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Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta‐analysis
Author(s) -
Khattiyawittayakun Likhit,
Seresirikachorn Kachorn,
Chitsuthipakorn Wirach,
Kanjanawasee Dichapong,
Snidvongs Kornkiat
Publication year - 2018
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22193
Subject(s) - medicine , acoustic rhinometry , decongestant , nasal administration , nasal congestion , confidence interval , adverse effect , meta analysis , relative risk , randomized controlled trial , gastroenterology , nose , anesthesia , surgery , immunology , antihistamine
Background Intranasal corticosteroid (INCS) is the most efficacious medicine for treating chronic rhinitis. A decongestant and INCS combination (INCS‐D) is considered for nasal congestion that is not improved by INCS. This study aimed to investigate the effects of INCS‐D on chronic rhinitis. Methods Literature searches were performed using MEDLINE and EMBASE. Randomized controlled trials studying the effects of INCS‐D vs INCS alone for treating chronic rhinitis were included. Data were pooled for meta‐analysis. Outcomes were nasal symptoms, disease‐specific quality of life, objective tests for nasal patency, and adverse events. Results Six studies (1071 patients) met the inclusion criteria. There were no differences between INCS‐D and INCS on total nasal symptom scores (standardized mean difference [SMD] −0.85; 95% confidence interval [CI], −2.09 to 0.40; p = 0.18), nasal congestion scores (SMD −0.13; 95% CI, −0.46 to 0.20; p = 0.43), and the Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.12; 95% CI, −0.66 to 0.42; p = 0.66). After 1 week, there were no differences on objective tests for nasal patency (acoustic rhinometry: SMD 0.04; 95% CI, −0.68 to 0.76, p = 0.91; and peak nasal inspiratory flow: SMD 0.08; 95% CI, −0.16 to 0.32; p = 0.52). Adverse events were not different between INCS‐D and INCS (risk ratio 1.09; 95% CI, 0.73 to 1.62). Conclusion Meta‐analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS‐D were comparable with INCS.