title: Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis.
abstract: The purpose of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the symptomatic management of corticosteroid nasal spray plus antihistamine (oral or local spray) with that of either therapy given alone, or placebo in patients with allergic rhinitis (AR). The PRISMA guidelines for meta-analysis reporting were followed. Total nasal symptom scores and individual nasal symptom scores were pooled after assessing heterogeneity among studies. The pooled estimates were expressed as weighted mean differences (WMD) between treatments. A total of ten studies fulfilled eligibility. Three trials studied the combination therapy of corticosteroid nasal spray and oral antihistamine. Pooled results of two trials failed to show significant difference on total nasal symptoms between combination therapy and intranasal corticosteroid alone (WMD = -0.20, 95 % CI -0.38 to -0.01, P = 0.04). The qualitative analysis showed that combination therapy has greater efficacy than oral antihistamines alone or placebo in improving symptoms. Seven trials investigated corticosteroid nasal spray plus antihistamine nasal spray. The cumulative meta-analysis of six RCTs revealed that combination therapy was superior to solo intranasal corticosteroid (WMD = -1.16, 95 % CI -1.49 to -0.83, P < 0.00001), solo intranasal antihistamine (WMD = -1.73, 95 % CI -2.08 to -1.38, P < 0.00001), and placebo (WMD = -2.81, 95 % CI -3.16 to -2.47, P < 0.00001) in improving total nasal symptom scores. Intranasal corticosteroid plus oral antihistamine have similar efficacy to intranasal corticosteroid alone, greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients. Intranasal corticosteroid plus intranasal antihistamine are significantly superior to either therapy given alone, or placebo.
authors.affiliation: Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, 519020, China.
authors.forename: Shaoyan
authors.initials: S
authors.lastname: Feng
authors.affiliation: Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, 519020, China. 13926927889@139.com.
authors.forename: Yunping
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
authors.forename: Zibin
authors.initials: Z
authors.lastname: Liang
authors.affiliation: Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Renqiang
authors.initials: R
authors.lastname: Ma
authors.affiliation: Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
authors.forename: Wanwei
authors.initials: W
authors.lastname: Cao
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000336:Aerosols; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage; D006634:Histamine H1 Antagonists / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D059085:Nasal Sprays; D016032:Randomized Controlled Trials as Topic; D065631:Rhinitis, Allergic / Q000188:drug therapy; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000336:Aerosols; D006633:Histamine Antagonists; D006634:Histamine H1 Antagonists; D059085:Nasal Sprays
keywords: Allergic rhinitis; Antihistamine; Corticosteroid nasal spray; Efficacy