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Intranasal budesonide lowers urticaria activity in aeroallergen-sensitized chronic idiopathic urticaria patients without improving quality of life.
Chronic idiopathic urticaria (CIU), a distressing condition marked by persistent hives, intense itching, and episodic angioedema lasting longer than 6 weeks, continues to challenge clinicians and patients alike. While second-generation H1 antihistamines remain the cornerstone of treatment, a substantial proportion of patients report incomplete symptom control, driving interest in adjunctive and alternative therapeutic strategies.
New evidence from a clinical trial led by Hassan Mohtadi et al. suggests that intranasal corticosteroids—commonly prescribed for allergic rhinitis (AR)—may help reduce urticaria disease activity in a select group of patients with CIU. The trial enrolled 69 adults diagnosed with CIU who also demonstrated sensitization to aeroallergens on skin prick testing. All volunteers were maintained on a stable regimen of a single nonsedating H1 antihistamine throughout the study period. Patients were randomly assigned to get either intranasal budesonide or a matching placebo for 6 months.
The active treatment consisted of budesonide nasal spray at a dose of 32 µg per actuation, administered as 2 sprays per nostril twice daily. Both investigators and volunteers were blinded to therapy allocation. Primary and secondary outcomes encompassed changes in urticaria symptoms, measured via the urticaria activity score (UAS), and patient-reported quality of life, assessed by the chronic urticaria quality of life questionnaire (CU-QoL). At baseline, clinical characteristics and demographic were well-balanced between the budesonide and placebo arms, allowing for a reliable comparison of therapeutic effects.
After 6 months of therapy, those receiving intranasal budesonide experienced a markedly greater reduction in urticaria activity than those receiving placebo. The mean difference in UAS between groups was 4.25, reaching statistical significance, indicating a clinically meaningful improvement in symptom burden. Contrarily, improvements in quality of life did not considerably differ between the groups. The mean difference in CU-QoL scores was 4.74, which was not statistically significant.
Thus, intranasal corticosteroids may offer additional symptom relief in adults with CIU who are sensitized to aeroallergens, even when standard antihistamine therapy is already in place. However, the lack of a corresponding improvement in overall quality of life underscores the multifactorial nature of CIU and the limitations of symptom-focused interventions alone. Researchers also noted the possibility of a placebo effect, highlighting the complexity of interpreting treatment responses in chronic urticaria.
Skin Health and Disease
Intranasal corticosteroids: a promising new approach for adults with chronic idiopathic urticaria linked to aeroallergens – a double-blind randomized clinical trial
Hassan Mohtadi et al.
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