Glucocorticoids are the most effective anti-inflammatory treatment for allergic diseases, and inhaled
glucocorticoids have now become the first-line treatment for
asthma.
Glucocorticoids were discovered in the 1940s as extracts of the adrenal cortex and this was followed by the isolation of
adrenocorticotropic hormone (
ACTH) from pituitary gland extracts.
Cortisone and
ACTH were found to be very beneficial in the treatment of
rheumatoid arthritis and Kendall, Reichstein and Hench received the Nobel Prize in Physiology and Medicine for this work in 1950. Bordley and colleagues first showed that
ACTH was very beneficial in the treatment of allergic diseases in 1949, but the use of systemic
glucocorticoids was limited by side effects. Inhaled
glucocorticoids were discovered from topical
steroids developed for skin
inflammation and
beclomethasone dipropionate was introduced in 1972, initially in low doses but later in higher doses, and became the standard treatment for persistent
asthma. Subsequently, inhaled
glucocorticoids were combined with long-acting β2-agonists in combination
inhalers for even greater therapeutic benefit. There is now a good understanding of the molecular basis for the anti-inflammatory effects of
glucocorticoids in allergic diseases. The search for even safer
glucocorticoids based on the dissociation of anti-inflammatory and side effect mechanisms is currently ongoing.