Intranasal Treatments for Allergic Rhinitis in Preschool- and School-Age Children: Network Meta-Analysis

Background: Intranasal medications are considered a first-line treatment of allergic rhinitis (AR). Objective: We performed a systematic review and network meta-analysis (NMA) comparing the efficacy and safety of intranasal antihistamines (INAH), intranasal corticosteroids (INCS), and their fixed combination (INAH+INCS) for the treatment of AR in children. Methods: We searched four electronic bibliographic and three clinical trial databases for randomized controlled trials assessing the use of INAH, INCS, and INAH+INCS in children (aged <18 years) with seasonal or perennial AR. We performed an NMA on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), development of adverse events, and withdrawals due to adverse events. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach for NMA. Results: We included 31 studies (12,168 participants). All assessed medication classes were more effective than placebo in improving the Total Nasal Symptom Score. For seasonal AR, INAH+INCS was associated with a higher probability of a clinically relevant improvement in the Total Ocular Symptom Score and RQLQ compared with INCS alone. For the treatment of perennial AR, INCS displayed a higher probability than INAH of meaningfully improving the RQLQ. We found no relevant differences regarding safety outcomes. For most comparisons, the certainty of evidence was deemed moderate or high. Conclusions: Intranasal medications are effective and safe in the treatment of AR in children, although their efficacy in improving nasal symptoms does not seem to be as high as in adults. Further research is needed because available evidence has provided mixed results depending on the AR type and outcome measures assessed.