Abstract
To date the evidence for use of antihistamines in the treatment of rhinosinusitis has been limited and controversial. A meta-analysis of randomized control trials (RCTs) investigating the effect of antihistamines in 184 patients with rhinosinusitis has recently demonstrated that the antihistamine loratadine significantly reduced nasal obstruction in allergic rhinitis (AR) patients with acute rhinosinusitis, but did not improve total nasal symptom score or rhinorrhea symptom [1]. Similarly, another meta-analysis involving 18 RCTs with 4342 patients suffering from acute viral rhinosinusitis has shown that antihistamines have a limited beneficial effect on severity of overall symptoms in adults in the short-term (days 1 and 2 of treatment), but not in mid to long term [2]. Braun and colleagues [3] have evaluated the adjunct effect of loratadine in acute exacerbation of sinusitis in patients with AR and found that loratadine provided additional improvement in control of sinusitis symptoms [3]. A study by McCormick and colleagues [4], however, has demonstrated that the effect of antihistamines was not significantly different compared to placebo in patients with acute rhinosinusitis. Desloratadine, a second-generation H1-antihistamine, has been found to inhibit cell activation in nasal polyps, indicating that this antihistamine might be useful in modulating the development of nasal polyps [5]. Indeed, another study has shown that desloratadine could also inhibit eosinophil inflammation in vitro, and that this effect was amplified in combination with mometasone furoate [6]. One clinical trial has demonstrated that while cetirizine also significantly reduces nasal sneezing and rhinorrhea compared to placebo, it does not have any effect on the number or size of polyps [7].
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Lou, H., Huang, Y., Zhang, L. (2022). Antihistamine. In: Zhang, L., Bachert, C. (eds) Chronic Rhinosinusitis. Springer, Singapore. https://doi.org/10.1007/978-981-16-0784-4_42
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