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07711146

Intranasal corticosteroids versus

oral H1 receptor antagonists in
allergic rhinitis: systematic
review of randomised controlled
trials

Journal reading

introduction

Allergic rhinitis is a common disease

characterised by nasal itch, sneezing, watery
and mucous rhinorrhoea, and nasal obstruction

It can cause considerable morbidity including

chronic sinusitis & otitis irritability and
impaired sleep affect quality of life.

Therapy avoiding allergens (when possible),

intranasal corticosteroids, short term
decongestants, oral/topical H1 receptor
antagonists (antihistamines), intranasal
cromoglycate, anticholinergic agents &
allergen immunotherapy.

Topical intranasal corticosteroids are

said 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??

objective

To determine whether intranasal

corticosteroids are superior to oral
H1 receptor antagonists
(antihistamines) in the treatment of
allergic rhinitis.

methods
Design : Meta-analysis of randomised
controlled trials.
Subject : 2267 subjects with allergic rhinitis in
16 randomised controlled trials (mean age 32
years, range 12 to 75 years), of whom 1247
(55%) were men)
Search strategy Medline and Embase
searches for randomised controlled trials of
topical corticosteroids and rhinitis.

methods

Analysis outcome symptom score and visual

analogue scale

Statistical analysis outcome data were extracted &

entered into RevMan 3.1 (Update Software, Oxford).

Categorical outcomes (global ratings) were analysed as

odds ratios and 95% confidence intervals, calculated by
Petos method for individual studies

Inclusion criteria

intranasal corticosteroids included beclomethasone

dipropionate, budesonide, flunisolide, fluocortin,
fluticasone propionate, mometasone, and triamcinolone
acetonide
any form of oral antihistamine
one of the following clinical outcomes nasal
symptoms (including total nasal symptom scores), eye
symptoms, global symptoms, nasal function (including
measurements of nasal resistance), and assessment of
quality of life.

Exlusion criteria

topical antihistamines or topical mast cell stabilisers

Not randomised
Not double blinded.
only nasal challenge with specific allergens or nonclinical outcomes.

Result

nasal blockage, nasal discharge, and sneezing 14

studies
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 Nasal

discharge (0.5, 0.6 to 0.4)).

I.N corticosteroid vs Oral Antihistamin in relieving

sneezing (0.49, 0.59 to 0.39).

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 symptoms was no significant difference between
intranasal corticosteroids and oral antihistamines on eye
symptoms 11 studies.
nasal discomfort was no significant difference
between the two treatments 1 study

result

Intranasal corticosteroids are considered safe. Local

adverse effects are usually mild (mucosal irritation,
epistaxis), and nasal septal perforation is exceptionally
rare.

First generation oral antihistamines are safe, but

sedative and anticholinergic effects may be troublesome

intranasal corticosteroids is better than antihistamines as

first line treatment for allergic rhinitis ( basic on data and
with data on safety and cost effectiveness ).

The end..

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