Skip to main content

Advertisement

SpringerLink
Log in

Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The purpose of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the symptomatic management of corticosteroid nasal spray plus antihistamine (oral or local spray) with that of either therapy given alone, or placebo in patients with allergic rhinitis (AR). The PRISMA guidelines for meta-analysis reporting were followed. Total nasal symptom scores and individual nasal symptom scores were pooled after assessing heterogeneity among studies. The pooled estimates were expressed as weighted mean differences (WMD) between treatments. A total of ten studies fulfilled eligibility. Three trials studied the combination therapy of corticosteroid nasal spray and oral antihistamine. Pooled results of two trials failed to show significant difference on total nasal symptoms between combination therapy and intranasal corticosteroid alone (WMD = −0.20, 95 % CI −0.38 to −0.01, P = 0.04). The qualitative analysis showed that combination therapy has greater efficacy than oral antihistamines alone or placebo in improving symptoms. Seven trials investigated corticosteroid nasal spray plus antihistamine nasal spray. The cumulative meta-analysis of six RCTs revealed that combination therapy was superior to solo intranasal corticosteroid (WMD = −1.16, 95 % CI −1.49 to −0.83, P < 0.00001), solo intranasal antihistamine (WMD = −1.73, 95 % CI −2.08 to −1.38, P < 0.00001), and placebo (WMD = −2.81, 95 % CI −3.16 to −2.47, P < 0.00001) in improving total nasal symptom scores. Intranasal corticosteroid plus oral antihistamine have similar efficacy to intranasal corticosteroid alone, greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients. Intranasal corticosteroid plus intranasal antihistamine are significantly superior to either therapy given alone, or placebo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC (2007) A survey of the burden of allergic rhinitis in Europe. Allergy 85:17–25

    Article  Google Scholar 

  2. Schatz M (2007) A survey of the burden of allergic rhinitis in the USA. Allergy 85:9–16

    Article  Google Scholar 

  3. Bauchau V, Durham SR (2004) Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 24:758–764

    Article  CAS  PubMed  Google Scholar 

  4. Bachert C, van Cauwenberge P, Olbrecht J, van Schoor J (2006) Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy 61:693–698

    Article  CAS  PubMed  Google Scholar 

  5. Nathan RA, Meltzer EO, Derebery J, Campbell UB, Stang PE, Corrao MA, Allen G, Stanford R (2008) The prevalence of nasal symptoms attributed to allergies in the United States: findings from the burden of rhinitis in an America survey. Allergy Asthma Proc 29:600–608

    Article  PubMed  Google Scholar 

  6. Zhang Yuan, Zhang Luo (2014) Prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res 6:105–113

    Article  PubMed  Google Scholar 

  7. Bousquet J, Neukirch F, Bousquet PJ, Gehano P, Klossek JM, Le Gal M, Allaf B (2006) Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol 117:158–162

    Article  PubMed  Google Scholar 

  8. Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A (2007) Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case–control study. J Allergy Clin Immunol 120:381–387

    Article  PubMed  Google Scholar 

  9. Muliol J, Maurer M, Bousquet J (2008) Sleep and allergic rhinitis. J Investig Allergol Clin Immunol 18:415–419

    CAS  PubMed  Google Scholar 

  10. Dalal AA, Stanford R, Henry H, Borah B (2008) Economic burden of rhinitis in managed care: a retrospective claims data analysis. Ann Allergy Asthma Immunol 101:23–29

    Article  PubMed  Google Scholar 

  11. Delafuente JC, Davis TA, Davis JA (1989) Pharmacotherapy of allergic rhinitis. Clin Pharm 8:474–485

    CAS  PubMed  Google Scholar 

  12. Lieberman P (2009) Intranasal antihistamines for allergic rhinitis: mechanism of action. Allergy Asthma Proc 30:345–348

    Article  CAS  PubMed  Google Scholar 

  13. Levenson T, Greenberg PA (1996) Immunologic effects of intranasal corticosteroids. Allergy Asthma Proc 17:157–159

    Article  CAS  PubMed  Google Scholar 

  14. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schünemann HJ, Global Allergy and Asthma European Network, Grading of Recommendations Assessment, Development and Evaluation Working Group (2010) Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 126:466–476

    Article  PubMed  Google Scholar 

  15. Akerlund A, Andersson M, Leflein J, Lildholdt T, Mygind N (2005) Clinical trial design, nasal allergen challenge models, and considerations of relevance to pediatrics, nasal polyposis, and different classes of medications. J Allergy Clin Immunol 115:460–482

    Article  Google Scholar 

  16. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O’Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D, World Health Organization; GA(2)LEN; AllerGen (2008) Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 63:8–160

    Article  PubMed  Google Scholar 

  17. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration. http://www.cochrane-handbook.org. Accessed 10 May 2013

  18. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  19. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  20. Song F, Gilbody S (1998) Bias in meta-analysis detected by a simple, graphical test. Increase in studies of publication bias coincided with increasing use of meta-analysis. BMJ 316:471

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Wilson A, Dempsey OJ, Sims EJ, Coutie WJ, Paterson MC, Lipworth BJ (2000) Evaluation of treatment response in patients with seasonal allergic rhinitis using domiciliary nasal peak inspiratory flow. Clin Exp Allergy 30:833–838

    Article  CAS  PubMed  Google Scholar 

  22. Di Lorenzo G, Pacor ML, Pellitteri ME, Morici G, Di Gregoli A, Lo Bianco C, Ditta V, Martinelli N, Candore G, Mansueto P, Rini GB, Corrocher R, Caruso C (2004) Randomized placebo-controlled trial comparing fluticasone aqueous nasal spray in mono-therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonalallergic rhinitis. Clin Exp Allergy 34:259–267

    Article  PubMed  Google Scholar 

  23. Barnes ML, Ward JH, Fardon TC, Lipworth BJ (2006) Effects of levocetirizine as add-on therapy to fluticasone in seasonal allergic rhinitis. Clin Exp Allergy 36:676–684

    Article  CAS  PubMed  Google Scholar 

  24. Berger WE, Fineman SM, Lieberman P, Miles RM (1999) Double-blind trials of azelastine nasal spray monotherapy versus combination therapy with loratadine tablets and beclomethasone nasal spray in patients with seasonal allergic rhinitis. Rhinitis Study Groups. Ann Allergy Asthma Immunol 82:535–541

    Article  CAS  PubMed  Google Scholar 

  25. Ratner PH, Hampel F, Van Bavel J, Amar NJ, Daftary P, Wheeler W, Sacks H (2008) Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 100:74–81

    Article  CAS  PubMed  Google Scholar 

  26. Hampel FC, Ratner PH, Van Bavel J, Amar NJ, Daftary P, Wheeler W, Sacks H (2010) Double-blind, placebo-controlled study of azelastine and fluticasone in a single nasal spray delivery device. Ann Allergy Asthma Immunol 105:168–173

    Article  CAS  PubMed  Google Scholar 

  27. Meltzer EO, LaForce C, Ratner P, Price D, Ginsberg D, Carr W (2012) MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) in the treatment of seasonal allergic rhinitis: a randomized, double-blind, placebo-controlled trial of efficacy and safety. Allergy Asthma Proc 33:324–332

    Article  CAS  PubMed  Google Scholar 

  28. Carr W, Bernstein J, Lieberman P, Meltzer E, Bachert C, Price D, Munzel U, Bousquet J (2012) A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. J Allergy Clin Immunol 129:1282–1289

    Article  CAS  PubMed  Google Scholar 

  29. Meltzer E, Ratner P, Bachert C, Carr W, Berger W, Canonica GW, Hadley J, Lieberman P, Hampel FC, Mullol J, Munzel U, Price D, Scadding G, Virchow JC, Wahn U, Murray R, Bousquet J (2013) Clinically relevant effect of a new intranasal therapy (MP29-02) in allergic rhinitis assessed by responder analysis. Int Arch Allergy Immunol 161:369–377

    Article  CAS  PubMed  Google Scholar 

  30. Fabbri NZ, Abib-Jr E, de Lima ZollnerR (2014) Azelastine and budesonide (nasal sprays): Effect of combination therapy monitored by acoustic rhinometry and clinical symptom score in the treatment of allergic rhinitis. Allergy Rhinol (Providence) 5:78–86

    Article  Google Scholar 

  31. van Cauwenberge P, Bachert C, Passalacqua G, Bousquet J, Canonica GW, Durham SR, Fokkens WJ, Howarth PH, Lund V, Malling HJ, Mygind N, Passali D, Scadding GK, Wang DY (2000) Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 55:116–134

    Article  PubMed  Google Scholar 

  32. Bousquet J, Van Cauwenberge P, Khaltaev N (2001) Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 108:147–334

    Article  Google Scholar 

  33. Ridolo E, Montagni M, Melli V, Braido F, Incorvaia C, Canonica GW (2014) Pharmacotherapy of allergic rhinitis: current options and future perspectives. Expert Opin Pharmacother 15:73–83

    Article  CAS  PubMed  Google Scholar 

  34. Derendorf H, Munzel U, Petzold U, Maus J, Mascher H, Hermann R, Bousquet J (2012) Bioavailability and disposition of azelastine and fluticasone propionate when delivered by MP29-02, a novel aqueous nasal spray. Br J Clin Pharmacol 74:125–133

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Berger WE, Shah S, Lieberman P, Hadley J, Price D, Munzel U, Bhatia S (2014) Long-term, Randomized Safety Study of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) in subjects with chronic rhinitis. J Allergy Clin Immunol Pract 2:179–185

    Article  PubMed  Google Scholar 

  36. Price D, Shah S, Bhatia S, Bachert C, Berger W, Bousquet J, Carr W, Hellings P, Munzel U, Scadding G, Lieberman P (2013) A new therapy (MP29-02) is effective for the long-term treatment of chronic rhinitis. J Investig Allergol Clin Immunol 23:495–503

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Funded by Technology research grant from Zhuhai government (2014D0401990021).

Author information

Authors and Affiliations

  1. Department of Otolaryngology, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Road, Xiangzhou District, Zhuhai, 519020, China

    Shaoyan Feng & Yunping Fan

  2. Department of Radiation Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China

    Zibin Liang

  3. Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China

    Wanwei Cao

  4. Allergy and Cancer Center, Otorhinolarygology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Renqiang Ma

Authors
  1. Shaoyan Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yunping Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zibin Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renqiang Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wanwei Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yunping Fan.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Human and animal rights

The authors declare that no experiments were performed on humans or animals for this investigation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, S., Fan, Y., Liang, Z. et al. Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis. Eur Arch Otorhinolaryngol 273, 3477–3486 (2016). https://doi.org/10.1007/s00405-015-3832-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-015-3832-1

Keywords

Search

Navigation