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Evidence summaries

Intranasal Corticosteroids Versus Oral Antihistamines in Allergic Rhinitis

Intranasal corticosteroids are more effective than oral antihistamines for allergic rhinitis. Level of evidence: "A"

A systematic review 1 including 16 studies with a total of 2267 subjects was abstracted in DARE. The corticosteroids tested were beclomethasone (336 µg, 400 µg), budesonide (200 µg, 400 µg), fluticasone (200 µg), and triamcinolone (220 µg). The H1 receptor antagonists tested were dexchlorpheniramine (12 mg), terfenadine (120 mg), loratadine (10 mg) and cetirizine (10 mg). The effect on sneezing, total nasal symptoms, and eye symptoms were significantly heterogeneous between studies. Other combined outcomes were homogeneous. Intranasal corticosteroids produced significantly greater relief than oral antihistamines of nasal blockage (SMD -0.63, 95% CI -0.73 to -0.53), nasal discharge (SMD -50, 95% CI -0.60 to -0.40), sneezing (SMD -0.49, 95% CI -0.59 to -0.39), nasal itch (SMD -0.38, 95% CI -0.49 to -0.27), postnasal drip (SMD -0.24, 95% CI -0.42 to -0.06), and total nasal symptoms (OR 0.26, 95% CI 0.08 to 0.8). There was no significant difference between intranasal corticosteroids and oral antihistamines on eye symptoms.

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