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. Author manuscript; available in PMC: 2020 Jun 10.
Published in final edited form as: Int Forum Allergy Rhinol. 2018 Feb;8(2):108–352. doi: 10.1002/alr.22073

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.

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