Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

Abstract

Background Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH-LTRA on (1) composite nasal symptom score (standardized mean difference [SMD]: −0.20; 95% confidence interval [CI]: −0.36, −0.03), (2) rhinorrhea (SMD: −0.14; 95% CI: −0.27, −0.02), and (3) sneezing (SMD: −0.15; 95% CI: −0.27, −0.02). Subgroup analyses revealed that results favored the effects of AH-LTRA for perennial AR (SMD: −0.57; 95% CI: −0.87, −0.26) but not in the seasonal AR subgroup (SMD: −0.09; 95% CI: −0.21, 0.04), P = .004. There were no differences between AH-LTRA and AH on nasal obstruction, itching, ocular symptoms, Rhinoconjunctivitis Quality of life Questionnaire and adverse events. Due to limited number of included studies, effects on asthma and pediatric subgroups could not be assessed. Conclusion For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

“…The study also demonstrates the possibility that patients with perennial AR benefit more from combination therapy [126]. Another study also shows that combination therapy with LTRA + SAH provides greater beneficial effects against composite nasal symptoms, rhinorrhea, sneezing, and rhinoconjunctivitis symptoms in patients with AR and patients with perennial AR [127].…”

Allergic Rhinitis: A Clinical and Pathophysiological Overview

“…A meta-analysis study showed higher efficacy of leukotriene receptor antagonist compared with H1 antihistamines during nighttime symptoms but not in daytime symptoms ( 100 ). Other meta-analysis studies demonstrated that combination therapy of leukotriene receptor antagonist plus H1 antihistamines conferred increased efficacy in reducing daytime symptoms ( 101 , 102 ).…”

Leukotriene receptor antagonist addition to intranasal steroid: systematic review and meta-analysis

“…The findings of our meta-analysis do not recom- as or less effective than oral antihistamines for AR (34) ; moreover, it is less effective than INCS2. LTRA combined with oral H1 antihistamine might be considered when failure of antihistamine monotherapy (2,32,35) . In this situation, the formulation MP-AzeFlu of INCS is better evidence-based option validated by previous studies (36) , meta-analysis (37,38) , and clinical guidelines (33,39) .…”