Combination treatment with intranasal corticosteroid and intranasal antihistamine provides superior relief of symptoms in patients with allergic rhinitis, according to a meta-analysis published in the journal Allergy.¹

Researchers from South Korea conducted a systematic review and meta-analysis to compare the outcomes of combination therapy versus monotherapy. After a search for trials evaluating treatments for allergic rhinitis, 13 randomized-controlled trials were included in the final analysis.

Results showed that significant decrease in the mean morning and evening 12-hour reflective Total Nasal Symptom Score (TNSS) following treatment with the combination of intranasal steroid and intranasal antihistamine compared to intranasal steroid monotherapy (mean deviation -0.44).

Similarly, reduction in the Total Ocular Symptom Score was more with combination treatment than with intranasal steroid treatment alone (MD -0.62). Although a decrease in the total symptom score was seen with the combination treatment vis-à-vis steroid monotherapy, the decline was not significant (MD -0.66).

Patients also reported a better quality of life after treatment with the combination of intranasal steroid and antihistamine as evident by the improvement noted in the total mean Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score versus treatment with intranasal steroid alone (MD -0.24).

More patients treated with the combination reported adverse events related to the treatment with relative risk of 1.52, but not serious events. The most commonly occurring adverse event was dysgeusia (with a relative risk of 7.40.

This study has shown that compared to monotherapy with steroids, intranasal steroids and antihistamines administered together acted in synergism and was associated with significant improvement in the nasal and ocular symptoms in patients with allergic rhinitis. They also had a better quality of life and the treatment was quite well-tolerated. The adverse events associated with the treatment were non-serious in nature.

These findings are in accordance with the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis, which also states that the combination therapy has the advantage of rapid onset of action and more effective relief of symptoms compared to treatment with either intranasal steroid or intranasal antihistamine alone.²

Hence, this combination approach can come to the aid of allergic rhinitis patients with difficult to control oculonasal symptoms or in whom the symptoms are persistent despite treatment with intranasal steroids.

References

1. Minji Kim, et al; Work Group for Rhinitis, the Korean Academy of Asthma, Allergy and Clinical Immunology. Intranasal antihistamine and corticosteroid to treat allergic rhinitis: A systematic review and meta-analysis. Allergy. 2022 Jun 18. doi: 10.1111/all.15415.
2. Wise SK, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018 Feb;8(2):108-352. doi: 10.1002/alr.22073.