TABLE IX.B.1.a-1.
Evidence for the role of oral H1 antihistamines in the management of allergic rhinitis
Study | Year | LOE | Study design | Study groups | Clinical endpoint | Conclusion |
---|---|---|---|---|---|---|
Mullol et al.1175 | 2015 | 1a | SR | Rupatadine | Allergy symptoms, ARIA criteria, AE | Rupatadine is recommended for use in adults and children for intermittent/persistent AR and SAR/PAR. |
Ridolo et al.1174 | 2015 | 1a | SR | Bilastine; cetirizine; desloratadine | Subjective and objective measures, TNSS, RQLQ | Bilastine at therapeutic dose has similar efficacy to other second-generation oral antihistamines. Demonstrated improvement in TNSS and RQLQ with good safety profile. |
Scadding1176 | 2015 | 1a | Review of consensus statements: ARIA, EAACI, Royal College of Paediatrics, and Child Health | Oral antihistamines | – | Second-generation, non-sedating, antihistamines are recommended for mild to moderate AR and in combination for severe AR. Sedating antihistamines should not be used. |
Compalati & Canonica1171 | 2013 | 1a | SR | Rupatadine | Allergy symptoms, AE | Favorable risk-benefit ratio for rupatadine in treating AR. |
Mösges et al.1177 | 2013 | 1a | SR and meta-analysis | Desloratadine; ebastine; fexofenadine; levocetirizine | TSS and TNSS | Second-generation levocetirizine significantly improved symptom scores especially in severe AR cases. |
Compalati et al.1178 | 2011 | 1a | SR and meta-analysis | Fexofenadine | TSS, individual symptoms (sneezing, rhinorrhea, itching congestion), AE | Fexofenadine has good efficacy with improvement in outcome measures. No significant AE compared to placebo. |
Ferrer1179 | 2011 | 1a | SR | Levocetirizine; desloratadine; fexofenadine | TSS, PNIF, decongestion test, QOL, pruritus, ESS, wheal and flare, AE | Oral newer-generation antihistamines are well tolerated in adults and children. Efficacy and improvement in QOL and nasal obstruction. Benefits outweigh harm. Very low risk of sedation. No QT prolongation found. |
Mösges et al.1180 | 2011 | 1a | SR and meta-analysis | Levocetirizine; loratadine | TSS, DNS, DES, in patients with persistent and SAR/PAR | Improvement in TSS, Total 5 Symptoms Score, daytime nasal symptoms, and QOL. |
Brozek et al.1167 | 2010 | 1a | SR with consensus statement | Oral antihistamines | Evidence was graded and recommendation given | Strong recommendation to use second-generation oral antihistamines that do not cause sedation and do not interact with CYP450 enzyme. |
Bachert1182 | 2009 | 1a | SR | Desloratadine; fexofenadine; levocetirizine; cetirizine; loratadine; terfenadine | TSS, PNIF, TSSC (with nasal obstruction), nasal congestion, and obstruction | Oral antihistamines have good efficacy for improving both subjective and objective measures, effective in relieving nasal congestion associated with AR compared to placebo. |
Katiyar & Prakash1181 | 2009 | 1a | SR | Rupatadine; ebastine; cetirizine; loratadine; desloratadine | ARIA criteria evaluated for: intermittent/persistent, SAR/PAR. TSS, DTSSm, DSSm, QT changes | Rupatadine is a non-sedating, efficacious, and safe oral H1 antihistamine for intermittent/persistent, SAR/PAR. |
Bachert & van Cauwenberge1183 | 2007 | 1a | SR | Desloratadine | TSS, TNSS, TNNSS, PNIF, for intermittent/persistent SAR/PAR | Desloratadine is well tolerated and efficacious for intermittent and persistent AR with reductions in congestion, TSS, TNSS, and TNNSS, with improved QOL. |
Canonica et al.1184 | 2007 | 1a | SR and meta-analysis | Desloratadine | TSS, TNSS, nasal airflow | Reduction in TSS, TNSS, and improved nasal airflow. |
Patou et al.1185 | 2006 | 1a | SR and meta-analysis | Levocetirizine | Nasal obstruction | Improved nasal obstruction under artificial and natural allergen exposure. |
Schenkel1186 | 2006 | 1a | SR | Desloratadine | Morning symptoms, TSS, TNSS, TNNSS | Desloratadine improves TSS and improved QOL in patients with SAR/PAR. 24-hour action makes it effective in controlling morning symptoms. |
Hore et al.1187 | 2005 | 1a | SR of RDBCT | H1 antihistamine vs placebo | Nasal obstruction | Oral H1 antihistamines improve nasal obstruction by 22% over placebo. |
Passalacqua & Canonica1188 | 2005 | 1a | SR | Levocetirizine; desloratadine | Nasal symptoms, wheal-flare response, QOL, TSS | Improved QOL and TSS for SAR/PAR. Levocetirizine has a faster onset. |
Bousquet et al.1170 | 2004 | 1a | SR with consensus statement | Desloratadine | ARIA/EAACI criteria efficacy, safety, pharmacology | Desloratadine is recommended for treating patients with AR. |
Greisner1189 | 2004 | 1a | SR | Cetirizine; desloratadine; fexofenadine; loratadine | Onset of action | Inconsistent results. Onset of action is dependent on how it is defined and measured. |
Limon & Kockler1190 | 2003 | 1a | SR | Desloratadine | TSS, TNSS, TNNSS, nasal congestion, nasal airflow, TASS for SAR/PAR | Desloratadine is a safe and efficacious for patients with SAR/PAR. Improved TSS, TNSS, and TNNSS, TASS, nasal congestion. Nasal congestion was excluded in the PAR group. |
Bojkowski et al.1191 | 1989 | 1a | SR | Acrivastine (40 studies reviewed) | Rhinoconjunctivitis symptoms, nasal congestion, adverse events, drowsiness, CNS depression for SAR/PAR | Newer-generation oral H1 antihistamine acrivastine has excellent efficacy for patients with SAR/PAR. Improved nasal congestion. Small increase in drowsiness over terfenadine. No CNS depression found. |
AE = adverse effects; AR = allergic rhinitis; ARIA = Allergic Rhinitis and its Impact of Asthma; CNS = central nervous system; DES = Daytime Eye Symptoms; DNS = Daytime Nasal Symptoms; DSSm = mean Daily Symptom Score; DTSSm = mean Total Daily Symptom Score; EAACI = European Academy of Allergy and Clinical Immunology; ESS = Epworth Sleepiness Scale; H1 = histamine receptor H1; LOE = level of evidence; PAR = perennial allergic rhinitis; QOL = quality of life; QT = measure of time between the onset of ventricular depolarization and completion of ventricular repolarization; RDBCT = randomized double-blind controlled trial; RQLQ = Rhinoconjunctivitis Quality of Life Questionnaire; SAR = seasonal allergic rhinitis; SR = systematic review; TASS = Total Asthma Symptom Score; TNNSS = Total Non-Nasal Symptom Score; TNSS = Total Nasal Symptom Score; TSS = Total Symptom Score; PNIF = peak nasal inspiratory flow; TSSC = Total Symptom Severity Complex.