TY - JOUR

T1 - Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis

T2 - A systematic review and meta-analysis

AU - Juel-Berg, Nanna

AU - Darling, Peter

AU - Bolvig, Julie

AU - Foss-Skiftesvik, Majken H

AU - Halken, Susanne

AU - Winther, Lone

AU - Hansen, Kirsten Skamstrup

AU - Askjaer, Nikolaj

AU - Heegaard, Steffen

AU - Madsen, Anders R

AU - Opstrup, Morten S

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007.OBJECTIVE: To compare INS with nonsedating OAs as treatments for AR.METHODS: The systematic review and meta-analysis were based on the Grades of Recommendation, Assessment, Development, and Evaluation principles and the Patient, Intervention, Comparison, and Outcome approach. Primary literature was searched up to January 22, 2015. Criteria for eligibility were randomized controlled trials that compared the efficacy and/or adverse effects of INS and OA in patients with AR. Continuous outcome data were analyzed by using standardized mean differences (SMD) for multiple outcome measures, and mean differences in the case of a single study or outcome. Pooled estimates of effects, 95% confidence interval (CI), were calculated by using random-effects models.RESULTS: The meta-analysis included five randomized controlled trials with a total of 990 patients. INS were superior to OAs in improving total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]) and in relieving the following: nasal obstruction (SMD -0.56 [95% CI, -0.82 to -0.29]), rhinorrhea (SMD -0.47 [95% CI, -1.00 to 0.05]), nasal itching (SMD -0.42 [95% CI, -0.65 to -0.18]), sneezing (SMD -0.52 [95% CI, -0.73 to -0.32]), and quality of life mean difference -0.90 [95% CI, -1.18 to -0.62]). There was no difference in relief of ocular symptoms (SMD -0.08 [95% CI, -0.23 to 0.08]). In addition, four randomized controlled trials were included in a narrative analysis. The results in the narrative analysis were comparable with those found in the meta-analysis.CONCLUSION: INS were superior to OAs in improving nasal symptoms and quality of life in patients with AR.

AB - BACKGROUND: Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007.OBJECTIVE: To compare INS with nonsedating OAs as treatments for AR.METHODS: The systematic review and meta-analysis were based on the Grades of Recommendation, Assessment, Development, and Evaluation principles and the Patient, Intervention, Comparison, and Outcome approach. Primary literature was searched up to January 22, 2015. Criteria for eligibility were randomized controlled trials that compared the efficacy and/or adverse effects of INS and OA in patients with AR. Continuous outcome data were analyzed by using standardized mean differences (SMD) for multiple outcome measures, and mean differences in the case of a single study or outcome. Pooled estimates of effects, 95% confidence interval (CI), were calculated by using random-effects models.RESULTS: The meta-analysis included five randomized controlled trials with a total of 990 patients. INS were superior to OAs in improving total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]) and in relieving the following: nasal obstruction (SMD -0.56 [95% CI, -0.82 to -0.29]), rhinorrhea (SMD -0.47 [95% CI, -1.00 to 0.05]), nasal itching (SMD -0.42 [95% CI, -0.65 to -0.18]), sneezing (SMD -0.52 [95% CI, -0.73 to -0.32]), and quality of life mean difference -0.90 [95% CI, -1.18 to -0.62]). There was no difference in relief of ocular symptoms (SMD -0.08 [95% CI, -0.23 to 0.08]). In addition, four randomized controlled trials were included in a narrative analysis. The results in the narrative analysis were comparable with those found in the meta-analysis.CONCLUSION: INS were superior to OAs in improving nasal symptoms and quality of life in patients with AR.

KW - Administration, Intranasal

KW - Administration, Oral

KW - Adrenal Cortex Hormones

KW - Humans

KW - Quality of Life

KW - Rhinitis, Allergic

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

KW - Meta-Analysis

KW - Review

U2 - 10.2500/ajra.2016.30.4397

DO - 10.2500/ajra.2016.30.4397

M3 - Review

C2 - 28234147

VL - 31

SP - e19-e28

JO - American Journal of Rhinology & Allergy

JF - American Journal of Rhinology & Allergy

SN - 1945-8924

IS - 1

ER -