Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes

Background: In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful to the patient. Objectives: Investigate if the depot-steroid treatment of allergic rhinitis instead of immunotherapy increases risk of steroid-related diseases. Methods: A retrospective study based on Danish National Registries 1995-2011 covering diagnoses, medications, as well as clinical outcomes. The main analysis was time dependent poisson regression models with results presented as rate ratios (RR), and incidence per 1000 patient years. Steroid use was defined as minimum one injection during April July for at least three consecutive years. Treatment with specific immunotherapy against grass, birch or both was used as non-steroid control group. Relative risk of adverse outcomes such as osteoporosis, infections, diabetes and/or tendon rupture was investigated. Results: We identified 47,382 individuals with rhinitis; 55.8% treated with steroids, 37.6% with immunotherapy, and 6.7% with both. No significant differences in infections or tendon rupture were observed. For steroid treatment RR of diabetes was 1.5 (95% CI: 1.3-1.8; P < 0.001), incidence 3.9 (95% CI: 3.5-4.3), and RR of osteoporosis was 1.2 (95% CI: 1.0-1.5; P = 0.023), incidence 2.8 (95% CI: 2.5-3.1). Risk of diabetes culminated within the first two years of treatment start. Conclusions: Compared to immunotherapy regular use of depot-steroid injections to treat allergic rhinitis is associated with increased risk of being diagnosed with diabetes and osteoporosis. Clinical implications: Treating seasonal allergic rhinitis with depot-steroid injections should be abandoned and replaced with imnnunotherapy, as annual depot-steroid treatment is associated with increased risk of diabetes and osteoporosis. (C) 2013 Elsevier Ltd. All rights reserved.