ABSTRACT
Objective To systematically review the efficacy of corticosteroid nasal spray plus antihistamine versus either therapy given alone or placebo in patients with allergic rhinitis (AR).Methods The PubMed, EMbase, Google Scholar and The Cochrane Library were electronically searched for randomized controlled trials ( RCTs ) about the efficacy of corticosteroid plus antihistamine for AR .The duration of the search was from the inception of the databases to April 2015 . After literature selection , data extraction and quality assessment conducted by two reviewers independently , meta-analysis was conducted using RevMan 5.3 software.Results Ten studies involving 6568 patients were finally included .The qualitative analysis showed that the combination therapy had greater efficacy than oral antihistamines alone or placebo on improving symptoms.The results of meta-analysis showed that pooled results of two trials failed to show significant difference in total nasal symptoms between combination therapy and intranasal corticosteroid alone [ WMD =-0.20, 95%CI (-0.38,-0.01),P=0.04].The cumulative meta-analysis of six RCTs showed that the combination therapy was superior to intranasal corticosteroid alone[WMD=-1.16, 95%CI( -1.49,-0.83), P<0.00001], intranasal antihistamine alone[WMD=-1.73, 95%CI( -2.08,-1.38),P<0.00001], and placebo [WMD =-2.81, 95%CI( -3.16,-2.47), P<0.00001].Conclusion Intranasal corticosteroid plus oral antihistamine has similar efficacy to intranasal corticosteroid alone, greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients . Intranasal corticosteroid plus intranasal antihistamine is significantly superior to either therapy given alone or placebo .