Nielsen L P, Mygind N, Dahl R
Department of Clinical Pharmacology, University of Aarhus, Denmark.
Drugs. 2001;61(11):1563-79. doi: 10.2165/00003495-200161110-00004.
Whether first-line pharmacological treatment of allergic rhinitis should be antihistamines or intranasal corticosteroids has been discussed for several years. First-generation antihistamines are rarely used in the treatment of allergic rhinitis, mainly because of sedative and anticholinergic adverse effects. On the basis of clinical evidence of efficacy, no second-generation antihistamine seems preferable to another. Similarly, comparisons of topical and oral antihistamines have been unable to demonstrate superior efficacy for one method of administration over the other. Current data documents no striking differences in efficacy and safety parameters between intranasal corticosteroids. When the efficacy of antihistamines and intranasal corticosteroids are compared in patients with allergic rhinitis, present data favours intranasal corticosteroids. Interestingly, data do not show antihistamines as superior for the treatment of conjunctivitis. Safety data from comparative studies in patients with allergic rhinitis do not indicate differences between antihistamines and intranasal corticosteroids. Combining antihistamines and intranasal corticosteroids in the treatment of allergic rhinitis does not provide any additional effect to intranasal corticosteroids alone. On the basis of current data, intranasal corticosteroids seem to offer superior relief in allergic rhinitis than antihistamines.
过敏性鼻炎的一线药物治疗应该使用抗组胺药还是鼻内用糖皮质激素，这一问题已讨论多年。第一代抗组胺药很少用于治疗过敏性鼻炎，主要是因为其具有镇静和抗胆碱能的不良反应。基于疗效的临床证据，没有哪种第二代抗组胺药似乎比另一种更具优势。同样，局部用和口服抗组胺药的比较也未能证明一种给药方法比另一种具有更高的疗效。目前的数据表明，鼻内用糖皮质激素在疗效和安全性参数方面没有显著差异。在过敏性鼻炎患者中比较抗组胺药和鼻内用糖皮质激素的疗效时，目前的数据支持鼻内用糖皮质激素。有趣的是，数据并未显示抗组胺药在治疗结膜炎方面更具优势。过敏性鼻炎患者比较研究的安全性数据并未表明抗组胺药和鼻内用糖皮质激素之间存在差异。在过敏性鼻炎治疗中联合使用抗组胺药和鼻内用糖皮质激素，并不会比单独使用鼻内用糖皮质激素产生任何额外效果。基于目前的数据，鼻内用糖皮质激素在过敏性鼻炎中似乎比抗组胺药能提供更好的缓解效果。
