Intranasal Medications Show Efficacy in Treating Allergic Rhinitis: Study
Researchers have found that most intranasal medications, including corticosteroids and antihistamines, are effective in improving nasal and ocular symptoms, as well as the quality of life for patients with perennial or seasonal allergic rhinitis (AR). However, there are notable differences in the certainty of evidence supporting their efficacy. This study was published in the The Journal of Allergy and Clinical Immunology. The study was conducted by Bernardo S. and colleagues.
Allergic rhinitis (AR) is a common condition that affects the nasal passages, causing symptoms such as sneezing, congestion, and itchy eyes. Intranasal medications, such as corticosteroids and antihistamines, are often used to manage AR symptoms. However, the effectiveness of these medications has not been systematically compared against placebo.
A systematic review was conducted to evaluate the efficacy of individual intranasal corticosteroids and antihistamines in adult patients with seasonal or perennial AR. The review included randomized controlled trials that compared the use of intranasal medications versus placebo.
The assessed outcomes included:
Total Nasal Symptom Score (TNSS)
Total Ocular Symptom Score (TOSS)
Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ)
Random-effects meta-analyses were performed to compare mean differences in outcomes for each medication and placebo. Evidence certainty was assessed using the GRADE approach.
The key findings of the study were:
• A total of 151 primary studies were included in the review, with most studies focusing on patients with seasonal AR.
• Most assessed treatments were found to be more effective than placebo in improving symptoms and quality of life for both perennial and seasonal AR.
• In seasonal AR, azelastine-fluticasone, fluticasone furoate, and fluticasone propionate showed the highest probability of moderate or large improvements in TNSS and RQLQ.
• Azelastine-fluticasone also displayed the highest probability of moderate or large improvements in TOSS.
• Evidence certainty was rated as "high" in 6 out of 46 analyses, "moderate" in 23 out of 46 analyses, and "low" or "very low" in 17 out of 46 analyses.
The study's findings suggest that intranasal medications are generally effective in treating rhinitis symptoms and improving quality of life. However, the varying levels of evidence certainty indicate that additional research may be needed to further support the use of certain medications.
Intranasal medications, including corticosteroids and antihistamines, are effective in managing allergic rhinitis symptoms and improving quality of life. Nonetheless, the certainty of evidence supporting their efficacy varies, highlighting the need for further research in this area.
Reference:
Sousa-Pinto, B., Vieira, R. J., Brozek, J., Cardoso-Fernandes, A., Lourenço-Silva, N., Ferreira-da-Silva, R., Ferreira, A., Gil-Mata, S., Bedbrook, A., Klimek, L., Fonseca, J. A., Zuberbier, T., Schünemann, H. J., & Bousquet, J. (2024). Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis. The Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2024.04.016
