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For allergic rhinitis (AR), intranasal corticosteroids (INCS) are the first-line standard-of-care.
Medication adherence to intranasal corticosteroids in allergic rhinitis remains suboptimal, primarily due to forgetfulness, sensory dissatisfaction, and concerns about adverse effects, despite a favorable safety profile.
For allergic rhinitis (AR), intranasal corticosteroids (INCS) are the first-line standard-of-care. Despite proven clinical potency in controlling nasal congestion, rhinorrhea, sneezing, and itching, real-world medication adherence, safety perceptions, and sensory preferences markedly influence treatment outcomes. Evaluating these factors is fundamental to optimizing long-term AR management and patient satisfaction.
This systematic review and meta-analysis evaluated medication adherence rates, sensory characteristics (scent, taste, aftertaste), and adverse effects linked with INCS in intermittent and persistent AR.
Literature search was executed across the Cochrane Library, Scopus, Web of Science, and PubMed, for English-language studies. Eligible studies incorporated randomized controlled trials (RCTs) and observational studies involving adults (≥18 years) diagnosed with AR and treated with INCS therapy. Data on adherence, patient-reported sensory attributes, and safety outcomes were extracted and analyzed.
A total of 31 studies encompassing 10,582 adult AR sufferers were incorporated, consisting of 10 cross-sectional studies and 21 RCTs. Reported adherence rates to INCS varied widely, ranging from 28% to 87%, with a pooled average of 55.8%, indicating suboptimal compliance.
The leading cause of non-adherence was forgetfulness (63.1–77.8%), followed by experienced adverse events (26.4–61.5%) and concerns regarding potential side effects (3.8–31.5%). Sensory factors also influenced patient preference and adherence, with scent (38%), taste (28.5%), and aftertaste (24.3%) emerging as key differentiators among INCS formulations.
Commonly reported adverse events encompassed headache, epistaxis (nosebleeds), nasopharyngitis, nasal dryness, and nasal irritation. A meta-analysis of 8 RCTs illustrated no vital difference in overall adverse event risk between INCS and control groups (risk ratio 1.05), confirming the favorable safety profile of INCS therapy.
Adherence to INCS in AR remains suboptimal, primarily owing to forgetfulness, sensory dissatisfaction, and concerns regarding adverse effects. Addressing these barriers via patient education, improved formulation design, reminder strategies, and individualized treatment plans may boost long-term adherence and clinical outcomes. A multimodal, patient-centered approach is recommended to maximize INCS efficacy for AR.
Asian Pacific Journal of Allergy and Immunology
Medication adherence, sensory attributes, and adverse effects of intranasal corticosteroids in allergic rhinitis patients: A systematic review and meta-analysis
Baharudin Abdullah et al.
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