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Ellis AK, Cook V, Keith PK, Mace SR, Moote W, O'Keefe A, Quirt J, Rosenfield L, Small P, Watson W. Focused allergic rhinitis practice parameter for Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:45. [PMID: 39118164 PMCID: PMC11311964 DOI: 10.1186/s13223-024-00899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/21/2024] [Indexed: 08/10/2024]
Abstract
Allergic rhinitis (AR) is a prevalent disease in Canada that affects both children and adults. Several guidelines for the management of AR have been published by professional allergy societies worldwide. However, there are regional differences in the clinical management of AR, and regulatory approval of some AR pharmacotherapies varies among countries. Thus, six research questions specific to the treatment of AR in Canada were identified for this focused practice parameter. Reviews of the literature published since 2016 were conducted to obtain evidence-based support for the responses of the Work Group to each research question. In response to research question 1 "In patients with symptoms indicative of AR, is serum-specific IgE sufficient to identify candidates for immunotherapy or is a skin prick test mandatory?" the Work Group concluded that either sIgE testing or skin prick test are acceptable for diagnosing AR and guiding immunotherapy. In response to research question 2 "When taking into account the preferences of the patient and the prescriber (stakeholder engagement) should second-generation oral antihistamine (OAH) or intranasal corticosteroid (INCS) be first line?" the Work Group concluded that existing guidelines generally agree on the use of INCS as a first-line therapy used for AR, however, patient and provider preferences and considerations can easily shift the first choice to a second-generation OAH. In response to research question 3 "Is a combination intranasal antihistamine (INAH)/INCS formulation superior to INCS plus OAH? Do they become equivalent after prolonged use?" the Work Group concluded that that the combination INAH/INCS is superior to an INCS plus OAH. However, there was insufficient evidence to answer the second question. In response to research question 4 "Do leukotriene receptor antagonists (LTRA) have a greater benefit than OAH in AR for some symptoms to justify a therapeutic trial in those who cannot tolerate INCS?" the Work Group concluded that LTRAs have inferior, or at best equivalent, daytime or overall symptom control compared with OAH, but LTRAs may improve nighttime symptom control and provide benefits in patients with AR and concomitant asthma. In response to research question 5 "Should sublingual immunotherapy (SLIT) tablets be considered first-line immunotherapeutic options over subcutaneous immunotherapy (SCIT) based on the evidence of efficacy?" the Work Group concluded that the choice of SLIT or SCIT cannot be made on efficacy alone, and differences in other factors outweigh any differences in efficacy. In response to research question 6 "Based on efficacy data, should ALL patients seen by an allergist be offered SLIT or SCIT as a treatment option?" the Work Group concluded that the efficacy data suggests that SLIT or SCIT should be used broadly in patients with AR, but other clinical concerns also need to be taken into consideration.
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Affiliation(s)
- Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Victoria Cook
- Community Allergy Clinic, Victoria, BC, and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Paul K Keith
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sean R Mace
- Mace Allergy and Clinical Immunology, Toronto, ON, Canada
| | | | - Andrew O'Keefe
- Department of Pediatrics, Memorial University, St. John's, NL, Canada
| | - Jaclyn Quirt
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lana Rosenfield
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Small
- Jewish General Hospital, Montreal, QC, Canada
| | - Wade Watson
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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Klimek L, Werminghaus P, Casper I, Cuevas M. The pharmacotherapeutic management of allergic rhinitis in people with asthma. Expert Opin Pharmacother 2024; 25:101-111. [PMID: 38281139 DOI: 10.1080/14656566.2024.2307476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Up to 90% of asthmatic patients have comorbid allergic rhinitis (AR). Although appropriate therapy of AR can improve asthma symptoms and management, AR is often underdiagnosed and under-treated in asthmatics.A non-systematic literature research was conducted on AR as a comorbidity and risk factor of asthma. Latest international publications in medical databases, international guidelines, and the Internet were reviewed. AREAS COVERED Based on the conducted literature research there is proved evidence of the necessity of diagnosis and treatment of AR in patients with asthma because it affects health care utilization. Therefore, it is recommended in national and global guidelines. EXPERT OPINION AR increases the risk of asthma development and contributes to the severity of an existing asthma. Early treatment of AR with drugs as intranasal steroids, antihistamines, leukotriene receptor antagonists, and especially allergen-specific immunotherapy can reduce the risk of asthma development and the concomitant medication use in addition to severity of symptoms in AR and asthma.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | | | - Ingrid Casper
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Mandy Cuevas
- Clinic and Policlinic of Otorhinolaryngology, Head and Neck Surgery, University Clinic Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Becerik Ç, Karaca ÇT, Özcan Z, Kul S, Toros SZ. The Role of Substance P Receptor Antagonists in Allergic Rhinitis: Ovalbumin-Induced Rat Model. Laryngoscope 2023; 133:2891-2897. [PMID: 36856158 DOI: 10.1002/lary.30628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Substance P is a peptide from the tachykinin family, which is found in peripheral and central nervous systems, causing vasodilation and increased secretion in the nasal mucosa. In this study, we aimed to investigate whether the experimental model of allergic rhinitis will cause allergic changes in the larynx and to compare the effects of aprepitant, a substance P antagonist, on nasal symptoms in allergic rhinitis, and histopathological changes in the nasal and laryngeal mucosa with antihistamine and leukotriene receptor antagonists (LTRA). STUDY DESIGN An experimental animal study. METHOD The study was carried out on 34 healthy 8-12 weeks old female Sprague Dawley rats in 5 groups. The rats in which an experimental allergic rhinitis model was created with ovalbumin were scored by observing their nasal symptoms, and nasal and laryngeal mucous membranes included in the study were evaluated histopathologically after medications. RESULTS As a result of the analysis of the data obtained from the study, antihistamine and LTRA significantly reduced the symptoms of nose scratching and sneezing, while aprepitant did not affect nasal symptoms. In the histopathological examination of the larynx, effects that would make a significant difference were found in the allergy group when compared to the control group. On the larynx, aprepitant reduced pseudostratification significantly compared to the allergy group. CONCLUSION Aprepitant provides histopathological changes in the treatment of allergic rhinitis, but does not have sufficient effect on nasal symptoms. The effect of aprepitant on the larynx has not been clearly demonstrated. LEVEL OF EVIDENCE NA Laryngoscope, 133:2891-2897, 2023.
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Affiliation(s)
- Çağrı Becerik
- Department of Otorhinolaryngology, Kemalpaşa State Hospital, İzmir, Turkey
| | - Çiğdem T Karaca
- Department of Otorhinolaryngology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Zühal Özcan
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Selim Kul
- Department of Otorhinolaryngology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Sema Z Toros
- Department of Otorhinolaryngology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
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Richards GA, McDonald M, Gray CL, De Waal P, Friedman R, Hockman M, Karabus SJ, Lodder CM, Mabelane T, Mosito SM, Nanan A, Peter JG, Quitter THC, Seedat R, Van den Berg S, Van Niekerk A, Vardas E, Feldman C. Allergic rhinitis: Review of the diagnosis and management: South African Allergic Rhinitis Working Group. S Afr Fam Pract (2004) 2023; 65:e1-e11. [PMID: 37916698 PMCID: PMC10623625 DOI: 10.4102/safp.v65i1.5806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Allergic rhinitis (AR) has a significant impact on the community as a whole with regard to quality of life and its relationship to allergic multi-morbidities. Appropriate diagnosis, treatment and review of the efficacy of interventions can ameliorate these effects. Yet, the importance of AR is often overlooked, and appropriate therapy is neglected. The availability of effective medications and knowledge as to management are often lacking in both public and private health systems. METHODS This review is based on a comprehensive literature search and detailed discussions by the South African Allergic Rhinitis Working Group (SAARWG). RESULTS The working group provided up-to-date recommendations on the epidemiology, pathology, diagnosis and management of AR, appropriate to the South African setting. CONCLUSION Allergic rhinitis causes significant, often unappreciated, morbidity. It is a complex disease related to an inflammatory response to environmental allergens. Therapy involves education, evaluation of allergen sensitisation, pharmacological treatment, allergen immunotherapy (AIT) and evaluation of the success of interventions. Regular use of saline; the important role of intranasal corticosteroids, including those combined with topical antihistamines and reduction in the use of systemic steroids are key. Practitioners should have a thorough knowledge of associated morbidities and the need for specialist referral.Contribution: This review summarises the latest developments in the diagnosis and management of AR such that it is a resource that allows easy access for family practitioners and specialists alike.
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Affiliation(s)
- Guy A Richards
- Department of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Zhang M, Ao T, Cheng L. Highlights of the treatment of allergic rhinitis according to Chinese guidelines. Curr Opin Allergy Clin Immunol 2023; 23:334-340. [PMID: 37357787 DOI: 10.1097/aci.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines. RECENT FINDINGS Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients. SUMMARY This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.
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Affiliation(s)
- Min Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Tian Ao
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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De Carli M, Capezzali E, Tonon S, Frossi B. Mechanism and clinical evidence of immunotherapy in allergic rhinitis. FRONTIERS IN ALLERGY 2023; 4:1217388. [PMID: 37601646 PMCID: PMC10434251 DOI: 10.3389/falgy.2023.1217388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Allergic rhinitis is a common upper airway disease caused by hypersensitivity to various aeroallergens. It causes increased inflammation throughout the body and may be complicated by other otolaryngological pathologies such as chronic hyperplastic eosinophilic sinusitis, nasal polyposis, and serous otitis media. Allergic rhinitis is an IgE-mediated disease and immunotherapy can be a possible approach for patients to limit the use of antihistamines and corticosteroids. There is evidence that allergen immunotherapy can prevent the development of new sensitizations and reduce the risk of later development of asthma in patients with allergic rhinitis. However, some patients do not benefit from this approach and the efficacy of immunotherapy in reducing the severity and relapse of symptoms is still a matter of debate. This review highlights new aspects of allergic rhinitis with a particular focus on the impact of sexual dimorphism on the disease manifestation and efficacy to the allergen specific immunotherapy.
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Affiliation(s)
- Marco De Carli
- Second Unit of Internal Medicine, University Hospital of Udine, Udine, Italy
| | | | - Silvia Tonon
- Department of Medicine, University of Udine, Udine, Italy
| | - Barbara Frossi
- Department of Medicine, University of Udine, Udine, Italy
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Alomair BM, Al-Kuraishy HM, Al-Gareeb AI, Al-Buhadily AK, Alexiou A, Papadakis M, Alshammari MA, Saad HM, Batiha GES. Mixed storm in SARS-CoV-2 infection: A narrative review and new term in the Covid-19 era. Immun Inflamm Dis 2023; 11:e838. [PMID: 37102645 PMCID: PMC10132185 DOI: 10.1002/iid3.838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Coronavirus disease 2019 (Covid-19) is caused by a novel severe acute respiratory syndrome coronavirus virus type 2 (SARS-CoV-2) leading to the global pandemic worldwide. Systemic complications in Covid-19 are mainly related to the direct SARS-CoV-2 cytopathic effects, associated hyperinflammation, hypercytokinemia, and the development of cytokine storm (CS). As well, Covid-19 complications are developed due to the propagation of oxidative and thrombotic events which may progress to a severe state called oxidative storm and thrombotic storm (TS), respectively. In addition, inflammatory and lipid storms are also developed in Covid-19 due to the activation of inflammatory cells and the release of bioactive lipids correspondingly. Therefore, the present narrative review aimed to elucidate the interrelated relationship between different storm types in Covid-19 and the development of the mixed storm (MS). In conclusion, SARS-CoV-2 infection induces various storm types including CS, inflammatory storm, lipid storm, TS and oxidative storm. These storms are not developing alone since there is a close relationship between them. Therefore, the MS seems to be more appropriate to be related to severe Covid-19 than CS, since it develops in Covid-19 due to the intricate interface between reactive oxygen species, proinflammatory cytokines, complement activation, coagulation disorders, and activated inflammatory signaling pathway.
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Affiliation(s)
- Basil Mohammed Alomair
- Department of Medicine, College of Medicine, Internal Medicine and Endocrinology, Jouf University, Al-Jouf, Saudi Arabia
| | - Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali K Al-Buhadily
- Department of Clinical Pharmacology, Medicine, and Therapeutic, Medical Faculty, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, New South Wales, Australia
- AFNP Med, Wien, Austria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal, Germany
| | - Majed Ayed Alshammari
- Department of Medicine, Prince Mohammed Bin Abdulaziz Medical City, Sakaka, Al-Jouf, Saudi Arabia
| | - Hebatallah M Saad
- Department of Pathology, Faculty of Veterinary Medicine, Matrouh University, Marsa, Matruh, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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Thomas B, Train A, Allan GM. Les antihistaminiques pour la rhinosinusite allergique. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e268-e269. [PMID: 36100395 PMCID: PMC9470200 DOI: 10.46747/cfp.6809e268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Betsy Thomas
- Experte en données probantes cliniques au Collège des médecins de famille du Canada
| | - Anthony Train
- Professeur adjoint au Département de médecine familiale à l'Université Queen's à Kingston (Ontario)
| | - G Michael Allan
- Directeur des Programmes et du soutien à la pratique au Collège des médecins de famille du Canada
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Thomas B, Train A, Allan GM. Antihistamines for allergic rhinosinusitis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:670. [PMID: 36100381 PMCID: PMC9470183 DOI: 10.46747/cfp.6809670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Betsy Thomas
- Clinical Evidence Expert at the College of Family Physicians of Canada
| | - Anthony Train
- Assistant Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - G Michael Allan
- Director of Programs and Practice Support at the College of Family Physicians of Canada
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Sharma K, Akre S, Chakole S, Wanjari MB. Allergic Rhinitis and Treatment Modalities: A Review of Literature. Cureus 2022; 14:e28501. [PMID: 36185919 PMCID: PMC9514154 DOI: 10.7759/cureus.28501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
Allergic rhinitis is a highly prevalent disease affecting the quality of life of millions of patients. Immunotherapy, medication, and allergen avoidance are all part of the treatment for allergic rhinitis. Allergic rhinitis causes an increase in inflammation throughout the body. As a result, asthma, chronic hyperplastic eosinophilic sinusitis, nasal polyposis, and serous otitis media are all associated with allergic rhinitis. Treatment that is effective should target systemic inflammation and its underlying causes. It has a negative impact on work productivity and academic achievement in both children and adults. Understanding the pathophysiology of allergic rhinitis, how it relates to its comorbid disorders, and how different therapy choices affect the pathophysiology of both allergic rhinitis and its related comorbidities are essential for providing effective treatment. As the quality of air around us is changing, there is an increased chance of allergies. Along with nasal and ocular symptoms that are directly linked to the allergic process, these symptoms' interference with sleep results in daytime tiredness and a decreased quality of life. In this paper, we look at pathogenesis, causes, signs, symptoms, and treatment modalities in patients with allergic rhinitis.
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Nur Husna SM, Tan HTT, Md Shukri N, Mohd Ashari NS, Wong KK. Allergic Rhinitis: A Clinical and Pathophysiological Overview. Front Med (Lausanne) 2022; 9:874114. [PMID: 35463011 PMCID: PMC9021509 DOI: 10.3389/fmed.2022.874114] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 01/25/2023] Open
Abstract
Allergic rhinitis (AR) represents a global health concern where it affects approximately 400 million people worldwide. The prevalence of AR has increased over the years along with increased urbanization and environmental pollutants thought to be some of the leading causes of the disease. Understanding the pathophysiology of AR is crucial in the development of novel therapies to treat this incurable disease that often comorbids with other airway diseases. Hence in this mini review, we summarize the well-established yet vital aspects of AR. These include the epidemiology, clinical and laboratory diagnostic criteria, AR in pediatrics, pathophysiology of AR, Th2 responses in the disease, as well as pharmacological and immunomodulating therapies for AR patients.
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Affiliation(s)
- Siti Muhamad Nur Husna
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Hern-Tze Tina Tan
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Norasnieda Md Shukri
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor Suryani Mohd Ashari
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Kah Keng Wong
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Pharmacotherapy focusing on for the management of otitis media with effusion in children: Systematic review and meta-analysis. Auris Nasus Larynx 2022; 49:748-754. [PMID: 35341623 DOI: 10.1016/j.anl.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/15/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the evidence for treating children with otitis media with effusion with pharmacotherapy. DATA SOURCES For the systematic review, data were retrieved from PubMed, Cochrane database, and the Japan Medical Abstracts Society Database (1st January 1995 through 31th May 2019). STUDY SELECTION Articles addressing pharmacotherapy for the management of otitis media with effusion in children were selected in English. DATA EXTRACTION The database was searched using the keywords "Otitis Media with effusion or secretory otitis media" and the following medical agents: carbocysteine, antihistamines, leukotriene receptor antagonist, and steroid nasal spray. DATA SYNTHESIS After a critical review of 18 studies, studies addressing steroid nasal spray were eligible for quantitative synthesis. Intranasal steroids for OME showed no benefit with OR 1.155 (95% CI 0.834-1.598) within one month. Conversely, intranasal steroids have effects for OME with OR 1.858 (95% CI 1.240-2.786) for more than one month. CONCLUSIONS We found evidence of benefit from treatment of OME in children with intranasal steroids and S-carboxymethylcysteine at longer-term follow-up.
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