Comment:The quality of evidence is downgraded by study quality (unclear allocation concealment) and imprecise results (few trials in comparisons).
A Cochrane review [Abstract] 1 included 13 studies with a total of 2045 subjects. The patients had mainly perennial rhinitis symptoms and negative allergy tests. Most studies were conducted in a secondary or tertiary healthcare setting. No studies reported outcomes beyond 3 months follow-up. Intranasal corticosteroid (INC) dosage ranged from 50 to 2000 µg daily. INCs improve patient-reported disease severity as measured by total nasal symptom score at up to 4 weeks (SMD -0.74, 95% CI -1.15 to -0.33; 4 studies, n=131). However, between 4 weeks and 3 months the evidence is uncertain (SMD -0.24, 95% CI -0.67 to 0.20; 3 studies; n=85). INC treatment slightly improves patient-reported disease severity as measured by total nasal symptom score change from baseline to 4 weeks (SMD -0.15, 95% CI -0.25 to -0.05; 4 studies, n=1465). The risk of epistaxis is higher in the INC group (RR 2.10, 95% CI 1.24 to 3.57; 4 studies, n=1174). The absolute risk difference (RD) was 0.04 with a number needed to treat for an additional harmful outcome (NNTH) of 25 (95% CI 16.7 to 100). Two studies (n=55) provided data for the objective measurements of airflow. Neither found a difference between INCs and placebo (rhinomanometry SMD -0.46, 95% CI -1.06 to 0.14; peak expiratory flow rate SMD 0.78, 95% CI -0.47 to 2.03). I
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