Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
Allergy. 2012 Nov;67(11):1423-9. doi: 10.1111/all.12023. Epub 2012 Sep 17.
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.
To investigate the use of systemic steroids to treat allergic rhinitis in Denmark and the role of SCIT as an alternative.
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.
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.
Systemic steroid injections are still widely used to treat pollen allergy. Specific immunotherapy can greatly reduce the need for steroids.
全世界有超过 4 亿人患有过敏性鼻炎，这对个人的整体健康有重大影响。大多数患者自行使用非处方药物治疗，但严重病例需要使用局部皮质类固醇和/或免疫疗法（SCIT）。尽管 ARIA 指南不鼓励使用全身性皮质类固醇，但一般从业者经常使用这种治疗方法。
调查丹麦使用全身性类固醇治疗过敏性鼻炎的情况，以及 SCIT 作为替代治疗的作用。
这是一项基于丹麦国家注册数据库的回顾性研究，时间范围为 1995 年至 2009 年。将类固醇使用定义为至少连续三年每年四月至七月至少接受一次类固醇注射。包括草（Phleum pratense）、桦木（Betula verrucosa）或两者的 SCIT 治疗。
总体而言，有 39173 人接受了 SCIT 或类固醇治疗；93.1%仅接受类固醇治疗，6.9%接受了 SCIT 和/或类固醇治疗。类固醇与 SCIT 的比例为 14:1（P<0.0001）。仅接受类固醇治疗的患者每年平均接受 1.6 次类固醇注射，而接受 SCIT 治疗的患者为 1.0 次（P<0.0001）。在接受 SCIT 治疗的患者中，84%在接受 SCIT 治疗后无需使用类固醇（P<0.0001）。与仅接受类固醇治疗的患者相比，接受草、桦木或两者的 SCIT 治疗后接受类固醇治疗的风险比分别为 0.65、0.83 和 0.72（P<0.0001）。如果患者在 1 至 3 年后对 SCIT 治疗反应良好，则可获得最大的风险降低。
全身性类固醇注射仍广泛用于治疗花粉过敏。特异性免疫疗法可以大大减少对类固醇的需求。
