Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis

doi:10.1016/S1081-1206(10)62085-6

Annals of Allergy, Asthma & Immunology

Volume 89, Issue 5, November 2002, Pages 479-484

https://doi.org/10.1016/S1081-1206(10)62085-6 Get rights and content

Objective

We performed a systematic review of randomized, controlled trials to determine whether intranasal corticosteroids offered an advantage over topical antihistamines in the treatment of allergic rhinitis.

Data Sources

We searched for studies using MEDLINE, Embase, Cinahi, and Cochrane databases, pharmaceutical companies, and references of included trials.

Study Selection

Criteria for considering trials included: 1) published randomized controlled trials; 2) single- or double-blind studies; and 3) presence of one of the following clinical outcomes: nasal symptoms, eye symptoms, global symptoms evaluation of quality of life and side effects.

Results

Nine studies including 648 subjects (mean age 30.4 years, range 13 to 73) with allergic rhinitis were selected. Intranasal corticosteroids produced significantly greater reduction of total nasal symptoms (standardized mean difference −0.36, 95% confidence interval −0.57 to −0.14), sneezing (−0.41, −0.57 to −0.24), rhinorrhea (−0.47, −0.64 to −0.29), itching (−0.38, −0.56 to −0.19), and nasal blockage (−0.86, −1.07 to −0.64) than did topical antihistamines. There was no significant difference between treatments for ocular symptoms (−0.07, −0.27 to 0.12). The effects on sneezing, rhinorrhea, itching, and ocular symptoms were significantly heterogeneous between studies. Other outcomes (total nasal symptom score and nasal blockage) were homogeneous between studies. Subgroup and sensitivity analysis suggested that most of the heterogeneity of outcomes could be explained on the basis of the methodologic quality of studies.

Conclusions

Intranasal corticosteroids produced greater relief of nasal symptoms than did topical antihistamines (topical H₁ receptor antagonists). However, there was no difference in the relief of the ocular symptoms.

REFERENCES (49)

RF Lemanske
A review of the current guidelines for allergic rhinitis and asthma
J Allergy Clin Immunol
(1998)
S Clark
Dangers of non-sedating antihistamines
Lancet
(1997)
AR Jadad et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996)
I Olkin
Statistical and theoretical consideration in metaanalysis
Clin Epidemiol
(1995)
R DerSimonian et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986)
A Pelucchi et al.
Effect of intranasal azelastine and beclomethasone dipropionate on nasal symptoms, nasal cytology, and bronchial responsiveness to methacholine in allergic rhinitis in response to grass pollens
J Allergy Clin Immunol
(1995)
MA Stern et al.
Nasal budesonide offers superior symptom relief in perennial allergic rhinitis in comparison to nasal azelastine
Ann Allergy Asthma Immunol
(1998)
EF Juniper et al.
Comparison of beclomethasone dipropionate aqueous nasal spray, astemizole, and the combination in the prophylactic treatment of ragweed pollen-induced rhinoconjunctivitis
J Allergy Clin Immunol
(1989)
W Schoenwetter et al.
Comparison of intranasal triamcinolone acetonide with oral loratadine for the treatment of patients with seasonal allergic rhinitis
Clin Ther
(1995)
DI Bernstein et al.
Comparison of triamcinolone acetonide nasal inhaler with astemizole in the treatment of ragweed-induced allergic rhinitis
J Allergy Clin Immunol
(1996)

EA Bronsky et al.

Fluticasone propionate aqueous nasal spray compared with terfenadine tablets in the treatment of seasonal allergic rhinitis

J Allergy Clin Immunol

(1996)

J Condemi et al.

Triamcinolone acetonide aqueous nasal spray versus loratadine in seasonal allergic rhinitis: efficacy and quality of life

Ann Allergy Asthma Immunol

(2000)

International Consensus Report on the diagnosis and management of rhinitis

International Rhinitis Management Working Group

Allergy

(1994)

P Van-Cauwenberge et al.

Consensus statement on the treatment of allergy rhinitis

Allergy

(2000)

B Lundback

Epidemiology of rhinitis an asthma

Clin Exp Allergy

(1998)

RM Sly

Changing prevalence of allergy rhinitis and asthma

Ann Allergy Asthma Immunol

(1999)

ST Holgate

The epidemic of allergy and asthma

Nature

(1999)

B Sibbald

Epidemiology of allergy rhinitis

B Wuthrich et al.

Prevalence of atopy an pollinosis in the population of Switzerland (SAPALDIA study). Swiss Study on Air Pollution and Lung Disease in Adult

Int Arch Allergy Immunol

(1995)

D Strachan et al.

Worldwide variations in prevalence of symptoms of allergy rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Pediatr Allergy Immunol

(1997)

JM Weiner et al.

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

BMJ

(1997)

FE Simons et al.

The pharmacology and use of H₁- receptor-antagonist drugs

N Engl J Med

(1994)

CV Glass

Meta-analysis in Social Research

(1981)

JL Fleiss

The statistical basis of meta-analysis

Stat Methods Med Res

(1993)

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ORIGINAL ARTICLESIntranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis

Objective

Data Sources

Study Selection

Results

Conclusions

J Allergy Clin Immunol

Lancet

Control Clin Trials

Clin Epidemiol

Control Clin Trials

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

Clin Ther

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

International Rhinitis Management Working Group

Allergy

Consensus statement on the treatment of allergy rhinitis

Allergy

Epidemiology of rhinitis an asthma

Clin Exp Allergy

Changing prevalence of allergy rhinitis and asthma

Ann Allergy Asthma Immunol

The epidemic of allergy and asthma

Nature

Epidemiology of allergy rhinitis

Prevalence of atopy an pollinosis in the population of Switzerland (SAPALDIA study). Swiss Study on Air Pollution and Lung Disease in Adult

Int Arch Allergy Immunol

Worldwide variations in prevalence of symptoms of allergy rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Pediatr Allergy Immunol

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

BMJ

The pharmacology and use of H1- receptor-antagonist drugs

N Engl J Med

Meta-analysis in Social Research

The statistical basis of meta-analysis

Stat Methods Med Res

ORIGINAL ARTICLES
Intranasal corticosteroids versus topical H₁ receptor antagonists for the treatment of allergic rhinitis: a systematic review with meta-analysis

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

The pharmacology and use of H₁- receptor-antagonist drugs