Table 1

Topical corticosteroids v systemic histamine antagonists in treatment of allergic seasonal rhinitis

CitationStudy group and type (level of evidence)OutcomeKey resultsComment
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 OH1AAnalysis 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 symptomsNo significant difference between INC and OH1A in relieving eye symptomsMeta-analysis of 11 RCT, OH1A could be beneficial ancillary to INC for treatment of eye symptoms.
Comparison INC v OH1A on cost effectivenessINC are more cost effective than OH1AIndividual studies suggest cost effectiveness
Total outcomeINC are recommended as 1st line treatment of allergic rhinitisSafety issues were considered
van Cauwenberge et al (2000)Consensus statementAdvice on treatment of seasonal allergic rhinitisINC are recommended as 1st line treatment of moderate to severe symptoms of SARNo 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