Intranasal corticosteroid and intranasal antihistamine therapies did a better job of alleviating nasal and ocular symptoms in allergic rhinitis than intranasal corticosteroid therapy alone, according to a review. Examples of these medications include fluticasone or mometasone nasal sprays (corticosteroids,) plus azelastine or olopatadine nasal sprays (antihistamines.)
The combination also more significantly improved quality of life, Minji Kim, MD, PhD, of the department of pediatrics at Chungnam National University Sejong Hospital, Sejong, Korea, and colleagues wrote in the review, which was published in Allergy. The review assessed 13 randomized controlled trials, with 10 evaluating differences in symptom scores and 12 describing adverse events. The combination of intranasal corticosteroid (INCS) and intranasal antihistamine (INAH) therapies produced a more significant reduction in mean morning and evening 12-hour reflective total nasal symptom scores (TNSS) than INCS monotherapy (mean deviation [MD] = –0.44; 95% CI, –0.61 to –0.27; I2 = 8%).
The combination also produced a more significant reduction in total ocular symptom scores than INCS monotherapy (MD = –0.62; 95% CI, –1.05 to –0.19; I2 = 36%). However, it did not lead to a more significant reduction in total symptom score (TSS; MD = –0.53; 95% CI, –2.83 to 1.77; I2= 99%).Further, total mean Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores significantly improved with the combined therapy (MD = –0.24; 95% CI, –0.42 to –0.06; I2 = 79%). However, the combination treatment did not exceed the thresholds of minimally clinically important differences of 0.28 for TNSS or 0.5 for RQLQ.
The researchers also found significantly greater risks for treatment-emergent adverse events with INCS/INAH combination therapy than with INCS monotherapy (RR = 1.52; 95% CI, 1.28-1.81; I2 = 1%). The risk is especially great, the researchers found, for dysgeusia, or a bad or bitter taste in the mouth or throat (RR = 7.4; 95% CI, 3.6-15.23; I2 = 0%). The researchers did not find a significant risk with the combination therapy for serious adverse events (RR = 1.72; 95% CI, 0.47-6.38; I2 = 0%).
Overall, the researchers called INCS/INAH combination therapy significantly better for alleviating nasal and ocular symptoms and improving quality of life among patients with allergic rhinitis than INCS monotherapy. The researchers cautioned, however, that there were uncertainties related to bias in the studies they reviewed, along with deviations from intended interventions and missing outcome data. They recommended further studies to verify the potential therapeutic utility of combination therapy compared with monotherapy.