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Allergic Rhinitis: Intranasal Steroids or Antihistamines?

Am Fam Physician. 1999 Apr 1;59(7):1997-1998.

Allergic rhinitis is a common condition that appears to be increasing dramatically in prevalence. Besides local symptoms, rhinitis can cause fatigue, diminish work performance and quality of life, and predispose patients to sinusitis and otitis. The two principal treatment strategies are intranasal corti-costeroids and systemic antihistamines (H1-receptor antagonists) but, despite multiple studies, the choice of therapy is often arbitrary. Weiner and colleagues conducted a meta-analysis of randomized, controlled trials to compare the efficacy of antihistamines and intranasal corticosteroids in the management of allergic rhinitis.

Searches of literature databases and contact with researchers identified 16 trials that met the study's criteria for quality. These trials included 2,267 patients and generally assessed the effect of therapy on nasal blockage, itch, discharge, sneezing, postnasal drip and general nasal discomfort.

Apart from one study in which oral therapy was shown to provide better relief of sneezing, intranasal steroids provided significantly greater relief of symptoms in all categories in every study. No significant difference was found between the two therapies in relief of eye symptoms.

The authors conclude that despite methodologic differences between the studies, the finding that intranasal steroids provide superior symptomatic relief in allergic rhinitis is remarkably consistent. No evidence of severe adverse effects have been found even after five years of continuous use. Steroids also were more cost effective than oral antihistamines as first-line therapy. The authors propose that oral antihistamines may be best used as ancillary therapy, particularly in patients with eye symptoms.

Weiner JM, et al. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ. December 12, 1998;317:1624–9.


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