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Comparison of intranasal vs. oral therapies for AR management

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Created On: 20/01/2026

Allergic rhinitis (AR) is a prevalent ailment typically managed with intranasal or oral medications.

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Key take away

Intranasal treatments outperform oral medications in alleviating symptoms and improving quality of life in seasonal allergic rhinitis.

Background

Allergic rhinitis (AR) is a prevalent ailment typically managed with intranasal or oral medications. Yet, the comparative effectiveness of these treatments remains uncertain, with many clinical recommendations based on low-certainty evidence. This systematic review and meta-analysis evaluated whether intranasal corticosteroids (INCS) or intranasal antihistamines (INAH) provide superior symptom control and quality of life improvements compared with oral antihistamines (OAH) or leukotriene receptor antagonists (LTRA), aiming to clarify optimal management strategies for patients.

Method

The authors carried out a series of randomized controlled trials (RCTs) identified from 4 bibliographic databases and 3 clinical trial registries. Eligible studies enrolled patients aged 12 years and older with seasonal AR (SAR) or perennial AR (PAR) and directly compared INCS or antihistamines with OAH or LTRA.

Key endpoints included rhinoconjunctivitis quality of life questionnaire (RQLQ), total nasal symptom score (TNSS), incidence of adverse events, total ocular symptom score (TOSS), and treatment withdrawals due to adverse events. The certainty of evidence was rigorously examined via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

Result

A total of 35 RCTs evaluating patients with SAR were identified, with most classified as having an unclear risk of bias. INCS and INAH consistently outperformed oral therapies in mitigating nasal and ocular symptoms as well as boosting quality of life in AR patients (Table 1).

Conclusion

INCS and INAH show significantly better symptom control and greater improvements in quality of life compared with OAH or LTRA, with clear superiority demonstrated across nasal symptoms, ocular symptoms, and validated patient-reported outcomes in SAR.