Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis

Nanna Juel-Berg; Peter Darling; Julie Bolvig; Majken H Foss-Skiftesvik; Susanne Halken; Lone Winther; Kirsten Skamstrup Hansen; Nikolaj Askjaer; Steffen Heegaard; Anders R Madsen; Morten S Opstrup

doi:10.2500/ajra.2016.30.4397

Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis

Nanna Juel-Berg, Peter Darling, Julie Bolvig, Majken H Foss-Skiftesvik, Susanne Halken, Lone Winther, Kirsten Skamstrup Hansen, Nikolaj Askjaer, Steffen Heegaard, Anders R Madsen, Morten S Opstrup

Department of Clinical Medicine

18 Citations (Scopus)

Abstract

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.

Original language	English
Journal	American Journal of Rhinology & Allergy
Volume	31
Issue number	1
Pages (from-to)	e19-e28
ISSN	1945-8924
DOIs	https://doi.org/10.2500/ajra.2016.30.4397
Publication status	Published - 1 Jan 2017

Keywords

Administration, Intranasal
Administration, Oral
Adrenal Cortex Hormones
Humans
Quality of Life
Rhinitis, Allergic
Treatment Outcome
Comparative Study
Journal Article
Meta-Analysis
Review

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Juel-Berg, N., Darling, P., Bolvig, J., Foss-Skiftesvik, M. H., Halken, S., Winther, L., Hansen, K. S., Askjaer, N., Heegaard, S., Madsen, A. R., & Opstrup, M. S. (2017). Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis. American Journal of Rhinology & Allergy, 31(1), e19-e28. https://doi.org/10.2500/ajra.2016.30.4397

Juel-Berg, N, Darling, P, Bolvig, J, Foss-Skiftesvik, MH, Halken, S, Winther, L, Hansen, KS, Askjaer, N, Heegaard, S, Madsen, AR & Opstrup, MS 2017, 'Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis', American Journal of Rhinology & Allergy, vol. 31, no. 1, pp. e19-e28. https://doi.org/10.2500/ajra.2016.30.4397

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abstract = "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.",

keywords = "Administration, Intranasal, Administration, Oral, Adrenal Cortex Hormones, Humans, Quality of Life, Rhinitis, Allergic, Treatment Outcome, Comparative Study, Journal Article, Meta-Analysis, Review",

author = "Nanna Juel-Berg and Peter Darling and Julie Bolvig and Foss-Skiftesvik, {Majken H} and Susanne Halken and Lone Winther and Hansen, {Kirsten Skamstrup} and Nikolaj Askjaer and Steffen Heegaard and Madsen, {Anders R} and Opstrup, {Morten S}",

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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 - 2017/1/1

Y1 - 2017/1/1

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

SN - 1945-8924

VL - 31

SP - e19-e28

JO - American Journal of Rhinology & Allergy

JF - American Journal of Rhinology & Allergy

IS - 1

ER -

Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis

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Keywords

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