Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta‐analysis

Khattiyawittayakun, Likhit; Seresirikachorn, Kachorn; Chitsuthipakorn, Wirach; Kanjanawasee, Dichapong; Snidvongs, Kornkiat

doi:10.1002/alr.22193

Cited by 14 publications

(5 citation statements)

References 19 publications

(61 reference statements)

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“…These drugs are indicated for maximum 10 days and are ineffective in NAR [84]. The most recent metaanalysis by Khattiyawittayakun et al showed no benefits compared to ICS monotherapy, neither in NAR nor in PAR [93].…”

Section: Is It Recommended To Add Other Drugs To Inhaled Corticosteromentioning

confidence: 99%

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Duse¹,

Santamaria²,

Verga³

et al. 2021

Ital J Pediatr

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Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

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Section: Is It Recommended To Add Other Drugs To Inhaled Corticosteromentioning

confidence: 99%

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Duse¹,

Santamaria²,

Verga³

et al. 2021

Ital J Pediatr

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“…This controversy extends to higher level evidence as well. A 2018 SRMA of two studies by Khattiyawittayakun et al 2198 . determined that there was no demonstrable benefit to the addition of an INDC to INCS, and an IT reduction should be recommended in AR patients refractory to first‐line therapy with INCS.…”

Section: Managementmentioning

confidence: 99%

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

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106

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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“…Decongestants increase noradrenaline release, which activates the alpha-1 and -2 adrenergic receptors and results in vasoconstriction. 6 Nasal saline irrigation improves symptoms by clearing out allergens and mucus, thinning the nasal discharge, and promoting mucociliary clearance. Leukotriene increases vascular permeability and elicits smooth muscle contraction.…”

Section: Introductionmentioning

confidence: 99%

“…When monotherapy of primary treatment fails to control the symptoms, physicians may consider combined medical therapy for additional therapeutic effects. Decongestants increase noradrenaline release, which activates the alpha‐1 and ‐2 adrenergic receptors and results in vasoconstriction 6 . Nasal saline irrigation improves symptoms by clearing out allergens and mucus, thinning the nasal discharge, and promoting mucociliary clearance.…”

Section: Introductionmentioning

confidence: 99%

Combined medical therapy in the treatment of allergic rhinitis: Systematic review and meta‐analyses

Chitsuthipakorn

Hoang

Kanjanawasee

et al. 2022

Int Forum Allergy Rhinol

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Background: Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for patients with allergic rhinitis (AR). When monotherapy of either primary treatment fails to control symptoms, combined medical therapy is an option. In this meta-analysis we assessed the additional effects of different medical combinations compared with primary treatments. Methods: Systematic searches on PubMed and EMBASE were updated on November 4, 2021. Randomized, controlled trials comparing the effects of combinations with monotherapy were included. There were 7 comparisons: (1) ATHdecongestant vs ATH; (2) ATH-leukotriene receptor antagonist (LTRA) vs ATH; (3) INCS-ATH vs INCS; (4) INCS-LTRA vs INCS; (5) INCS-decongestion vs INCS; (6) INCS-saline irrigation vs INCS; and (7) ATH-saline irrigation vs ATH. Data were pooled for meta-analysis. Outcomes were composite nasal symptom score, composite ocular symptom score, quality of life (QoL), and adverse events. Results: Fifty-three studies were included. Compared with ATH alone, the ATHdecongestant combination improved composite nasal symptoms; ATH-LTRA improved nasal symptoms in patients with perennial AR; and ATH-nasal saline improved both symptoms and QoL. Compared with INCS alone, the INCSintranasal ATH combination improved nasal symptoms, ocular symptoms, and QoL; INCS-LTRA improved ocular symptoms but not nasal symptoms; and INCS-nasal saline improved QoL but not symptoms. There were no additional effects observed from adding oral ATH or topical decongestant to INCS. Conclusion: After ATH monotherapy fails to control symptoms, addition of decongestant, saline, or LTRA can improve the outcomes. When INCS monotherapy is ineffective, addition of intranasal ATH can improve nasal symptoms; LTRA can improve ocular symptoms, and saline irrigation can improve QoL.

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Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta‐analysis

Abstract: Meta-analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS-D were comparable with INCS.

Cited by 14 publications

References 19 publications

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Combined medical therapy in the treatment of allergic rhinitis: Systematic review and meta‐analyses

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