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Table 1 Efficacy of drugs to treat AR and recommendation level, according to Aggregate Grade of Evidence (AGE) from International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis [12]

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