Allergic rhinitis is a very common condition affecting approximately 20% of children and adults in the United States. It is characterized by nasal congestion, rhinorrhea, and sneezing as well as various other irritable symptoms. Allergic rhinitis contributes to a significant societal and economic burden as well given the cost of medical visits, pharmacotherapy, and sick days. Regarding treatment for allergic rhinitis, commonly used medications include antihistamine receptor antagonists as well as intranasal corticosteroids. A systematic review and meta-analysis from 2017 compared intranasal corticosteroids with oral antihistamines. Five randomized controlled trials were included in the meta-analysis with a total of 990 patients. The data were analyzed using standard mean differences (SMD) or mean difference for a single study or outcome. Intranasal corticosteroids were superior to oral antihistamines in regards to the following symptoms: total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]), 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). Thus, in the treatment of allergic rhinitis, intranasal corticosteroids should be first line pharmacologic therapy. Oral antihistamines may be used if the primary symptoms are itching, sneezing and rhinorrhea rather than nasal congestion or if intranasal corticosteroids alone are insufficient.
References: Allergic Rhinitis