D1.470 - Comparison of long-term (52 week therapy) maintenance vs. as-needed intranasal corticosteroid therapy in pediatric allergic rhinitis: assessment using exhaled breath condensate leukotriene E4

Recent studies suggest that cysteinyl leukotrienes (cysLTs) in exhaled breath condensate (EBC) can serve as predictive markers for inflammatory status and treatment efficacy in allergic diseases. This study aimed to evaluate the long-term (52 weeks) therapeutic effectiveness of daily maintenance versus as-needed intranasal corticosteroid use in children with allergic rhinitis (AR), using EBC leukotriene E4 (LTE4) as an objective inflammatory marker.

Eighteen children with AR (median age: 4 years 7 months) were enrolled and treated with fluticasone furoate for 52 weeks. Patients were divided into two groups: Group A (daily use, n=8) and Group B (as-needed use, n=10). Symptom scores (SS) and EBC LTE4 levels were measured at weeks 0, 4, 8, 12, 24, 36, and 52.

No significant difference in SS and EBC LTE4 level existed between groups at baseline (week 0). Both groups showed significant clinical improvement starting from week 8 (P< 0.01). However, Group A achieved significantly lower (better) symptom scores than Group B at week 52 (1.3 vs. 2.3, P<0.01). EBC LTE4 levels significantly decreased in both groups after 52 weeks (Group A: 74.7 to 9.8 pg/mL; Group B: 72.8 to 24.3 pg/mL, P<0.01). At the end of the study, LTE4 levels in Group A were significantly lower than those in Group B (9.8 vs. 24.3 pg/mL, P<0.01).

Daily maintenance therapy with intranasal corticosteroids is more effective than as-needed use for long-term management of pediatric AR. Furthermore, LTE4 assessment in EBC is a valuable tool for monitoring airway inflammation in these patients.