The Efficacy and Safety of Selective H1-Antihistamine versus Leukotriene Receptor Antagonist for Seasonal Allergic Rhinitis: A Meta-Analysis

Abstract

BackgroundBoth selective H1-antihistamine (SAH) and leukotriene receptor antagonist (LTRA) have been shown to be effective in treating patients with seasonal allergic rhinitis (SAR), but it is still uncertain which treatment option is optimal. This meta-analysis was aimed to compare the efficacy and safety of SAH and LTRA for SAR.Materials and MethodsPubMed, EMBASE and the Cochrane Library were searched for all eligible studies that compared the efficacy and safety of SAH and LTRA for SAR up to September 7, 2014. The pooled mean difference (MD), odd ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using a fixed- or random-effects model.ResultsNine studies with 5781 SAR patients were included. The results showed that SAH is superior to LTRA in terms of the daytime eye symptoms score (DESS) and composite symptoms score (CSS) for SAR (MD = 0.06, 95% CI, 0.03 to 0.10, P = 0.000, I 2 = 99%; MD = 0.03, 95% CI, 0.01 to 0.05, P = 0.010, I 2 = 98%), whereas LTRA overmatched SAH with respect to the night-time symptoms score (NSS) (MD = −0.04, 95% CI, −0.05 to −0.02, P = 0.000, I 2 = 97%). Additionally, the results of subgroup analysis indicated that the dose, duration and gender of the patients might impact the comparisons of the effects of SAH and LTRA on their efficacy for SAR.ConclusionThis meta-analysis suggested that SAH and LTRA have similar effects and safety for SAR, but SAH is more appropriate for daytime nasal symptoms (congestion, rhinorrhea, pruritus and sneezing), while LTRA is better suited for nighttime symptoms (difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening), respectively. Meanwhile, the dose, duration and gender of patients may influence the anti-SAR effects of SAH and LTRA.

How an online survey on the treatment of allergic rhinitis and its impact on asthma (ARIA) detected specialty-specific knowledge-gaps

“…A metanalysis showed that monotherapy with an antihistamine or LTRAs has low to moderate efficacy in the treatment of seasonal AR, but both are less effective than intranasal GCS [ 11 ]. LTRAs might be useful, especially for the nighttime symptoms of AR [ 12 ], but not allergic conjunctivitis [ 13 ]. Recently, a combination of both, antihistamine plus LTRAs has been showing promising results for patients with AR [ 14 ].…”

Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis

“…Compared to nonsedating antihistamines, LTRAs tend to provide more relief of nasal congestion. However, a meta-analysis by Xu and colleagues 357 comparing the efficacy and safety of selective antihistamines and LTRAs for the treatment of seasonal AR, and a clinical trial by Liu and colleagues 358 comparing the effect of treatment with montelukast or loratadine in patients with AR indicated that antihistamines and LTRAs had similar effects for seasonal AR. Indeed, a combined use of montelukast and loratadine has been suggested to provide the most effective treatment for seasonal AR and associated eye symptoms.…”

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

“…By binding competitively to CysLT1, LTRAs such as montelukast, zafirlukast, and pranlukast block the effects of CysLTs and improve the symptoms of chronic respiratory diseases, particularly bronchial asthma and AR [120]. A recent meta-analysis suggests that H1-antihistamines (SAH) and LTRA have similar effects and safety profiles when used to treat seasonal AR; however, SAH is more appropriate for daytime nasal symptoms (congestion, rhinorrhea, pruritus, and sneezing) while LTRA is better suited for night-time symptoms (difficulty going to sleep, night-time awakenings, and nasal congestion on waking) [125]. Accumulating evidence shows the effectiveness of combination therapy with LTRAs and AH.…”