Topical corticosteroids v systemic histamine antagonists in treatment of allergic seasonal rhinitis
| Citation | Study group and type (level of evidence) | Outcome | Key results | Comment |
|---|---|---|---|---|
| INC, intranasal corticosteroids; OH1A, oral H1 receptor antagonists. | ||||
| Weiner et al (1998) | Meta-analysis of 16 RCT (total of 2267 subjects; mean age 32 years, range 12 to 75 years) | Comparison INC v OH1A on nasal symptoms (itch, nasal blockage, nasal discharge, and sneezing) | INC give greater relief of total nasal symptoms than OH1A | Analysis based on Cochrane methodology (albeit language bias) |
| Combined standardised mean difference −0.42 (95% CI −0.53 to −0.32). | ||||
| Level of evidence 1a (SR with (predominantly) homogeneity of RCT) | Comparison INC v OH1A on eye symptoms | No significant difference between INC and OH1A in relieving eye symptoms | Meta-analysis of 11 RCT, OH1A could be beneficial ancillary to INC for treatment of eye symptoms. | |
| Comparison INC v OH1A on cost effectiveness | INC are more cost effective than OH1A | Individual studies suggest cost effectiveness | ||
| Total outcome | INC are recommended as 1st line treatment of allergic rhinitis | Safety issues were considered | ||
| van Cauwenberge et al (2000) | Consensus statement | Advice on treatment of seasonal allergic rhinitis | INC are recommended as 1st line treatment of moderate to severe symptoms of SAR | No comment on identification of primary data or appraisal of the underlying evidence. Recommendation partially based on Weiner et al |
| Level 5: expert opinion without explicit critical appraisal | ||||