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Treatment Dose Increase Versus Co-Medication in Allergic Rhinitis: Systematic Review With Dose-Response Network
Bernardo Sousa-Pinto1,2, Rafael José Vieira1,2, Sara Gil-Mata1,2
1MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.
Allergy
|May 2, 2026
Summary
For allergic rhinitis (AR), doubling intranasal medication doses is often better than adding oral antihistamines. Adding intranasal corticosteroids to oral antihistamines also outperforms doubling oral antihistamine doses. Safety profiles were similar across strategies.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Clinical Medicine
Background:
- Patients with allergic rhinitis (AR) frequently require increased medication or combination therapy for symptom control.
- Optimizing treatment strategies for AR is crucial for patient well-being.
Purpose of the Study:
- To systematically review and compare the efficacy and safety of increased medication doses versus co-medication for allergic rhinitis.
- To provide evidence-based recommendations for AR treatment guidelines.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials involving intranasal and/or oral AR medications.
- Network meta-analysis (NMA) to compare monotherapy at increased doses versus co-medication.
- GRADE assessment for certainty of evidence.
Main Results:
- Co-medication with oral antihistamines (OAH) plus intranasal corticosteroids (INCS) improved nasal symptoms and quality of life more than doubling OAH dose.
- Doubling intranasal medication dose was more effective than adding OAH.
- Doubling INCS dose showed higher efficacy than adding intranasal antihistamines (INAH).
- No significant safety differences were observed between treatment strategies.
Conclusions:
- Doubling intranasal medication doses is preferable to adding OAH for AR management.
- Adding INCS to OAH is more effective than doubling OAH dose.
- Findings will inform upcoming ARIA-EAACI guidelines for AR treatment.
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