Intranasal antihistamine is superior to oral H1 antihistamine as an add-on therapy to intranasal corticosteroid for treating allergic rhinitis

Background Currently, a combination of intranasal corticosteroid (INCS) plus oral H1 antihistamine (OAH) or intranasal H1 antihistamine (INAH) therapy is frequently used in the treatment of allergic rhinitis (AR). The superiority of the 2 combined treatments needs to be further examined. Objective To identify the better of the 2 therapeutic strategies for treating AR. Methods A literature review was performed on MEDLINE, Cochrane Library, and EMBASE databases. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, meta-analyses of the total nasal symptom scores and individual nasal symptom scores were pooled based on studies that compared concomitant H1 antihistamines plus INCS with INCS alone in the treatment of AR. The pooled results were expressed as weighted mean differences between the treatments. For each selected study, we calculated the relative clinical impact based on the total nasal symptom scores as follows: 100 × (ScoreMonotherapy − ScoreCombined therapy) / ScoreMonotherapy. Results A total of 13 publications met our selection criteria, with 5066 patients. The pooled results revealed no significant weighted mean difference on the total nasal symptom scores between concomitant OAH plus INCS and INCS alone. As for the individual symptoms, the most common symptom that revealed remission was rhinorrhea, which was after OAH in combination with INCS. The combination therapy of INAH and INCS was superior to INCS alone. In an indirect comparison, the weighted mean relative clinical impact of INAH plus INCS was significantly higher than that of OAH plus INCS. Conclusion Intranasal H1 antihistamines have an add-on effect on intranasal corticosteroids, and the combination of intranasal H1 antihistamines plus intranasal corticosteroid is superior to that of oral H1 antihistamines plus intranasal corticosteroid in improving nasal symptoms for patients with AR.