Nasal corticosteroids and antihistamines are better than oral antihistamines and montelukast.

Guidelines recommend intranasal corticosteroids and antihistamines over oral antihistamines and montelukast for allergic rhinitis, but many providers and patients still favour oral preparations. Researchers conducted a systematic review to compare these products in adolescents and adults with seasonal allergic rhinitis.

Thirty-five randomised controlled trials provided outcomes for total nasal symptom scores and rhinitis quality-of-life scores. Nasal preparations were superior across all outcomes. The largest difference in benefit was seen between nasal corticosteroids and oral montelukast, followed by nasal corticosteroids versus oral antihistamines, and then nasal antihistamines versus oral antihistamines.

Comment: Most patients prefer taking a pill to using a nasal spray, but sprays clearly are more efficacious. For patients with intermittent mild-to-moderate symptoms, as-needed nasal antihistamines (azelastine or olopatadine) are a good option and start working within 15 minutes. For those with more persistent or severe symptoms, nasal corticosteroids (fluticasone, mometasone, triamcinolone or budesonide) are preferable but must be used consistently. And for those whose rhinitis is not controlled by one class of spray, combining nasal corticosteroids and nasal antihistamines is better than adding oral agents.

Avid J. Amrol, MD, Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.

Torres MI, et al. Intranasal versus oral treatments for allergic rhinitis: a systematic review with meta-analysis. J Allergy Clin Immunol Pract 2024; 12: 3404-3418.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.