Assalaamua’Alaikum Wr
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Transcript of Assalaamua’Alaikum Wr
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Assalaamuaalaikumwr.wb.
Fuad cipto
07711146
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Intranasal corticosteroids versus
oral H1receptor antagonists in
allergic rhinitis: systematic
review of randomised controlled
trials
Journal reading
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introduction
Allergic rhinitis is a common diseasecharacterised by nasal itch, sneezing, wateryand mucous rhinorrhoea, and nasal obstruction
It can cause considerable morbidity includingchronic sinusitis & otitis irritability andimpaired sleep affect quality of life.
Therapy avoiding allergens (when possible),intranasal corticosteroids, short termdecongestants, oral/topical H
1
receptorantagonists (antihistamines), intranasalcromoglycate, anticholinergic agents &allergen immunotherapy.
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Topical intranasal corticosteroids aresaid to be more effective than oral
antihistamines in controlling nasal
blockage and discharge.
Oral antihistamines are said to be better
at treating nasal itch, sneezing, and eye
symptoms.
WHICH ONE MORE EFFECTIVNESS THAN OTHER??
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objective
To determine whether intranasal
corticosteroids are superior to oral
H1receptor antagonists
(antihistamines) in the treatment of
allergic rhinitis.
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methods
Design : Meta-analysis of randomisedcontrolled trials.
Subject : 2267 subjects with allergic rhinitis in
16 randomised controlled trials (mean age 32years, range 12 to 75 years), of whom 1247(55%) were men)
Search strategy
Medline and Embasesearches for randomised controlled trials oftopical corticosteroids and rhinitis.
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methods
Analysis outcome
symptom score and visualanalogue scale
Statistical analysis outcomedata were extracted &entered into RevMan 3.1 (Update Software, Oxford).
Categorical outcomes (global ratings) were analysed asodds ratios and 95% confidence intervals, calculated byPetosmethod for individual studies
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Inclusion criteria
intranasal corticosteroids included beclomethasonedipropionate, budesonide, flunisolide, fluocortin,fluticasone propionate, mometasone, and triamcinoloneacetonide
any form of oral antihistamine one of the following clinical outcomesnasal
symptoms (including total nasal symptom scores), eyesymptoms, global symptoms, nasal function (including
measurements of nasal resistance), and assessment ofquality of life.
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Exlusion criteria
topical antihistamines or topical mast cell stabilisers Not randomised
Not double blinded.
only nasal challenge with specific allergens or non-
clinical outcomes.
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Result
nasal blockage, nasal discharge, and sneezing
14studies
I.N corticosteroid vs Oral Antihistamin for nasal blockage(combined standardised mean difference 0.63 (95%
confidence interval 0.73 to 0.53)).
I.N corticosteroid vs Oral Antihistamin for Nasaldischarge (0.5, 0.6 to 0.4)).
I.N corticosteroid vs Oral Antihistamin in relievingsneezing (0.49, 0.59 to 0.39).
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I.N corticosteroid vs Oral Antihistamin for nasal itch(combined standardised mean difference 0.38, 0.49 to
0.21).11 studies
I.N corticosteroid vs Oral Antihistamin for Total nasal
symptom (0.42, 0.53 to 0.32).9 studies. Eye symptomswas no significant difference between
intranasal corticosteroids and oral antihistamines on eye
symptoms11 studies.
nasal discomfortwas no significant differencebetween the two treatments1 study
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result
Intranasal corticosteroids are considered safe. Localadverse effects are usually mild (mucosal irritation,epistaxis), and nasal septal perforation is exceptionallyrare.
First generation oral antihistamines are safe, butsedative and anticholinergic effects may be troublesome
intranasal corticosteroids is better than antihistamines asfirst line treatment for allergic rhinitis ( basic on data andwith data on safety and cost effectiveness ).
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The end..
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