BACKGROUND: In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful to the patient. OBJECTIVES: Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases. METHODS: A retrospective study based on Danish National Registries 1995-2011 covering diagnoses, medications, as well as clinical outcomes. The main analysis was time dependent poisson regression models with results presented as rate ratios (RR), and incidence per 1000 patient years. Steroid use was defined as minimum one injection during April-July for at least three consecutive years. Treatment with specific immunotherapy against grass, birch or both was used as non-steroid control group. Relative risk of adverse outcomes such as osteoporosis, infections, diabetes and/or tendon rupture was investigated. RESULTS: We identified 47,382 individuals with rhinitis; 55.8% treated with steroids, 37.6% with immunotherapy, and 6.7% with both. No significant differences in infections or tendon rupture were observed. For steroid treatment RR of diabetes was 1.5 (95% CI: 1.3-1.8; P < 0.001), incidence 3.9 (95% CI: 3.5-4.3), and RR of osteoporosis was 1.2 (95% CI: 1.0-1.5; P = 0.023), incidence 2.8 (95% CI: 2.5-3.1). Risk of diabetes culminated within the first two years of treatment start. CONCLUSIONS: Compared to immunotherapy regular use of depot-steroid injections to treat allergic rhinitis is associated with increased risk of being diagnosed with diabetes and osteoporosis. CLINICAL IMPLICATIONS: Treating seasonal allergic rhinitis with depot-steroid injections should be abandoned and replaced with immunotherapy, as annual depot-steroid treatment is associated with increased risk of diabetes and osteoporosis.
BACKGROUND: In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay feverpatients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful to the patient. OBJECTIVES: Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases. METHODS: A retrospective study based on Danish National Registries 1995-2011 covering diagnoses, medications, as well as clinical outcomes. The main analysis was time dependent poisson regression models with results presented as rate ratios (RR), and incidence per 1000 patient years. Steroid use was defined as minimum one injection during April-July for at least three consecutive years. Treatment with specific immunotherapy against grass, birch or both was used as non-steroid control group. Relative risk of adverse outcomes such as osteoporosis, infections, diabetes and/or tendon rupture was investigated. RESULTS: We identified 47,382 individuals with rhinitis; 55.8% treated with steroids, 37.6% with immunotherapy, and 6.7% with both. No significant differences in infections or tendon rupture were observed. For steroid treatment RR of diabetes was 1.5 (95% CI: 1.3-1.8; P < 0.001), incidence 3.9 (95% CI: 3.5-4.3), and RR of osteoporosis was 1.2 (95% CI: 1.0-1.5; P = 0.023), incidence 2.8 (95% CI: 2.5-3.1). Risk of diabetes culminated within the first two years of treatment start. CONCLUSIONS: Compared to immunotherapy regular use of depot-steroid injections to treat allergic rhinitis is associated with increased risk of being diagnosed with diabetes and osteoporosis. CLINICAL IMPLICATIONS: Treating seasonal allergic rhinitis with depot-steroid injections should be abandoned and replaced with immunotherapy, as annual depot-steroid treatment is associated with increased risk of diabetes and osteoporosis.
Authors: Sarah K Wise; Sandra Y Lin; Elina Toskala; Richard R Orlandi; Cezmi A Akdis; Jeremiah A Alt; Antoine Azar; Fuad M Baroody; Claus Bachert; G Walter Canonica; Thomas Chacko; Cemal Cingi; Giorgio Ciprandi; Jacquelynne Corey; Linda S Cox; Peter Socrates Creticos; Adnan Custovic; Cecelia Damask; Adam DeConde; John M DelGaudio; Charles S Ebert; Jean Anderson Eloy; Carrie E Flanagan; Wytske J Fokkens; Christine Franzese; Jan Gosepath; Ashleigh Halderman; Robert G Hamilton; Hans Jürgen Hoffman; Jens M Hohlfeld; Steven M Houser; Peter H Hwang; Cristoforo Incorvaia; Deborah Jarvis; Ayesha N Khalid; Maritta Kilpeläinen; Todd T Kingdom; Helene Krouse; Desiree Larenas-Linnemann; Adrienne M Laury; Stella E Lee; Joshua M Levy; Amber U Luong; Bradley F Marple; Edward D McCoul; K Christopher McMains; Erik Melén; James W Mims; Gianna Moscato; Joaquim Mullol; Harold S Nelson; Monica Patadia; Ruby Pawankar; Oliver Pfaar; Michael P Platt; William Reisacher; Carmen Rondón; Luke Rudmik; Matthew Ryan; Joaquin Sastre; Rodney J Schlosser; Russell A Settipane; Hemant P Sharma; Aziz Sheikh; Timothy L Smith; Pongsakorn Tantilipikorn; Jody R Tversky; Maria C Veling; De Yun Wang; Marit Westman; Magnus Wickman; Mark Zacharek Journal: Int Forum Allergy Rhinol Date: 2018-02 Impact factor: 3.858
Authors: Steven P Cohen; Arun Bhaskar; Anuj Bhatia; Asokumar Buvanendran; Tim Deer; Shuchita Garg; W Michael Hooten; Robert W Hurley; David J Kennedy; Brian C McLean; Jee Youn Moon; Samer Narouze; Sanjog Pangarkar; David Anthony Provenzano; Richard Rauck; B Todd Sitzman; Matthew Smuck; Jan van Zundert; Kevin Vorenkamp; Mark S Wallace; Zirong Zhao Journal: Reg Anesth Pain Med Date: 2020-04-03 Impact factor: 6.288
Authors: Ahmed B Bayoumy; Felicia van Schie; Inge Stegeman; Esther B Blijleven; Erwin L van der Veen; Jacob A de Ru Journal: Laryngoscope Investig Otolaryngol Date: 2021-09-04
Authors: Valerie Hox; Evelijn Lourijsen; Arnout Jordens; Kristian Aasbjerg; Ioana Agache; Isam Alobid; Claus Bachert; Koen Boussery; Paloma Campo; Wytske Fokkens; Peter Hellings; Claire Hopkins; Ludger Klimek; Mika Mäkelä; Ralph Mösges; Joaquim Mullol; Laura Pujols; Carmen Rondon; Michael Rudenko; Sanna Toppila-Salmi; Glenis Scadding; Sophie Scheire; Peter-Valentin Tomazic; Thibaut Van Zele; Martin Wagemann; Job F M van Boven; Philippe Gevaert Journal: Clin Transl Allergy Date: 2020-01-03 Impact factor: 5.871