Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Int Forum Allergy Rhinol. 2018 Oct;8(10):1083-1092. doi: 10.1002/alr.22166. Epub 2018 Jun 19.
A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH-INCS) for treating AR.
Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH-INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease-specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events.
Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH-INCS decreased total nasal symptom scores (standardized mean difference [SMD], -0.13; 95% confidence interval [CI], -0.19 to -0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, -0.12, 95% CI, -0.20 to -0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH-INCS combination but did show benefit with intranasal AH-INCS (SMD, -0.18; 95% CI, -0.27 to -0.09; p < 0.001). There were no significant differences with regard to disease-specific quality of life (SMD, -0.07; 95% CI, -0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, -0.03 L/min; 95% CI, -0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events.
Intranasal AH-INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH-INCS is not recommended.
对于过敏鼻炎（AR）患者，在单一疗法效果不足时，常联合使用 H1 抗组胺药（AH）和鼻内皮质类固醇（INCS）。本系统综述旨在确定 AH 联合 INCS（AH-INCS）治疗 AR 的效果。
使用 Medline 和 Embase 进行文献检索。纳入研究 AH-INCS 对比 INCS 单药治疗 AR 患者的随机对照试验。主要结局为总鼻部症状评分、总眼部症状评分和疾病特异性生活质量。次要结局为鼻气道通畅的客观测试和不良事件。
纳入 16 项研究（4026 名患者）。与 INCS 相比，AH-INCS 降低了总鼻部症状评分（标准化均数差 [SMD]，-0.13；95%置信区间 [CI]，-0.19 至 -0.06；p < 0.001；10 项研究，3348 名患者）和总眼部症状评分（SMD，-0.12；95% CI，-0.20 至 -0.04；p = 0.003；6 项研究，2378 名患者）。亚组分析表明，口服 AH-INCS 联合治疗并无获益，但鼻内 AH-INCS 治疗有获益（SMD，-0.18；95% CI，-0.27 至 -0.09；p < 0.001）。疾病特异性生活质量（SMD，-0.07；95% CI，-0.16 至 0.02；p = 0.12；6 项研究，1981 名患者）、鼻吸气峰流速（MD，-0.03 L/min；95% CI，-0.57 至 0.50；p = 0.91；1 项研究，54 名患者）或不良事件均无显著差异。
与 INCS 相比，鼻内 AH-INCS 可改善 AR 的鼻部和眼部症状。不推荐口服 AH-INCS。
