Meta Analysis Study and Systemic Review of the Efficacy of Combination of H1 Antihistamine with Intranasal Corticosteroid in Management of Allergic Rhinitis

A.E.Abd El-Raouf1, M.F.Shendy1, N.G.Kazeem1, M.A.El-Awady2, M.M.S.Ibrahim1"


A combination of Intranasal H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (INAH-INCS) for treating AR using meta analysis and up to date with different upcoming new modalities. Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of INAH-INCS vs INCS monotherapy for treating patients with AR were included. The primary (main) outcome was reflective total nasal symptom scores (rTNSS). The secondary outcomes were disease-specific Rhinoconjunctivitis quality of life Questionnaire (RQLQ) and adverse events. Seven studies (1616 patients) met the inclusion criteria. Six of them used in study difference of rTNSS , Three of them in study difference of RQLQ and Two of them in study of adverse events (headache,epistaxis,URTI and nausea) . Compared with INCS, INAH-INCS decreased reflective total nasal symptom scores (standardized mean difference [SMD], – 0.178; 95% confidence interval [CI], -0.295 to-0.060; p =0.003) favoring INCs / INAH over INCs alone or OAH alone. Subgroup analysis indicated no benefit with the INAH-INCS combination in RQLQ or Adverse events . This systematic review favors the combination of Intranasal AH plus INCS over INCS alone. There were no differences between use of the oral AH plus INCS combination and INCS alone. Also, we found no differences between the 2 groups with regard to adverse events.

Key words

Antihistamines, Histamine antagonist, Steroids, Corticos- teroids, Allergic rhinitis.