Oral Agents or Nasal Sprays for Allergic Rhinitis?

Guidelines recommend intranasal steroids and antihistamines over oral antihistamines and montelukast for allergic rhinitis, but many providers and patients still favor oral preparations. Researchers conducted a systematic review to compare these products in adolescents and adults with seasonal allergic rhinitis.

Thirty-five randomized controlled trials provided outcomes for total nasal symptom scores and rhinitis quality-of-life scores. Nasal preparations were superior across all outcomes. The largest difference in benefit was seen between nasal steroids and oral montelukast, followed by nasal steroids versus oral antihistamines, and then nasal antihistamines versus oral antihistamines.