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As-needed intranasal corticosteroid (INCS) spray is frequently used by people suffering from allergic rhinitis (AR), especially when symptoms remain inadequately controlled.
Regular INCS use delivers greater symptom relief and quality-of-life improvement than as-needed dosing, although as-needed INCS remains more effective than antihistamines in treating allergic rhinitis.
As-needed intranasal corticosteroid (INCS) spray is frequently used by people suffering from allergic rhinitis (AR), especially when symptoms remain inadequately controlled. This systematic review and meta-analysis evaluated the clinical effectiveness of as-needed INCS therapy for mitigating AR symptoms.
A comprehensive literature search identified randomized controlled trials comparing as-needed INCS use with regular INCS dosing, as-needed antihistamines, or placebo. The key outcomes included disease-specific quality of life (DSQoL) and total nasal symptom score (TNSS).
A total of 8 randomized controlled studies involving 882 volunteers were included. Regular INCS use exhibited substantially greater improvement in DSQoL, TNSS, nasal congestion, nasal peak inspiratory flow, and sneezing, though with small effect sizes. No notable differences were noted between regular and as-needed INCS use for rhinorrhea, ocular symptoms, symptom-free days, or nasal itching. Compared to as-needed antihistamines and placebo, as-needed INCS showed superior symptom relief with moderate effect sizes. Across all treatment comparisons, the adverse event rates were similar.
Routine daily use of INCS provided better improvement in TNSS and quality-of-life measures compared to as-needed use. However, as-needed INCS still outperformed both as-needed antihistamines and placebo. Overall, the therapeutic benefits of as-needed INCS were more comparable to regular INCS use than to placebo or antihistamine-only treatment, suggesting their potential role as an effective flexible treatment option for AR.
Rhinology
As-needed intranasal corticosteroid spray for allergic rhinitis: a systematic review and meta-analysis
M P Hoang et al.
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