Intranasal corticosteroids for non-allergic rhinitis

• Published in: Cochrane database of systematic reviews 2019-11, Vol.2019 (11)
• Main Authors: Segboer, Christine, Gevorgyan, Artur, Avdeeva, Klementina, Chusakul, Supinda, Kanjanaumporn, Jesada, Aeumjaturapat, Songklot, Reeskamp, Laurens F, Snidvongs, Kornkiat, Fokkens, Wytske
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Child health; Ear, nose & throat; Humans; Nasal Sprays; Non‐malignant disease; Randomized Controlled Trials as Topic; Rhinitis - drug therapy
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD010592.pub2

Non-allergic rhinitis is defined as dysfunction and non-infectious inflammation of the nasal mucosa that is caused by provoking agents other than allergens or microbes. It is common, with an estimated prevalence of around 10% to 20%. Patients experience symptoms of nasal obstruction, anterior rhinorrhoea/post-nasal drip and sneezing. Several subgroups of non-allergic rhinitis can be distinguished, depending on the trigger responsible for symptoms; these include occupation, cigarette smoke, hormones, medication, food and age. On a cellular molecular level different disease mechanisms can also be identified. People with non-allergic rhinitis often lack an effective treatment as a result of poor understanding and lack of recognition of the underlying disease mechanism. Intranasal corticosteroids are one of the most common types of medication prescribed in patients with rhinitis or rhinosinusitis symptoms, including those with non-allergic rhinitis. However, it is unclear whether intranasal corticosteroids are truly effective in these patients. To assess the effects of intranasal corticosteroids in the management of non-allergic rhinitis. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 7); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 July 2019. Randomised controlled trials (RCTs) comparing intranasal corticosteroids, delivered by any means and in any volume, with (a) placebo/no intervention or (b) other active treatments in adults and children (aged ≥ 12 years). We used the standard methodological procedures expected by Cochrane. The primary outcomes were patient-reported disease severity and a significant adverse effect - epistaxis. Secondary outcomes were (disease-specific) health-related quality of life, objective measurements of airflow and other adverse events. We used GRADE to assess the certainty of the evidence for each outcome. We included 34 studies (4452 participants); however, only 13 studies provided data for our main comparison, intranasal corticosteroids versus placebo. The participants were mainly defined as patients with perennial rhinitis symptoms and negative allergy tests. No distinction between different pheno- and endotypes could be made, although a few studies only included a specific phenotype such as pregnancy rhinitis, vasomot