EAACI, systemic steroids, chronic nasal inflammation, chronic sinus inflammation, rhinitis treatment, rhinosinusitis guidelines, steroid side effects, steroid-sparing alternatives
EAACI Guidance on Systemic Steroids in Chronic Nasal & Sinus Inflammation
Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper
- Valerie Hox,
- Evelijn Lourijsen,
- Arnout Jordens,
- Kristian Aasbjerg,
- Ioana Agache,
- Isam Alobid,
- Claus Bachert,
- Koen Boussery,
- Paloma Campo,
- Wytske Fokkens,
- Peter Hellings,
- Claire Hopkins,
- Ludger Klimek,
- Mika Mäkelä,
- Ralph Mösges,
- Joaquim Mullol,
- Laura Pujols,
- Carmen Rondon,
- Michael Rudenko,
- Sanna Toppila-Salmi,
- Glenis Scadding,
- Sophie Scheire,
- Peter-Valentin Tomazic,
- Thibaut Van Zele,
- Martin Wagenmann,
- Job F. M. van Boven,
- Philippe Gevaert
- Volume 10Issue 1Clinical and Translational Allergy
- First Published online: September 28, 2020
Source: https://onlinelibrary.wiley.com/doi/10.1186/s13601-019-0303-6
Introduction
The European Academy of Allergy and Clinical Immunology (EAACI) has published comprehensive guidelines on the use of systemic steroids (oral or injected corticosteroids) for chronic nasal and sinus inflammation—conditions like rhinitis and rhinosinusitis.
Key Concerns About Systemic Steroids
- High Risk of Side Effects: Weight gain, Cushingoid appearance, slowed growth in children, increased infection risk.
- Long-Term Complications: Bone density loss (osteoporosis), adrenal suppression, metabolic disturbances.
EAACI Recommendations
- First-Line Therapy:
- Intranasal corticosteroid sprays
- Oral antihistamines
- Saline nasal irrigation
- Systemic Steroids:
- Reserved for short-term, acute flare-ups in severe, treatment-resistant cases only
- Should always be accompanied by close medical monitoring
- Steroid-Sparing Strategies:
- Biologic therapies (e.g., monoclonal antibodies like omalizumab)
- Immunomodulatory agents
- Allergen immunotherapy
Patient Conversation Guide
- Review the balance of benefits versus risks when considering systemic steroids.
- If pediatric, ensure regular growth assessments.
- Prioritize non-systemic treatments before initiating oral or injected corticosteroids.
Conclusion
Systemic steroids can rapidly control severe rhinitis and rhinosinusitis flares but pose significant health risks. In line with EAACI guidance, clinicians should exhaust safer, first-line therapies and limit systemic steroid use to brief, carefully monitored courses for patients unresponsive to other treatments.
For full details, read the EAACI position paper: