Juel-Berg Nanna, Darling Peter, Bolvig Julie, Foss-Skiftesvik Majken H, Halken Susanne, Winther Lone, Hansen Kirsten Skamstrup, Askjaer Nikolaj, Heegaard Steffen, Madsen Anders R, Opstrup Morten S
Department of Dermatology and Allergology, Copenhagen University Hospital, Gentofte, Denmark.
Am J Rhinol Allergy. 2017 Jan 9;31(1):19-28. doi: 10.2500/ajra.2016.30.4397.
Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007.
To compare INS with nonsedating OAs as treatments for AR.
The systematic review and meta-analysis were based on the Grades of Recommendation, Assessment, Development, and Evaluation principles and the Patient, Intervention, Comparison, and Outcome approach. Primary literature was searched up to January 22, 2015. Criteria for eligibility were randomized controlled trials that compared the efficacy and/or adverse effects of INS and OA in patients with AR. Continuous outcome data were analyzed by using standardized mean differences (SMD) for multiple outcome measures, and mean differences in the case of a single study or outcome. Pooled estimates of effects, 95% confidence interval (CI), were calculated by using random-effects models.
The meta-analysis included five randomized controlled trials with a total of 990 patients. INS were superior to OAs in improving total nasal symptoms score (SMD -0.70 [95% CI, -0.93 to -0.47]) and in relieving the following: nasal obstruction (SMD -0.56 [95% CI, -0.82 to -0.29]), rhinorrhea (SMD -0.47 [95% CI, -1.00 to 0.05]), nasal itching (SMD -0.42 [95% CI, -0.65 to -0.18]), sneezing (SMD -0.52 [95% CI, -0.73 to -0.32]), and quality of life mean difference -0.90 [95% CI, -1.18 to -0.62]). There was no difference in relief of ocular symptoms (SMD -0.08 [95% CI, -0.23 to 0.08]). In addition, four randomized controlled trials were included in a narrative analysis. The results in the narrative analysis were comparable with those found in the meta-analysis.
INS were superior to OAs in improving nasal symptoms and quality of life in patients with AR.
鼻内用糖皮质激素（INS）（糖皮质激素鼻喷雾剂）和口服抗组胺药（OA）是变应性鼻炎（AR）患者最常用的两种治疗方法。据我们所知，尚无关于该主题的系统评价，包括2007年后发表的试验。
比较INS与非镇静性OA治疗AR的效果。
本系统评价和荟萃分析基于推荐分级、评估、制定与评价（GRADE）原则以及患者、干预措施、对照和结局（PICO）方法。检索截至2015年1月22日的原始文献。纳入标准为比较INS与OA对AR患者疗效和/或不良反应的随机对照试验。连续型结局数据采用标准化均数差值（SMD）分析多个结局指标，单项研究或结局则采用均数差值分析。采用随机效应模型计算效应合并估计值及95%置信区间（CI）。
荟萃分析纳入5项随机对照试验，共990例患者。INS在改善总鼻症状评分（SMD -0.70 [95% CI，-0.93至-0.47]）以及缓解以下症状方面优于OA：鼻塞（SMD -0.56 [95% CI，-0.82至-0.29]）、流涕（SMD -0.47 [95% CI，-1.00至0.05]）、鼻痒（SMD -0.42 [95% CI，-0.65至-0.18]）、打喷嚏（SMD -0.52 [95% CI, -0.73至-0.32]）以及生活质量均数差值-0.90 [95% CI，-1.18至-0.62]）。眼部症状缓解方面无差异（SMD -0.08 [95% CI，-0.23至0.08]）。此外，4项随机对照试验纳入叙述性分析。叙述性分析结果与荟萃分析结果相当。
INS在改善AR患者鼻症状和生活质量方面优于OA。
