Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position pa
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Clinical and Translational Allergy Open Access
REVIEW
Benefits and harm of systemic steroids for short‑ and long‑term use in rhinitis and rhinosinusitis: an EAACI position paper Valerie Hox1* , Evelijn Lourijsen2, Arnout Jordens3, Kristian Aasbjerg4, Ioana Agache5, Isam Alobid6,7, Claus Bachert3,8, Koen Boussery9, Paloma Campo10, Wytske Fokkens2, Peter Hellings11, Claire Hopkins12, Ludger Klimek13, Mika Mäkelä14, Ralph Mösges15, Joaquim Mullol6, Laura Pujols6, Carmen Rondon10, Michael Rudenko16, Sanna Toppila‑Salmi14, Glenis Scadding17, Sophie Scheire9, Peter‑Valentin Tomazic18, Thibaut Van Zele3, Martin Wagemann19, Job F. M. van Boven20 and Philippe Gevaert3
Abstract Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosi‑ nusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease. Keywords: Glucocorticosteroids, Rhinitis, Rhinosinusitis Introduction Chronic upper airway inflammation is one of the most prevalent chronic disease entities in the world with rhinitis being the most common presentation form affecting 30% of the Western population [1]. Rhinitis is defined as an inflammation of the lining of the nose and is characterized by nasal symptoms including rhinorrhoea, sneezing, nasal blockage and/or itching of the nose. Allergic rhinitis (AR) is the best-known form of non-infectious rhinitis and is associated with an IgE-mediated immune response against allergens [1]. However, a substantial group of rhinitis patients has no known allergy and they form a very heterogeneous nonallergic rhinitis (NAR) patient population suffering from *Correspondence: [email protected] 1 Cliniques Universitaires Saint-Luc Brussels, Av. Hippocrate 10, 1200 Brussels, Belgium Full list of author information is available at the end of the article
drug-induced rhinitis, occupational rhinitis, irritantinduced rhinitis, hormonally linked rhinitis and idiopathic rhinitis [2, 3]. When inflammation of the nasal mucosa extends to the mucosa of the paranasal sinuses, the consensus term of rhinosinusitis is used. Rhinosinusitis has been shown to affect about 10% of the Western population [4]. In addition to rhinitis symptoms, rhinosinusitis is characterized by postnasal drip, facial pressure and reduction or loss of smell [5]. Acute rhinosinusitis (ARS) is a very common condition and mostly of viral origin [5]. About 0.5–2% of the viral ARS are complicated by a bacterial infection [5]. Chronic rhinosinusitis (CRS) i
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