Intranasal corticosteroids versus oral H-1, receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials

Objective To determine whether intranasal corticosteroids are superior to o ral H-1 receptor antagonists (antihistamines) in the treatment of allergic rhinitis. Design Meta-analysis of randomised controlled trials comparing intranasal c orticosteroids with oral antihistamines. Setting Randomised controlled trials conducted worldwide and published betw een 1966 and 1997. Subjects 2267 subjects with allergic rhinitis in 16 randomised controlled t rials. Main outcome measures Nasal blockage, nasal discharge, sneezing, nasal itch , postnasal drip, nasal discomfort, total nasal symptoms, nasal resistance, and eye symptoms and global ratings. Outcomes measured on different scales were combined to determine pooled odds ratios (categorical outcomes) or st andardised mean differences (continuous outcomes). Assessment of heterogene ity between studies, and subgroup analyses of eye symptoms, were undertaken . Results Intranasal corticosteroids produced significantly greater relief th an oral antihistamines of nasal blockage (standardised mean difference - 0. 63, 95% confidence interval - 0.73 to - 0.53), nasal discharge (- 0.5, - 0. 6 to - 0.4), sneezing (- 0.49, - 0.59 to - 0.39), nasal itch (- 0.38, - 0.4 9 to - 0.21), postnasal drip (- 0.24, - 0.42 to - 0.06), and total nasal sy mptoms (- 0.42, - 0.53 to - 0.32), and global ratings gave an odds ratio fo r deterioration of symptoms of 0.26 (0.08 to 0.8). There were no significan t differences between treatments for nasal discomfort, nasal resistance, or eve symptoms. The effects on sneezing, total nasal symptoms, and eye sympt oms were significantly heterogeneous between studies. Other combined outcom es Were homogeneous between studies. Subgroup analysis of the outcome of ey e symptoms suggested that the duration of assessment (averaged mean score o ver the study period versus mean score at end of study period) might have a ccounted for the heterogeneity. Conclusion The results of this systematic review, together with data on saf ety and cost effectiveness, support the use of intranasal corticosteroids o ver oral antihistamines as first line treatment for allergic rhinitis.