Intranasal Versus Oral Treatments for Allergic Rhinitis: A Systematic Review With Meta-Analysis.

Data de publicação: 01/01/2024 Data Ahead of Print: 07/09/2024

Autores da FMUP

João De Almeida Lopes Da Fonseca

Autor

Participantes de fora da FMUP

Torres MI
Gil-Mata S
Bognanni A
Ferreira-da-Silva R
Yepes-Nuñez JJ
Lourenço-Silva N
Cardoso-Fernandes A
Ferreira A
Ferreira-Cardoso H
Portela D
Teles J
Kvedariene V
Torres MJ
Klimek L
Pfaar O
Brussino L
Zuberbier T
Schünemann H
Bousquet J
Sousa-Pinto B
Vieira RJ
Allergic Rhinitis and its Impact on Asthma 2024 Guideline Panel

Unidades de investigação

Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
Medicina da Comunidade, Informação e Decisão em Saúde
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

BACKGROUND: Treatments for allergic rhinitis include intranasal or oral medications. OBJECTIVE: To perform a systematic review with meta-analysis comparing the effectiveness of intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists in improving allergic rhinitis symptoms and quality of life. METHODS: We searched four bibliographic databases and three clinical trial datasets for randomized controlled trials (1) assessing patients aged 12 years and older with seasonal or perennial allergic rhinitis, and (2) comparing intranasal corticosteroids or antihistamines versus oral antihistamines or leukotriene receptor antagonists. We performed a meta-analysis of the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals owing to adverse events. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: We included 35 studies, most of which assessed patients with seasonal allergic rhinitis and displayed an unclear risk of bias. Superiority of intranasal treatments was found for all assessed outcomes. Intranasal corticosteroids were more effective than oral antihistamines at improving the TNSS (mean difference [MD], -0.86; 95% CI, -1.21 to -0.51; I(2) = 70%), Total Ocular Symptom Score (MD, -0.36; 95% CI, -0.56 to -0.17; I(2) = 0%), and RQLQ (MD, -0.88; 95% CI, -1.15 to -0.61; I(2) = 0%), which were mostly associated with clinically meaningful improvements. Superiority of intranasal corticosteroids at improving the TNSS was also found against oral leukotriene receptor antagonists (MD, -1.05; 95% CI, -1.33 to -0.77). Intranasal antihistamines were more effective than oral antihistamines at improving the TNSS (MD, -0.47; 95% CI, -0.81 to -0.14; I(2) = 0%) and RQLQ (MD, -0.31; 95% CI, -0.56 to -0.06; I(2) = 0%). CONCLUSIONS: Randomized controlled trials suggest that intranasal treatments are more effective than oral treatments at improving symptoms and quality of life in seasonal allergic rhinitis.

Dados da publicação

ISSN/ISSNe:: 2213-2198, 2213-2201
Tipo:: Article
Páginas:: 3404-3418
DOI:: 10.1016/j.jaip.2024.09.001
Link para outro recurso:: www.scopus.com

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Torres MI:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Gil-Mata S:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Bognanni A:: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
Ferreira-da-Silva R:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Yepes-Nuñez JJ:: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

School of Medicine, Universidad de los Andes, Bogotá, Colombia

Fundación Santa Fé de Bogota, Bogotá D.C., Colombia
Lourenço-Silva N:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Cardoso-Fernandes A:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Ferreira A:: CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal

Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
Ferreira-Cardoso H:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Portela D:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Teles J:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Kvedariene V:: Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Torres MJ:: Allergy Unit, Málaga Regional University Hospital of Málaga, Malaga University, ARADyAL, Malaga, Spain
Klimek L:: Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany

Center for Rhinology and Allergology, Wiesbaden, Germany
Pfaar O:: Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
Brussino L:: Department of Medical Sciences, University of Torino, Torino, Italy

Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
Zuberbier T:: Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
Fonseca JA:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Schünemann H:: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Clinical Epidemiology and Research Center, Humanitas University and Humanitas Research Hospital, Milan, Italy
Bousquet J:: Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany

Allergic Rhinitis and Its Impact on Asthma, Montpellier, France
Sousa-Pinto B:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Vieira RJ:: MEDCIDS, Department of Community Medicine, Information, and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal

CINTESIS@RISE, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

Keywords

Allergic rhinitis; GRADE approach; Intranasal antihistamines; Intranasal corticosteroids; Leukotriene receptor antagonists; Meta-analysis; Oral antihistamines