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What's the Preferred First-Line Treatment for Allergic Rhinitis?

Sufferers from allergic rhinitis now enjoy a wide array of therapies for their bothersome affliction, leading to uncertainty about which ones work best. The most commonly prescribed medications are intranasal corticosteroids and oral antihistamines. These investigators performed a meta-analysis to assess the comparative effects of these two therapies on different allergic symptoms.

A total of 16 randomized, controlled trials with 2,267 subjects were evaluated. Outcomes included nasal symptoms (blockage, discharge, sneezing, itch, postnansal drip, discomfort, resistance, and total nasal symptoms), eye symptoms, and global assessment. Steroids gave significantly more relief than antihistamines for nasal blockage, discharge, sneezing, itch, postnasal drip, and total nasal symptoms. Compared with antihistamines, steroids had an odds ratio of 0.26 for deterioration of symptoms, according to global ratings. There were no differences between treatments for nasal discomfort, nasal resistance, and eye symptoms. All 3 studies that evaluated cost-effectiveness favored nasal steroids.

Comment: Although part of the analysis was confounded by the inclusion of studies with differences in scoring symptoms, the majority of the findings were very strong. These findings, coupled with safety data and cost-effectiveness data, make it clear that nasal steroids deserve to be first-line therapy for allergic rhinitis. A large recently published trial came to the same conclusion as this meta-analysis (see JW Oct 1 1998, p. 152, accession number 980908001, and J Fam Pract 1998; 47:118).

— KI Marton

Published in Journal Watch General Medicine January 26, 1999

Citation(s):

Weiner JM et al. Intranasal corticosteroids versus oral H₁ receptor antagonists in allergic rhinitis: Systematic review of randomised controlled trials. BMJ 1998 Dec 12 317 1624-1629.

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