduce the need for systemic steroids in allergic rhinitis.

BACKGROUND: Worldwide, more than 400 million individuals have allergic rhinitis, which has a significant impact on the individual's general health. Most patients self-medicate with over-the-counter drugs, but severe cases need treatment with topical corticosteroids and/or immunotherapy (SCIT). Although the ARIA guidelines discourage the use of systemic corticosteroids, this treatment is often used by general practitioners. AIMS: To investigate the use of systemic steroids to treat allergic rhinitis in Denmark and the role of SCIT as an alternative.
METHODS: A retrospective study based on Danish National Registry databases 1995-2009. Steroid use was defined as a minimum of one steroid injection during April-July for at least three consecutive years. SCIT treatment against grass (Phleum pratense), birch (Betula verrucosa) or both was included.
RESULTS: Overall, 39 173 individuals were treated with either SCIT or steroids; 93.1% received only steroids, and 6.9% received SCIT and/or steroids. The steroid-to-SCIT ratio was 14 : 1 (P < 0.0001). The mean annual steroid injections were 1.6 in the steroid-only group and 1.0 in the SCIT group (P < 0.0001). Of the SCIT-treated individuals, 84% did not need steroids after SCIT treatment (P < 0.0001). The hazard ratios of receiving steroids after SCIT against grass, birch or both were 0.65, 0.83 and 0.72, respectively (P < 0.0001), when compared with the steroids-only group. The maximum hazard reduction was obtained if patients responded well to SCIT treatment after one to 3 years.
CONCLUSIONS: Systemic steroid injections are still widely used to treat pollen allergy. Specific immunotherapy can greatly reduce the need for steroids.