Intranasal corticosteroids versus topical H1 receptor antagonists for the treatment of allergic rhinitis:: a systematic review with meta-analysis

Objective: We performed a systematic review of randomized, controlled trials to determine whether intranasal corticosteroids offered an advantage over topical anti histamines in the treatment of allergic rhinitis. Data Sources: We searched for studies using MEDLINE, Embase, Cinahi, and Cochrane databases, pharmaceutical companies, and references of included trials. Study Selection: Criteria for considering trials included: 1) published randomized controlled trials: 2) single- or double-blind studies; and 3) presence of one of the following clinical outcomes: nasal symptoms. eye symptoms, global symptoms evaluation of quality of life and side effects. Results: Nine studies including 648 subjects (mean age 30.4 years, range 13 to 73) with allergic rhinitis were selected. Intranasal corticosteroids produced significantly greater reduction of total nasal symptoms (standardized mean difference -0.36, 95% confidence interval -0.57 to -0.14), sneezing, (-0.41. -0.57 to -0.24), rhinorrhea (-0.47, -0.64 to -0.29), itching (-0.38, -0.56 to -0.19). and nasal blockage (-0.86, -1.07 to -0.64) than did topical antihistamines. There was no significant difference between treatments for ocular symptoms (-0.07. -0.27 to 0.12). The effects on sneezing, rhinorrhea, itching, and ocular symptoms were significantly heterogeneous between studies. Other outcomes (total nasal symptom score and nasal blockage) were homogeneous between studies. Subgroup and sensitivity analysis suggested that most of the heterogeneity of outcomes could be explained on the basis of the methodologic quality of studies. Conclusions: Intranasal corticosteroids produced greater relief of nasal symptoms than did topical antihistamines (topical H, receptor antagonists). However. there was no difference in the relief of the ocular symptoms.