Waddell A N, Patel S K, Toma A G, Maw A R
University Department of Otolaryngology, St Michael's Hospital, Bristol, UK.
J Laryngol Otol. 2003 Nov;117(11):843-5. doi: 10.1258/002221503322542818.
The treatment of allergic rhinitis has been revolutionized by the introduction of topical nasal steroids, which are one of the commonest prescriptions from otolaryngology departments. With so many different sprays available on the market, the literature was reviewed for the efficacy, side-effect profile and relative cost of each product and the following conclusions made: (1) A meta-analysis of randomized controlled trials comparing the efficacy of intranasal corticosteroids and oral antihistamines in the treatment of allergic rhinitis showed a clear benefit in favour of intranasal steroids in relieving nasal symptoms. (2) There is no clear evidence to support the suggestion that one steroid spray is more effective than another in the treatment of seasonal or perennial allergic rhinitis. (3) All the sprays have a similar side-effect profile; the commonest being epistaxis with a reported incidence between 17 and 23 per cent. In all the clinical trials, the placebo spray had an appreciable rate of epistaxis of between 10 to 15 per cent. (4) Fluticasone causes a reduction in endogenous cortisol secretion but no significant adrenal suppression was seen with triamcinolone, beclomethasone, budesonide or mometasone. (5) There is little evidence that skeletal growth is restricted by the administration of topical nasal steroid sprays. (6) There is considerable variation in the daily cost of each spray. Beclomethasone, dexamethasone and budesonide are significantly cheaper than fluticasone, mometasone or triamcinolone.
局部鼻用类固醇的引入彻底改变了过敏性鼻炎的治疗方法，局部鼻用类固醇是耳鼻喉科最常用的处方药物之一。市面上有如此多不同的喷雾剂，本文对每种产品的疗效、副作用情况和相对成本进行了文献综述，并得出以下结论：（1）一项比较鼻内皮质类固醇和口服抗组胺药治疗过敏性鼻炎疗效的随机对照试验的荟萃分析表明，鼻内类固醇在缓解鼻部症状方面有明显优势。（2）没有明确证据支持一种类固醇喷雾剂在治疗季节性或常年性过敏性鼻炎方面比另一种更有效的说法。（3）所有喷雾剂的副作用情况相似；最常见的是鼻出血，报告发生率在17%至23%之间。在所有临床试验中，安慰剂喷雾剂的鼻出血发生率在10%至15%之间。（4）氟替卡松会导致内源性皮质醇分泌减少，但曲安奈德、倍氯米松、布地奈德或莫米松未见明显的肾上腺抑制作用。（5）几乎没有证据表明局部鼻用类固醇喷雾剂的使用会限制骨骼生长。（6）每种喷雾剂的每日成本有很大差异。倍氯米松、地塞米松和布地奈德明显比氟替卡松、莫米松或曲安奈德便宜。
