Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
Respir Med. 2013 Dec;107(12):1852-8. doi: 10.1016/j.rmed.2013.09.007. Epub 2013 Sep 20.
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.
Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases.
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.
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.
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.
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.
在丹麦，23%的成年人患有过敏性鼻炎。我们之前的研究表明，大多数花粉热患者的治疗方法是违反指南的类固醇注射。有人假设，每年接受 1-2 次类固醇注射对患者没有危害。
调查过敏性鼻炎的类固醇治疗是否会增加与类固醇相关的疾病的风险，而不是免疫疗法。
这是一项基于丹麦国家登记处 1995-2011 年的回顾性研究，涵盖了诊断、药物治疗以及临床结果。主要分析是时间依赖性泊松回归模型，结果以率比（RR）和每 1000 患者年的发病率表示。类固醇的使用定义为至少连续三年在 4 月至 7 月期间至少注射一次。特异性免疫疗法治疗草、桦或两者都被用作非类固醇对照组。研究了骨质疏松症、感染、糖尿病和/或肌腱断裂等不良后果的相对风险。
我们确定了 47382 名患有鼻炎的患者；55.8%接受类固醇治疗，37.6%接受免疫治疗，6.7%同时接受两种治疗。未观察到感染或肌腱断裂的显著差异。对于类固醇治疗，糖尿病的 RR 为 1.5（95%CI：1.3-1.8；P<0.001），发病率为 3.9（95%CI：3.5-4.3），骨质疏松症的 RR 为 1.2（95%CI：1.0-1.5；P=0.023），发病率为 2.8（95%CI：2.5-3.1）。糖尿病的风险在治疗开始后的头两年达到高峰。
与免疫疗法相比，常规使用类固醇注射治疗过敏性鼻炎与诊断为糖尿病和骨质疏松症的风险增加有关。
季节性过敏性鼻炎的类固醇注射治疗应该被放弃，代之以免疫疗法，因为每年的类固醇治疗与糖尿病和骨质疏松症的风险增加有关。
