Education - rhinitis

ENT Specialists Survey

Survey highlights 'crucial' safety issues in rhinitis treatment,
particularly in children. Children may be at risk of receiving rhinitis treatment that suppresses growth - but the problem can be avoided through careful selection of treatment. This was the overwhelming message emerging from a recent nationwide survey of ENT specialists.

According to the findings, the vast majority (91%) of specialists
surveyed said they considered growth suppression the most important potential adverse drug reaction associated with nasal steroids. And a similar proportion (88%) said the selection of a nasal steroid for a child should be based on its low potential for adverse effects on growth.

The use of systemic steroids has been linked to growth suppression but the danger is not necessarily avoided by using topical preparations because beclomethasone dipropionate [1] and budesonide[2] nasal sprays have both been associated with growth inhibition in children. By contrast, mometasone furoate (Nasonex) has evidence[3] to suggest that it may not suppress growth in children.

Commenting on the survey, Dr Chris Corrigan, Honorary Consultant Physician and Clinical Senior Lecturer in the Academic Department of Respiratory Medicine & Allergy at Guy's, King's and St Thomas's School of Medicine pointed out that adverse drug reactions surrounding the use of steroids were emotive issues, "Nevertheless, it seems sensible to use
a preparation that couples maximum efficacy with minimal systemic bioavailability, particularly in patients who are receiving additional topical corticosteroids for other diseases, such as asthma or eczema."

In the telephone survey, two out of three specialists (67%) said that, when selecting a nasal steroid for the management of allergic rhinitis, they rated a combination of high efficacy and low systemic bioavailability as very important (9 or more on a scale of 1-10). Indeed, guidelines for the management of rhinitis[4] recommend using topical once-daily nasal steroids with low bioavailability - namely mometasone furoate or fluticasone propionate.

Of the available treatments for rhinitis, the survey respondents rated mometasone furoate over any other treatment as one with an appropriate balance of efficacy and safety for the treatment of allergic rhinitis. When asked to rate the appropriateness of available treatments for rhinitis, 39% of ENT specialists rated mometasone furoate as being very appropriate (9 or more on a scale of 1-10), while 26% rated fluticasone propionate as very appropriate. The corresponding figures for triamcinolone acetonide, betamethasone sodium phosphate and beclomethasone dipropionate were 20%, 12% and 2% respectively. Other
available preparations were rated by less than 10% of respondents as very appropriate. Dr Corrigan reviewed the survey results and noted, "It is probably appropriate that mometasone furoate was at the top of this list, since this preparation is of particularly high potency and particularly low systemic bioavailability."

The safety of treatments for rhinitis should be a key consideration when managing patients, according to the results of the survey. Dr Samantha Walker, Head of Allergy & Research at the National Asthma & Respiratory Training Centre added that the balance of safety and efficacy is also important - taking a 'safe' treatment is not very useful if it fails to control symptoms.

The treatment of allergic rhinitis - now the most common chronic disease in man - is increasingly an issue for GPs. Since the 1950s the number of consultations GPs see for rhinitis has quadrupled. According to Dr Walker, the prevalence of allergic rhinitis is "rising and is now higher than it has ever been." Nevertheless, there are effective modern treatments capable of controlling symptoms in most people. According to the
guidelines for the management of rhinitis, topical corticosteroid nasal sprays and the newer non-sedating antihistamines are the mainstays of treatment.

This survey was conducted by telephone among 58 Ear, Nose & Throat specialists in the UK in June 2001 by the market research company Martin Hamblin according to the Market Research Society Code of Conduct. If you require a further breakdown of results, contact Juliet Roberts or Mike Livesey at Phase IV:
e-mail: Juliet@phaseiv.co.uk
Tel: 020 8288 0444
Fax: 020 8288 0445

Note: All nasal steroids have the potential to suppress growth. It is
recommended that the height of children on nasal steroids is regularly
monitored.

References
1      Skoner DP, Rachelefsky GS, Meltzer EO et al. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Paediatrics 2000; 105(2): electronic 23.
2      Wolthers OD, Pedersen S. Short-term growth in children with allergic rhinitis treated with oral antihistamine, depot and intranasal glucocorticosteroids. Acta Paediatr 1993; 82: 635-640.
3      Schenkel EJ, Skoner DP, Bronsky EA et al. Absence of growth retardation in children with perennial allergic rhinitis following 1 year of treatment with mometasone furoate aqueous nasal spray.    Paediatrics 2000; 105(2): electronic 22.
4      British Society for Allergy and Clinical Immunology ENT Sub-Committee.Rhinitis Management Guidelines. Third Edition. Martin Dunitz. 2000.

(From Press release - 28 June, 2001)