Abstract

Severe allergic nasal symptoms often require corticosteroids for control. Although I most often utilize intraturbinal injection, they may also be administered systemically (oral or intramuscular) or as nasal aerosols. I advise allergy testing and desensitization for refractory cases unresponsive to conservative management, or instances of recurrent severe symptoms requiring repeated intranasal steroid injections (eg, six or more in one year, five or more per year for two years). A survey of patients who had been treated by both allergy desensitization and intranasal steroid injection revealed a much greater patient acceptance of the latter treatment. Desensitization was judged by most patients as good to fair in providing relief, while all patients questioned in a random sampling rated intranasal steroid injection excellent to good. About half the patients had discontinued their allergy injections, generally because of lack of results or growing tired of repeated injections. Intranasal steroid injection affords good symptomatic relief for the patient with severe allergic rhinitis, while allergy desensitization offers the only “cure” possible. Both measures have a place in the management of nasal allergy. However, patients must be advised of the goals and limitations of each measure.