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Intranasal corticosteroids + intranasal antihistamines offer the most effective symptom relief and quality of life improvement for moderate-to-severe allergic rhinitis.
As per the findings of a network meta-analysis, combining intranasal corticosteroids (INCS) with intranasal antihistamines (INAH) yields the most significant symptom relief for individuals with moderate-to-severe allergic rhinitis (AR). The findings shed new light on how best to personalize treatment for those whose symptoms are inadequately controlled with monotherapies.
Researchers systematically reviewed 48 randomized controlled trials (RCTs) involving 17,188 participants, examining the effectiveness and safety of various combination therapies. These included combinations of INCS, INAH, oral antihistamines (OAH), and leukotriene receptor antagonists (LTRA). The analysis adhered to PRISMA standards and utilized a random-effects model to ascertain robust comparisons.
As found, INCS + INAH was the most beneficial in improving both Total Nasal Symptom Score (TNSS) and total ocular symptoms. Additionally, this combo, along with INCS and OAH, remarkably enhanced patients’ quality of life, as gauged by the Rhinitis Quality of Life Questionnaire (RQLQ). However, INCS + INAH was also linked with a slightly increased risk of adverse events, most commonly a bitter taste. Despite this, researchers highlight that the overall safety profile remained acceptable.
Hence, combination therapies, especially INCS + INAH, should be considered frontline strategies for moderate-to-severe AR. For those intolerant to the bitter taste, an alternative such as OAH + INCS could be considered.
International Forum of Allergy & Rhinology
Efficacy and Safety of Combined Pharmacotherapies in Moderate-to-Severe Allergic Rhinitis: A Network Meta-Analysis
Yuan Zhang et al.
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