We congratulate this story for its thorough and nuanced discussion of the costs of different allergy medications — a rarity in health news today. But if a story is going to call certain medications “the single most effective drug class for treating nasal allergies,” then we’d like to see that statement backed up with evidence and a quantification of the benefits. It’s also problematic for this story to rely on a source with extensive ties to pharmaceutical companies that make allergy drugs without alerting readers to these relationships. We’re glad that a second independent expert was consulted to help deliver an evaluation of the comparative benefits.
March is the beginning of spring and allergy season. It is estimated that 50 million people in the US, or 30 percent of adults, are affected by nasal allergies. There are a variety of treatment options, such as antihistamines and decongestants, as well as nasal steroid sprays, which are becoming available over the counter. With more drugs to choose from at the pharmacy, consumers need accurate reporting on these treatments to make informed decisions when buying allergy treatments.
The story goes above and beyond our standard here. There is a whole section on costs, which tells consumers to “expect to pay more.” Insurers will no longer cover the cost, the article says, so expect to shell out $17 to $23 for a one-month supply of non-prescription steroid nasal spray. The story also discusses the costs of antihistamines and says store-brand versions are a cheaper alternative to steroid sprays. An example is Walmart’s Equate loratadine tablets, which cost $7 for 60 24-hour doses.
The story claims steroid nasal sprays are the “single most effective drug class for treating nasal allergies” — a quote that is attributed to the American College of Allergy, Asthma & Immunology’s website. But this statement is not backed up with any quantitative data. How effective are these treatments? And how do they compare to other alternatives out there, like antihistamines and decongestants? How many patients put on this treatment would report experiencing a benefit? The story acknowledges that these sprays won’t work for everyone, but it wouldve been better to provide an estimate. There are several Cochrane reviews (meta-analyses based on multiple studies) on this topic, such as this one and this one, that could’ve been used to help quantify the story’s claims.
The story goes into the side effects of steroid nasal sprays, antihistamines and decongestants. Although none of these harms are quantified, we’ll give the story the benefit of the doubt.
The line that caught our attention was: “Labels caution that some children using the sprays may experience slower growth.” What kind of slower growth (mentally vs. physically)? How many children encountered this side effect? And is it worth the risk to ever use a steroid nasal spray? A few figures here would have been helpful to put this in perspective, because “slower growth” sounds like one of the more serious harms that someone could experience.
We give the story credit for quoting reputable organizations and expert groups, as well as allergists, regarding the relative merits of these treatments. However, the story did not provide any evidence to back up their claims. The reader has no idea if these claims are based on big clinical trials or small case series. Here’s the only comment that touches upon evidence: “The various sprays have never been studied head to head, so it’s impossible to say whether they vary in effectiveness.”
While that statement may well be true, many placebo-controlled trials have been conducted on these treatments, and those trials could’ve been cited to give readers an accurate reflection of the evidence base on this topic.
While there was no overt disease mongering, the story suggests that anyone who has allergies needs to see an allergist, which is not accurate and might be said to constitute a sort of “specialty service mongering.” In the majority of cases, the appropriate care setting is primary care. Inappropriate specialty care is a major contributor to rising health care costs.
There were some obvious conflicts of interest with one of the expert sources quoted in this story.
Dr. James Sublett is not only a Louisville allergist and president of the American College of Allergy, Asthma & Immunology, but he is also a “speaker for numerous pharmaceutical and medical device companies,” says his profile on the digital media company Everyday Health. A bit more digging finds that Sublett “has received payment for lectures from GlaxoSmithKline, Merck, Sunovion, and Teva and has stock/stock options with AllergyZone LLC,” according to disclosure statement for a 2013 study on cockroaches in The Journal of Allergy and Clinical Immunology.
We believe such conflicts of interests are troubling and should be disclosed, especially when the first product mentioned by the story includes a nasal steroid spray from GlaxoSmithKline – the same pharmaceutical company that engages Sublett as a speaker. That, together with the lead quote from the allergy group (where Sublett is president) claiming steroid nasal sprays are the “single most effective drug class,” throws the story somewhat off balance. We’re glad a second, seemingly independent expert was also consulted for her opinion.
The article did a great job comparing the various over-the-counter alternatives out there, from steroid nasal sprays like Flonase to antihistamines like Claritin to decongestants like Sudafed.
All these drugs are available over the counter, which the article mentions early in the story.
Nasal steroids are not a new concept: They have been developed since at least the 1950s and have been tested in lab and clinical trials since the 1990s.
What is new about Flonase is that it’s now available over the counter, after the US Food and Drug Administration approved its use without a prescription last July, according to media reports at the time.
Since this fact is clear early in the story, we give it a satisfactory rating.
The story includes enough original reporting that we can be sure it’s not based on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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