Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels

A systematic review and meta-analysis of loratadine combined with montelukast for the treatment of allergic rhinitis

Background: Loratadine and montelukast are clinical first-line drugs in the treatment of allergic rhinitis (AR). However, there is no clear evidence of the efficacy of loratadine combined with montelukast in the treatment of AR. This study aimed to evaluate the efficacy and safety of the loratadine-montelukast combination on AR. Methods: In this meta-analysis, searches were conducted on PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and China National Knowledge Infrastructure (CNKI). The search terms included loratadine, montelukast, allergic rhinitis, and clinical trials. Meta-analyses were conducted using Rev Man 5.3 and Stata 15 statistical software. Results: A total of 23 studies with 4,902 participants were enrolled. For the primary outcome, pooled results showed that loratadine-montelukast can significantly reduce total nasal symptom scores (TNSS), when compared with loratadine (SMD, -1.00; 95% CI, -1.35 to -0.65, p < 0.00001), montelukast (SMD, -0.46; 95% CI, -0.68 to -0.25, p < 0.0001), or placebo (SMD, -0.93; 95% CI, -1.37 to -0.49, p < 0.00001). For secondary outcomes, pooled results showed that compared with loratadine, loratadine-montelukast can significantly improve nasal congestion, nasal itching, nasal sneezing, nasal rhinorrhea, and rhinoconjunctivitis quality of life questionnaires (RQLQ). Compared with montelukast, loratadine-montelukast can significantly improve nasal itching, and nasal sneezing. Compared with placebo, loratadine-montelukast can significantly improve nasal congestion, and RQLQ. Conclusion: Loratadine-montelukast combination is superior to loratadine monotherapy, montelukast monotherapy, or placebo in improving AR symptoms. Therefore, loratadine-montelukast combination can be an option for patients with moderate-severe AR or poorly response to monotherapy. Systematic review registration number: clinicaltrials.gov, identifier CRD42023397519.

Effect of momethasone furoate combined with loratadine and montelukast sodium on inflammatory factors and pulmonary function in children with allergic rhinitis

OBJECTIVE

To compare the effects of mometasone furoate in combination with loratadine and montelukast sodium on inflammatory factors and pulmonary function in children with allergic rhinitis (AR).

METHODS

In this retrospective study, a total of 89 children with AR admitted to our hospital from March 2020 to October 2021 were enrolled. Among them, 47 children who received mometasone furoate combined with loratadine were designated group A, while the other 42 with mometasone furoate combined with montelukast sodium were group B. The clinical efficacy of both groups was compared, and the levels of inflammatory factors IL-6 and TNF-α as well as the changes of pulmonary function levels were tested during the treatment. Adverse reactions during treatment were recorded. Finally, children were followed up for 3 months to record rhinitis recurrence after discontinuation of the treatment.

RESULTS

There was no statistical difference in clinical treatment efficacy between both groups (P>0.05), while the levels of IL-6, TNF-α, and IgE were lower in children in group A than in group B at 2 weeks of treatment. Group A's lung function indexes, including forced expiratory volume in one second (FEV1%), forced expiratory volume in one second/forced vital capacity (FEV1/FVC) and peak expiratory flow (PEF), were higher than in group B (all P<0.05). The total incidence of adverse reactions was dramatically lower in group A than group B (P<0.05). Follow-up demonstrated no difference in the recurrence rate of rhinitis between both groups of children (P>0.05). Higher TNF-α after treatment, history of allergy, family history of rhinitis, combined asthma, and parental history of smoking were independent risk factors for relapse after discontinuation of the drug in children.

CONCLUSION

Both mometasone furoate combined with either loratadine or montelukast sodium had good effects in AR, while the first option had a faster inhibitory effect on inflammatory factors and a better protection of lung function in children.

The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis

BACKGROUND

Allergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR.

METHODS

PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software.

RESULTS

A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P = 0.45; I 2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P = 0.03; I 2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = -1.42; 95% CI [-1.55, -1.29]; P = 0.03; I 2 = 60%) in patients with AR.

CONCLUSION

Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.