Is As-Needed Nasal Corticosteroid Use Needed for Allergic Rhinitis Management?

Authors:
Lalitha Sukumar, PharmD
Alyssa Gallipani, PharmD, BCACP
Rahul Jacob, PharmD

Reviewers:
Jordan Ballou, PharmD, BCACP
Joseph Nardolillo, PharmD, BCACP

Citation: Thongngarm T, Wongsa C, Phinyo P, et al. As-needed versus regular use of fluticasone furoate nasal spray in patients with moderate to severe, persistent, perennial allergic rhinitis: a randomized controlled trial. J Allergy Clin Immunol Pract. 2021;9(3):1365-1373.e6.

The Problem

Do you feel like your nose has done more running than you have lately? Well, you are definitely not alone. Allergic rhinitis affects millions of children and adults. Indeed, it is the fifth most common chronic disease in the United States.¹  Although people do not die from allergic rhinitis, it sure can make you feel miserable, disturb sleep, impair daily activities, and can become expensive if not properly treated.²  In fact, the total direct medical cost of allergic rhinitis was estimated at $3.4 billion, with the majority attributable to prescription medications (46.6%) and outpatient visits (51.9%).³ Most treatments for allergic rhinitis are available over the counter and thus pharmacists are often the most accessible resource for patients who suffer from allergic rhinitis. Intranasal corticosteroids, such as fluticasone furoate, are the mainstay of treatment.⁴ It’s recommended to use intranasal corticosteroids on a daily basis since the onset of action takes a few days.⁴ In reality, however, patients adjust their treatment according to the severity of their symptoms. As-needed corticosteroid use is effective for the treatment and prevention of asthma symptoms.⁵ Can we apply this same concept to allergic rhinitis? Could the as-needed use of intranasal corticosteroids achieve the same outcomes as daily use?