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Intranasal corticosteroids versus

oral H1receptor antagonists in

allergic rhinitis: systematic

review of randomised controlled

trials

Journal reading


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introduction

Allergic rhinitis is a common diseasecharacterised by nasal itch, sneezing, wateryand mucous rhinorrhoea, and nasal obstruction

It can cause considerable morbidity includingchronic sinusitis & otitis irritability andimpaired sleep affect quality of life.

Therapy avoiding allergens (when possible),intranasal corticosteroids, short termdecongestants, oral/topical H

1

receptorantagonists (antihistamines), intranasalcromoglycate, anticholinergic agents &allergen immunotherapy.


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Topical intranasal corticosteroids aresaid to be more effective than oral

antihistamines in controlling nasal

blockage and discharge.

Oral antihistamines are said to be better

at treating nasal itch, sneezing, and eye

symptoms.

WHICH ONE MORE EFFECTIVNESS THAN OTHER??


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objective

To determine whether intranasal

corticosteroids are superior to oral

H1receptor antagonists

(antihistamines) in the treatment of

allergic rhinitis.


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methods

Design : Meta-analysis of randomisedcontrolled trials.

Subject : 2267 subjects with allergic rhinitis in

16 randomised controlled trials (mean age 32years, range 12 to 75 years), of whom 1247(55%) were men)

Search strategy

Medline and Embasesearches for randomised controlled trials oftopical corticosteroids and rhinitis.


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methods

Analysis outcome

symptom score and visualanalogue scale

Statistical analysis outcomedata were extracted &entered into RevMan 3.1 (Update Software, Oxford).

Categorical outcomes (global ratings) were analysed asodds ratios and 95% confidence intervals, calculated byPetosmethod for individual studies


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Inclusion criteria

intranasal corticosteroids included beclomethasonedipropionate, budesonide, flunisolide, fluocortin,fluticasone propionate, mometasone, and triamcinoloneacetonide

any form of oral antihistamine one of the following clinical outcomesnasal

symptoms (including total nasal symptom scores), eyesymptoms, global symptoms, nasal function (including

measurements of nasal resistance), and assessment ofquality of life.


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Exlusion criteria

topical antihistamines or topical mast cell stabilisers Not randomised

Not double blinded.

only nasal challenge with specific allergens or non-

clinical outcomes.


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Result

nasal blockage, nasal discharge, and sneezing

14studies

I.N corticosteroid vs Oral Antihistamin for nasal blockage(combined standardised mean difference 0.63 (95%

confidence interval 0.73 to 0.53)).

I.N corticosteroid vs Oral Antihistamin for Nasaldischarge (0.5, 0.6 to 0.4)).

I.N corticosteroid vs Oral Antihistamin in relievingsneezing (0.49, 0.59 to 0.39).


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I.N corticosteroid vs Oral Antihistamin for nasal itch(combined standardised mean difference 0.38, 0.49 to

0.21).11 studies

I.N corticosteroid vs Oral Antihistamin for Total nasal

symptom (0.42, 0.53 to 0.32).9 studies. Eye symptomswas no significant difference between

intranasal corticosteroids and oral antihistamines on eye

symptoms11 studies.

nasal discomfortwas no significant differencebetween the two treatments1 study


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result

Intranasal corticosteroids are considered safe. Localadverse effects are usually mild (mucosal irritation,epistaxis), and nasal septal perforation is exceptionallyrare.

First generation oral antihistamines are safe, butsedative and anticholinergic effects may be troublesome

intranasal corticosteroids is better than antihistamines asfirst line treatment for allergic rhinitis ( basic on data andwith data on safety and cost effectiveness ).


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