Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

Abstract

Objective To determine whether intranasal corticosteroids are superior to oral H 1 receptor antagonists (antihistamines) in the treatment of allergic rhinitis. Design Meta-analysis of randomised controlled trials comparing intranasal corticosteroids with oral antihistamines. Setting Randomised controlled trials conducted worldwide and published between 1966 and 1997. Subjects 2267 subjects with allergic rhinitis in 16 randomised controlled trials. Main outcome measures Nasal blockage, nasal discharge, sneezing, nasal itch, postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, and eye symptoms and global ratings. Outcomes measured on different scales were combined to determine pooled odds ratios (categorical outcomes) or standardised mean differences (continuous outcomes). Assessment of heterogeneity between studies, and subgroup analyses of eye symptoms, were undertaken. Results Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage (standardised mean difference − 0.63, 95% confidence interval − 0.73 to − 0.53), nasal discharge ( − 0.5, − 0.6 to − 0.4), sneezing ( − 0.49, − 0.59 to − 0.39), nasal itch ( − 0.38, − 0.49 to − 0.21), postnasal drip ( − 0.24, − 0.42 to − 0.06), and total nasal symptoms ( − 0.42, − 0.53 to − 0.32), and global ratings gave an odds ratio for deterioration of symptoms of 0.26 (0.08 to 0.8). There were no significant differences between treatments for nasal discomfort, nasal resistance, or eye symptoms. The effects on sneezing, total nasal symptoms, and eye symptoms were significantly heterogeneous between studies. Other combined outcomes were homogeneous between studies. Subgroup analysis of the outcome of eye symptoms suggested that the duration of assessment (averaged mean score over the study period versus mean score at end of study period) might have accounted for the heterogeneity. Conclusion The results of this systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis.

Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma

“…This reflects a persistent deficit in meeting guideline-based standard of care 28,29 for the majority of our sample who had moderate/ severe persistent rhinitis symptoms. Similarly, in other studies, use of intranasal steroid in both children and adults was also low, ranging from 11 to 26%.…”

The Effect of Combined Medical Treatment on Quality of Life in Persistent Allergic Rhinitis

“…Oral H1-antihistaminics are effective in improving the symptoms mediated by histamine discharge such as rhinorrhea, sneezing, nasal itching and eye symptoms; but are less effective on nasal congestion [5]. Intranasal glucocorticosteroids are the most effective medications available for the symptomatic treatment of allergic and nonallergic rhinitis [4,6]. Antihistaminics and intranasal corticosteroids are also effective in improving all symptoms of allergic rhinitis as well as ocular symptoms [7,8].…”

Place of Topical Steroid Therapy in the Treatment of Acute Rhinosinusitis

“…[62][63][64][65][66][67]. Было изучено более 300 публикаций по его применению, и они показали значимое снижение выраженности сим-птомов при ОРС как в качестве монотерапии, так и вместе с антибактериальной терапией [40,42,50].…”