TY - JOUR
T1 - Intranasal Versus Oral Treatments for Allergic Rhinitis
T2 - A Systematic Review With Meta-Analysis
AU - Torres, Maria Inês
AU - Gil-Mata, Sara
AU - Bognanni, Antonio
AU - Ferreira-da-Silva, Renato
AU - Yepes-Nuñez, Juan José
AU - Lourenço-Silva, Nuno
AU - Cardoso-Fernandes, António
AU - Ferreira, André
AU - Ferreira-Cardoso, Henrique
AU - Portela, Diana
AU - Teles, João
AU - Kvedariene, Violeta
AU - Torres, María Jose
AU - Klimek, Ludger
AU - Pfaar, Oliver
AU - Brussino, Luisa
AU - Zuberbier, Torsten
AU - Fonseca, João A.
AU - Schünemann, Holger
AU - Bousquet, Jean
AU - Sousa-Pinto, Bernardo
AU - Vieira, Rafael José
AU - Neves, Ana Luísa
AU - Pereira, Ana Margarida
AU - Bedbrook, Anna
AU - Valiulis, Arunas
AU - Jacomelli, Cristina
AU - Azzolini, Elena
AU - Parmelli, Elena
AU - Canonica, Giorgio Walter
AU - Zuberbier, Jaron
AU - Vecillas, Leticia de las
AU - Gilles, Louis
AU - Leemann, Lucas
AU - Ventura, Maria Teresa
AU - Savoure, Marine
AU - Dykewicz, Mark
AU - Hofmann-Apitius, Martin
AU - Papadopoulos, Nikolaos
AU - Lourenço, Olga
AU - Salmi, Sanna K.
AU - Williams, Sian
AU - Palamarchuk, Yuliia
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/12
Y1 - 2024/12
N2 - Background: Treatments for allergic rhinitis include intranasal or oral medications. Objective: To perform a systematic review with meta-analysis comparing the effectiveness of intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists in improving allergic rhinitis symptoms and quality of life. Methods: We searched four bibliographic databases and three clinical trial datasets for randomized controlled trials (1) assessing patients aged 12 years and older with seasonal or perennial allergic rhinitis, and (2) comparing intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists. We performed a meta-analysis of the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals owing to adverse events. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. Results: We included 35 studies, most of which assessed patients with seasonal allergic rhinitis and displayed an unclear risk of bias. Superiority of intranasal treatments was found for all assessed outcomes. Intranasal corticosteroids were more effective than oral antihistamines at improving the TNSS (mean difference [MD], –0.86; 95% CI, –1.21 to –0.51; I2 = 70%), Total Ocular Symptom Score (MD, –0.36; 95% CI, –0.56 to –0.17; I2 = 0%), and RQLQ (MD, –0.88; 95% CI, –1.15 to –0.61; I2 = 0%), which were mostly associated with clinically meaningful improvements. Superiority of intranasal corticosteroids at improving the TNSS was also found against oral leukotriene receptor antagonists (MD, –1.05; 95% CI, –1.33 to –0.77). Intranasal antihistamines were more effective than oral antihistamines at improving the TNSS (MD, –0.47; 95% CI, –0.81 to –0.14; I2 = 0%) and RQLQ (MD, –0.31; 95% CI, –0.56 to –0.06; I2 = 0%). Conclusions: Randomized controlled trials suggest that intranasal treatments are more effective than oral treatments at improving symptoms and quality of life in seasonal allergic rhinitis.
AB - Background: Treatments for allergic rhinitis include intranasal or oral medications. Objective: To perform a systematic review with meta-analysis comparing the effectiveness of intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists in improving allergic rhinitis symptoms and quality of life. Methods: We searched four bibliographic databases and three clinical trial datasets for randomized controlled trials (1) assessing patients aged 12 years and older with seasonal or perennial allergic rhinitis, and (2) comparing intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists. We performed a meta-analysis of the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals owing to adverse events. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. Results: We included 35 studies, most of which assessed patients with seasonal allergic rhinitis and displayed an unclear risk of bias. Superiority of intranasal treatments was found for all assessed outcomes. Intranasal corticosteroids were more effective than oral antihistamines at improving the TNSS (mean difference [MD], –0.86; 95% CI, –1.21 to –0.51; I2 = 70%), Total Ocular Symptom Score (MD, –0.36; 95% CI, –0.56 to –0.17; I2 = 0%), and RQLQ (MD, –0.88; 95% CI, –1.15 to –0.61; I2 = 0%), which were mostly associated with clinically meaningful improvements. Superiority of intranasal corticosteroids at improving the TNSS was also found against oral leukotriene receptor antagonists (MD, –1.05; 95% CI, –1.33 to –0.77). Intranasal antihistamines were more effective than oral antihistamines at improving the TNSS (MD, –0.47; 95% CI, –0.81 to –0.14; I2 = 0%) and RQLQ (MD, –0.31; 95% CI, –0.56 to –0.06; I2 = 0%). Conclusions: Randomized controlled trials suggest that intranasal treatments are more effective than oral treatments at improving symptoms and quality of life in seasonal allergic rhinitis.
KW - Allergic rhinitis
KW - GRADE approach
KW - Intranasal antihistamines
KW - Intranasal corticosteroids
KW - Leukotriene receptor antagonists
KW - Meta-analysis
KW - Oral antihistamines
UR - https://www.scopus.com/pages/publications/85205877552
U2 - 10.1016/j.jaip.2024.09.001
DO - 10.1016/j.jaip.2024.09.001
M3 - Article
C2 - 39251016
SN - 2213-2198
VL - 12
SP - 3404
EP - 3418
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 12
ER -