Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis.

Allergic rhinitis Intranasal antihistamines Intranasal corticosteroids Meta-analysis Systematic review

Journal

The Journal of allergy and clinical immunology
ISSN: 1097-6825
Titre abrégé: J Allergy Clin Immunol
Pays: United States
ID NLM: 1275002

Informations de publication

Date de publication:
27 Apr 2024
Historique:
received: 06 11 2023
revised: 08 04 2024
accepted: 16 04 2024
medline: 30 4 2024
pubmed: 30 4 2024
entrez: 30 4 2024
Statut: aheadofprint

Résumé

There is insufficient systematised evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR). To perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality-of-life of patients with perennial or seasonal AR. We searched four electronic bibliographic databases and three clinical trials databases for randomised controlled trials (i) assessing adult patients with seasonal or perennial AR and (ii) comparing the use of intranasal corticosteroids or antihistamines versus placebo. Assessed outcomes included the Total Nasal Symptom Score (TNSS), the Total Ocular Symptom Score (TOSS) and the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ). We performed random-effects meta-analyses of mean differences for each medication and outcome. We assessed evidence certainty using the GRADE approach. We included 151 primary studies, most of which assessed patients with seasonal AR and displayed unclear or high risk of bias. Both in perennial and seasonal AR, most assessed treatments were more effective than placebo. In seasonal AR, azelastine-fluticasone, fluticasone furoate and fluticasone propionate were the medications with the highest probability of resulting in moderate or large improvements in the TNSS and RQLQ. Azelastine-fluticasone displayed the highest probability of resulting in moderate or large improvements of TOSS. Overall, evidence certainty was considered "high" in 6/46 analyses, "moderate" in 23/46 analyses, and "low"/"very low" in 17/46 analyses. Most intranasal medications are effective in improving rhinitis symptoms and quality-of-life. However, there are relevant differences in the associated evidence certainty.

Sections du résumé

BACKGROUND BACKGROUND
There is insufficient systematised evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR).
OBJECTIVE OBJECTIVE
To perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality-of-life of patients with perennial or seasonal AR.
METHODS METHODS
We searched four electronic bibliographic databases and three clinical trials databases for randomised controlled trials (i) assessing adult patients with seasonal or perennial AR and (ii) comparing the use of intranasal corticosteroids or antihistamines versus placebo. Assessed outcomes included the Total Nasal Symptom Score (TNSS), the Total Ocular Symptom Score (TOSS) and the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ). We performed random-effects meta-analyses of mean differences for each medication and outcome. We assessed evidence certainty using the GRADE approach.
RESULTS RESULTS
We included 151 primary studies, most of which assessed patients with seasonal AR and displayed unclear or high risk of bias. Both in perennial and seasonal AR, most assessed treatments were more effective than placebo. In seasonal AR, azelastine-fluticasone, fluticasone furoate and fluticasone propionate were the medications with the highest probability of resulting in moderate or large improvements in the TNSS and RQLQ. Azelastine-fluticasone displayed the highest probability of resulting in moderate or large improvements of TOSS. Overall, evidence certainty was considered "high" in 6/46 analyses, "moderate" in 23/46 analyses, and "low"/"very low" in 17/46 analyses.
CONCLUSION CONCLUSIONS
Most intranasal medications are effective in improving rhinitis symptoms and quality-of-life. However, there are relevant differences in the associated evidence certainty.

Identifiants

DOI: 10.1016/j.jaci.2024.04.016 PMID: 38685482
pubmed: 38685482
pii: S0091-6749(24)00419-6
doi: 10.1016/j.jaci.2024.04.016
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Bernardo Sousa-Pinto (B)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Rafael José Vieira (RJ)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Jan Brozek (J)

Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada.

António Cardoso-Fernandes (A)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Nuno Lourenço-Silva (N)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Renato Ferreira-da-Silva (R)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

André Ferreira (A)

CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal.

Sara Gil-Mata (S)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Anna Bedbrook (A)

MASK-air SAS, Montpellier, France.

Ludger Klimek (L)

Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany.

João A Fonseca (JA)

MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.

Torsten Zuberbier (T)

Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.

Holger J Schünemann (HJ)

Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada.

Jean Bousquet (J)

Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; ARIA, Montpellier, France. Electronic address: jean.bousquet@orange.fr.

Classifications MeSH