ROLE OF VARIOUS ORAL ANTIHISTAMINES AS ADJUNCT TO TOPICAL STEROID and ANTIHISTAMINE IN THE MANAGEMENT OF PERENNIAL ALLERGIC RHINITIS

Abstract

Objective: Perennial Allergic Rhinitis (PAR) is a chronic inflammatory condition of the nasal mucosa, causing year-round symptoms like nasal congestion, sneezing, rhinorrhea, and itching, significantly impairing quality of life. Intranasal corticosteroids (INCS) combined with topical antihistamines are first-line therapy, but oral antihistamines are often used as adjuncts. This study evaluates the efficacy and safety of various oral antihistamines alongside standard intranasal therapy in PAR management.

Methods: A randomized controlled trial was conducted on 100 PAR patients, aged 18–60 y, divided into five groups (n=20). All groups received intranasal fluticasone propionate (27.5 mcg) and azelastine (140 mcg) twice daily for 12 w. Additionally, groups received one oral antihistamine daily: Levocetirizine (A), Desloratadine (B), Bilastine (C), Ebastine (D), or Olopatadine (E). Efficacy was assessed using Total Nasal Symptom Score (TNSS), symptom-specific scores, and Quality of Life (QoL). Data were analyzed with ANOVA; p<0.05 was significant.

Results: All groups showed significant TNSS reduction (p<0.001). Maximum improvement was in Groups B (6.5) and E (7.0) compared to A (4.5), C (4.2), and D (4.3). Symptom-specific analysis revealed superior outcomes in sneezing, nasal itching, and rhinorrhea for Groups B and E (p<0.05). QoL improved most in Groups B (22.5) and E (23.4). No serious adverse events were reported; mild sedation and dry mouth were infrequent and comparable across groups.

Conclusion: Desloratadine and Olopatadine as adjuncts to intranasal therapy provided superior symptom control and QoL improvement in PAR without significant adverse effects, supporting their role in combination therapy.