Clinical Assessment of Levocetirizine and Budesonide in Treatment of Persistent Allergic Rhinitis Regarding to Symptom Severity
Boonchu Kulapaditharom MD*, Kannika Pornprasertsuk MD*, Vipa Boonkitticharoen PhD**
Affiliation : * Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand ** Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Bangkok Thailand
Objective : To compare effectiveness of levocetirizine and budesonide in treatment of persistent allergic
rhinitis (PER) in patients with high and low total symptom scores (TSS).
Material and Method: Randomized, parallel-group study. Patients with PER were randomized to receive
levocetirizine 5 mg (n = 50) or budesonide 256 μg (n = 50) daily for 4 week and were followed-up for another
4 weeks post-treatment. TSS combining itching, sneezing, rhinorrhea, daytime and nighttime nasal
congestion was recorded daily during and after treatment for an entire period of 8 weeks. Efficacy variables
included area under curves depicting reduction and increase in TSSs over time relative to baselines and time
to response and symptom relapses.
Results : Symptoms were categorized as high and low using a median TSS of 8 as cutoff. Levocetirizine was as
effective in control of high and low symptoms except for time to achieve maximum effect (2 days versus 1 week,
respectively, p = 0.002) but was more effective in preventing relapses of high symptoms (p = 0.001). Budesonide
was more effective against high than low symptoms (p < 0.001) but showed no difference in preventing
relapses. Typical response rate of levocetirizine and budesonide were demonstrated in treatment of high
symptoms. Levocetirizine achieved its full effectiveness in 2 days while budesonide required 2 weeks. Budesonide
at full effect (after 2 weeks) was superior to levocetirizine (p = 0.004) but comparable for the entire treatment
of 4 weeks (p =.059) and was inferior to in preventing relapses (p = 0.001). No such difference could be
observed between these drugs in control of low symptoms.
Conclusion : The effectiveness of the drug treatment in the present study is dependent of symptom severity.
Levocetirizine bases on its rate of response and relapse was superior to budesonide in treatment of the high
symptom group and is comparable in the low symptom group.
Keywords : Persistent allergic rhinitis, Symptom severity, Levocetirizine, Budesonide
