https://orcid.org/0000-0003-3596-6625
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ABSTRACT
Background
The aim of this study was to assess the efficacy and safety of oral antihistamines (AHs), intranasal antihistamines (INAH) intranasal glucocorticosteroids (INCS), subcutaneous immunotherapy (SCIT), and sublingual immunotherapy (SLIT) in the management of allergic rhinitis (AR). The authors focused on the division into selected AR’s triggers: house dust mites (HDMs), grass pollen, and birch pollen.
Methods
For each drug and allergen class, a meta-analysis of the efficacy and adverse events (AEs) was performed. The obtained results were presented as a therapeutic index (TIX-Score).
Results
Twenty-seven randomized clinical trials (RCTs) were included. The best total efficacy was observed for: HDMs for INCS and grass pollen for combination of INCS with INAH in a single device and for INAH. Considering the data that was obtained for birch pollen, SLIT showed statistically significant total efficacy. Summation scores for efficacy and AEs showed highest TIX-Score for combination of INCS and INAH in a single device in grass pollen.
Conclusions
Treatment methods selected for this review may serve as an effective and safe treatment in reducing perennial and seasonal AR’s symptoms. However, due to high heterogeneity probably associated with potential confounders existence in control in some cases, results should be interpreted with caution.
Abbreviations
| AAdSS | = | Average Adjusted Symptom Score |
| AEs | = | Adverse events |
| AHs | = | Antihistamines |
| AI | = | AllergenImmunotherapy |
| AR | = | Allergic rhinitis |
| ARC | = | Allergic rhinoconjunctivitis |
| AUN/mL | = | Allergy Units Native |
| AZE | = | Azelastine |
| BDP | = | Beclomethasone dipropionate |
| CI | = | Confidence Interval |
| CSS | = | Composite Symptoms Score |
| EEC | = | Environmental Exposure Chamber |
| FAS | = | Full Analysis Set |
| FAS-NE | = | Full Analysis Set of the north‐east region |
| FFNS | = | Fluticasone furoate nasal spray |
| FP | = | Fluticasone propionate |
| GCs | = | Glucocorticosteroids |
| HDMs | = | House dust mites |
| I2 | = | Heterogeneity |
| IgE | = | Immunoglobulin E |
| INAH | = | Intranasal antihistamines |
| INCS | = | Intranasal glucocorticosteroids |
| IR | = | Index of Reactivity |
| iTNSS | = | instantaneous Total Nasal Symptom Score |
| MD | = | Mean Difference |
| MSCS | = | Mean Symptom Complex Severity Score |
| NCS | = | Nasal Congestion Score |
| OSS | = | Ocular Symptom Score |
| P | = | p-value |
| PAR | = | Perennial allergic rhinitis |
| PNSS | = | Physician-Assessed Overall Nasal Signs and Symptoms Severity Score |
| PPS | = | Per‐Protocol Set |
| QoL | = | Quality of Life |
| RCTs | = | Randomized clinical trials |
| RMS | = | RescueMedication Score |
| RQLQ | = | Rhinoconjunctivitis Quality of Life Questionnaire |
| RR | = | Risk Ratio |
| rTNSS | = | reflective Total Nasal Symptom Score |
| rTOSS | = | reflective Total Ocular SymptomScore |
| RTSS | = | Rhinoconjunctivitis Total Symptom Score |
| SAR | = | Seasonal allergic rhinitis |
| SB | = | Sublingual liquid birch pollen preparation |
| SCIT | = | SubcutaneousImmunotherapy |
| SD | = | Standard Deviation |
| SE | = | Standard Error |
| SLIT | = | Sublingual Immunotherapy |
| SMD | = | Standardized Mean Difference |
| SMS | = | Symptom Medication Scores |
| T5SS | = | Total 5 Symptoms Score |
| TIX-Score | = | tTherapeutic Index |
| TNPT | = | Titrated NasalProvocation Test |
| TNSS | = | Total Nasal Symptoms Score |
| TSSC | = | Total Symptom Severity Complex |
| VAS | = | Visual Analogue Scale |
| VCC | = | Vienna Challenge Chamber |
Author contributions
Monika Marko: Data curation; formal analysis; investigation; methodology; writing, review and editing.
Rafał Pawliczak: Conceptualization; funding acquisition; project administration; writing, review and editing.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2241364