From: Current treatment strategies for seasonal allergic rhinitis: where are we heading?
Type of drug and pharmaceutical preparations | AGE | Number of listed studies | Recommendation level |
---|---|---|---|
Oral H1 antihistamines | A | Level 1a: 21 studies | Strong recommendation |
Intranasal antihistamines | A | Level 1b: 43 studies Level 2b: 1 study | Recommendation |
Intranasal corticosteroids (INCS) | A | Level 1a: 15 studies Level 1b: 33 studies Level 2a: 3 studies Level 2b: 1 study Level 5: 1 study | Strong recommendation |
Combination: INCS and intranasal antihistamine | A | Level 1b: 9 studies Level 2b: 1 study Level 2c: 2 studies | Strong recommendation |
Oral corticosteroids | B | Level 1b: 5 studies Level 2b: 1 study Level 4: 3 studies | Recommendation against |
Injectable corticosteroids | B | Level 1b: 3 studies Level 2b: 3 studies Level 4: 7 studies | Recommendation against |
Oral decongestants | B | Level 1a: 2 studies Level 1b: 3 studies Level 3b: 2 studies Level 4: 2 studies | Option for pseudoephedrine for short term treatment Recommend against phenlylephrine |
Intranasal decongestants | B | Level 1b: 3 studies Level 2b: 1 study | Option |
Leukotriene receptor antagonists | A | Level 1a: 6 studies Level 1b: 17 studies Level 2a: 2 studies Level 2b: 3 studies Level 4: 3 studies | Recommendation against |
Cromolyn (DSCG) | A | Level 1b: 13 studies Level 2b: 9 studies | Option |
Intranasal anticholinergics (IPB) | B | Level 1b: 9 studies Level 2b: 5 studies | Option |
Biologics (omalizumab) | A | Level 1a: 1 study Level 1b: 5 studies | No indication |
Aggregate grade of evidence (AGE) | |
---|---|
Grade | Research quality |
A | Well-designed RCTs |
B | RCTs with minor limitations; overwhelming consistent evidence from observational studies |
C | Observational studies (case control and cohort design) |
D | Expert opinion; Case reports; Reasoning from first principles |