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Background About 12% of children are affected by allergic rhinoconjunctivitis ( AR). Although the main symptomatic treatments are intranasal corticosteroids ( INCS) (daily or on demand) and oral antihistamines, it remains unclear which treatment provides the best relief of symptoms. Therefore, this study examines whether daily use of INCS is superior to on-demand use or to oral antihistamines on demand. Methods A single-blinded randomized controlled trial in children (aged 6-18 years) with pollen-related AR. Patients received either INCS daily (fluticasone propionate), INCS on demand (fluticasone propionate) or oral antihistamine on demand (levocetirizine) for 3 months during the grass pollen season. A daily online symptom diary on both nose and eye symptoms was completed. The primary outcome was the percentage of symptom-free days. Results A total of 150 children were randomized. The percentage symptom-free days was in favour of INCS on demand (30%) compared with INCS daily (22%), that is 8% difference (95% CI −5 to +21%; not significant). The antihistamine on-demand group had 15% symptom-free days, that is 7% difference compared to INCS daily (95% CI −6 to +19%;, not significant). Patients in the INCS on-demand group used on average 61% less fluticasone than patients in the INCS daily group during the study period ( P < 0.0001). Conclusions This trial with three parallel treatment groups shows that INCS daily was not superior to INCS on demand or to antihistamine on demand regarding the number of symptom-free days. An on-demand INCS strategy has the advantage of a lower overall corticosteroid exposure and less costs. [ABSTRACT FROM AUTHOR]

The fractional concentration of nitric oxide in exhaled air (FENO) is elevated in atopic asthma and typically responds to treatment with inhaled corticosteroids (ICS). However, some patients have persistently high FENO levels despite treatment. We studied how optimizing the inhalation technique and increasing ICS doses would affect FENO in stable atopic asthmatic children who had elevated FENO while using ICS. In 41 stable asthmatic children who were treated with ICS (median daily dose 800 μg budesonide equivalent, range 100–1600 μg) and maintained FENO⩾20 p.p.b., we optimized the inhalation technique by thorough instruction and measured FENO 2 weeks later. Then, if FENO remained ⩾20 p.p.b., we increased the ICS dose and reassessed FENO 2 weeks later. Improving the inhalation technique did not reduce FENO. Increasing ICS from a daily median dose of 800 to 1200 μg budesonide had no significant effect on FENO. FENO correlated positively with symptom scores in the following 2 and 4 weeks ( P=0.001, 0.002) and β2-agonist use the 2 and 4 weeks following FENO measurement ( P=0.02, 0.004). We conclude that common steps in asthma treatment, i.e. inhalation instruction and increasing ICS dose, were both ineffective in reducing FENO in atopic asthmatic children with elevated FENO values despite treatment with ICS. This implies that FENO cannot simply be incorporated in current treatment guidelines. [ABSTRACT FROM AUTHOR]