title: Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis.
abstract: BACKGROUND
  Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007.
  
  
  OBJECTIVE
  To compare INS with nonsedating OAs as treatments for AR.
  
  
  METHODS
  The systematic review and meta-analysis were based on the Grades of Recommendation, Assessment, Development, and Evaluation principles and the Patient, Intervention, Comparison, and Outcome approach. Primary literature was searched up to January 22, 2015. Criteria for eligibility were randomized controlled trials that compared the efficacy and/or adverse effects of INS and OA in patients with AR. Continuous outcome data were analyzed by using standardized mean differences (SMD) for multiple outcome measures, and mean differences in the case of a single study or outcome. Pooled estimates of effects, 95% confidence interval (CI), were calculated by using random-effects models.
  
  
  RESULTS
  The meta-analysis included five randomized controlled trials with a total of 990 patients. INS were superior to OAs in improving total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]) and in relieving the following: nasal obstruction (SMD -0.56 [95% CI, -0.82 to -0.29]), rhinorrhea (SMD -0.47 [95% CI, -1.00 to 0.05]), nasal itching (SMD -0.42 [95% CI, -0.65 to -0.18]), sneezing (SMD -0.52 [95% CI, -0.73 to -0.32]), and quality of life mean difference -0.90 [95% CI, -1.18 to -0.62]). There was no difference in relief of ocular symptoms (SMD -0.08 [95% CI, -0.23 to 0.08]). In addition, four randomized controlled trials were included in a narrative analysis. The results in the narrative analysis were comparable with those found in the meta-analysis.
  
  
  CONCLUSIONS
  INS were superior to OAs in improving nasal symptoms and quality of life in patients with AR.
authors.affiliation: Department of Dermatology and Allergology, Copenhagen University Hospital, Gentofte, Denmark.
authors.forename: Nanna
authors.initials: N
authors.lastname: Juel-Berg
authors.forename: Peter
authors.initials: P
authors.lastname: Darling
authors.forename: Julie
authors.initials: J
authors.lastname: Bolvig
authors.forename: Majken H
authors.initials: MH
authors.lastname: Foss-Skiftesvik
authors.forename: Susanne
authors.initials: S
authors.lastname: Halken
authors.forename: Lone
authors.initials: L
authors.lastname: Winther
authors.forename: Kirsten Skamstrup
authors.initials: KS
authors.lastname: Hansen
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Askjaer
authors.forename: Steffen
authors.initials: S
authors.lastname: Heegaard
authors.forename: Anders R
authors.initials: AR
authors.lastname: Madsen
authors.forename: Morten S
authors.initials: MS
authors.lastname: Opstrup
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D006801:Humans; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones