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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.3.a.

Evidence for the role of oral decongestants in the management of allergic rhinitis

Study Year LOE Study design Study groups Clinical endpoint Conclusion
Salerno et al.1324 2005 1a SR

  1. Phenylpropanolamine;

  2. Placebo

 SBP, DBP, HR Phenylpropanolamine caused increase in SBP.
Salerno et al.1325 2005 1a SR

  1. Pseudoephedrine;

  2. Placebo

 SBP, DBP, HR Pseudoephedrine caused increase in SBP and HR.
Meltzer et al.1323 2015 1b RCT

  1. Phenylephrine 10 mg (n = 109);

  2. Phenylephrine 20 mg (n = 108);

  3. Phenylephrine 30 mg (n = 107);

  4. Phenylephrine 40 mg (n = 112);

  5. Placebo (n = 103)

 Daily reflective nasal congestion score Phenylephrine is not better than placebo at relieving nasal congestion.
Horak et al.1322 2009 1b RCT

  1. Pseudoephedrine;

  2. Phenylephrine;

  3. Placebo

 Subjective evaluation of nasal congestion Pseudoephedrine resulted in improvement in nasal congestion. Phenylephrine did not improve nasal congestion.
Mucha et al.1321 2006 1b RCT

  1. Pseudoephedrine;

  2. Montelukast

 Nasal symptoms, nPIF, QOL Significant improvement from baseline in all symptoms of AR, nPIF, and QOL with both pseudoephedrine and montelukast.
Vernacchio et al.1327 2008 3b Non-consecutive cohort Pseudoephedrine use in pediatric population Children less than 2 years of age are at the highest risk for toxicity with pseudoephedrine. Safe dosing recommendations are lacking for this age group.
Kernan et al.1326 2000 3b Case-control

  1. History of subarachnoid or intracerebral hemorrhage;

  2. Control

 Association between the use of phenylpropanolamine and the risk of a hemorrhagic stroke. Phenylpropanolamine is an independent risk factor for hemorrhagic stroke in women.
Roberge et al.1328 1999 4 Case report 2-year-old developed psychosis and ataxia after being overmedicated with pseudoephedrine/ dextromethorphan cough preparation.
Sauder et al.1329 1998 4 Case report 3-year-old with visual hallucinations caused by inappropriately high doses of pseudoephedrine.

AR = allergic rhinitis; DBP = diastolic blood pressure; HR = heart rate; LOE = level of evidence; nPIF = nasal peak inspiratory flow; QOL = quality of life; RCT = randomized controlled trial; SBP = systolic blood pressure; SR = systematic review.