Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Center of Excellence in Otolaryngology-Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand; Department of Otolaryngology, College of Medicine, Rangsit University, Bangkok, Thailand.
Rhinology. 2022 Aug 1;60(4):242-251. doi: 10.4193/Rhin21.355.
As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with allergic rhinitis (AR) who have suboptimal symptom control. This systematic review aimed to assess the effectiveness of as-needed INCS for treating AR.
Systematic searches for randomized controlled trials studying the effects of as-needed INCS compared to regular INCS, as-needed antihistamine, or placebo were performed. Primary outcomes were total nasal symptom score (TNSS) and disease-specific quality of life (DSQoL).
Eight studies (882 participants) met the criteria. Regular use of INCS showed greater improvements than as-needed INCS in TNSS, DSQoL, nasal peak inspiratory flow, sneezing, and nasal congestion scores with small effect sizes. There were no differences between regular and as-needed INCS usage for ocular symptoms, symptom-free days, nasal itching, and rhinorrhea scores. As-needed INCS was superior to as-needed antihistamine and placebo with medium effect sizes. There were no differences in risk of adverse events between the groups in all three comparisons.
Regular use of INCS improved total nasal symptoms score and DSQoL better than as-needed INCS. However, as-needed INCS improved TNSS better than as-needed antihistamine and placebo. The effects of as-needed INCS were closer to regular INCS usage than to placebo or as-needed AH usage.
按需使用鼻内皮质类固醇喷雾（INCS）常用于过敏鼻炎（AR）患者，这些患者的症状控制不理想。本系统评价旨在评估按需 INCS 治疗 AR 的疗效。
系统检索了比较按需 INCS 与常规 INCS、按需抗组胺药或安慰剂治疗效果的随机对照试验。主要结局指标为总鼻症状评分（TNSS）和疾病特异性生活质量（DSQoL）。
符合标准的 8 项研究（882 名参与者）纳入本分析。常规使用 INCS 在 TNSS、DSQoL、鼻峰吸气流速、打喷嚏和鼻塞评分方面的改善程度优于按需 INCS，差异具有统计学意义，但效应量较小。在眼部症状、无症状天数、鼻痒和流涕评分方面，常规和按需 INCS 的使用无差异。与按需抗组胺药和安慰剂相比，按需 INCS 的改善程度更优，差异具有统计学意义，且效应量中等。在所有三组比较中，各组间不良反应风险无差异。
常规使用 INCS 比按需 INCS 更能改善总鼻症状评分和 DSQoL。然而，按需 INCS 在 TNSS 方面的改善优于按需抗组胺药和安慰剂。按需 INCS 的作用更接近常规 INCS 治疗，而与安慰剂或按需 AH 治疗不同。
