Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta-analysis

Int Forum Allergy Rhinol. 2018 Dec;8(12):1445-1453. doi: 10.1002/alr.22193. Epub 2018 Jul 28.


Background: Intranasal corticosteroid (INCS) is the most efficacious medicine for treating chronic rhinitis. A decongestant and INCS combination (INCS-D) is considered for nasal congestion that is not improved by INCS. This study aimed to investigate the effects of INCS-D on chronic rhinitis.

Methods: Literature searches were performed using MEDLINE and EMBASE. Randomized controlled trials studying the effects of INCS-D vs INCS alone for treating chronic rhinitis were included. Data were pooled for meta-analysis. Outcomes were nasal symptoms, disease-specific quality of life, objective tests for nasal patency, and adverse events.

Results: Six studies (1071 patients) met the inclusion criteria. There were no differences between INCS-D and INCS on total nasal symptom scores (standardized mean difference [SMD] -0.85; 95% confidence interval [CI], -2.09 to 0.40; p = 0.18), nasal congestion scores (SMD -0.13; 95% CI, -0.46 to 0.20; p = 0.43), and the Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.12; 95% CI, -0.66 to 0.42; p = 0.66). After 1 week, there were no differences on objective tests for nasal patency (acoustic rhinometry: SMD 0.04; 95% CI, -0.68 to 0.76, p = 0.91; and peak nasal inspiratory flow: SMD 0.08; 95% CI, -0.16 to 0.32; p = 0.52). Adverse events were not different between INCS-D and INCS (risk ratio 1.09; 95% CI, 0.73 to 1.62).

Conclusion: Meta-analyses did not show benefits of topical decongestants addition to INCS. Adverse events of INCS-D were comparable with INCS.

Keywords: allergic; decongestant; rhinitis; steroids; vasoconstrictor.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Administration, Intranasal
  • Adrenal Cortex Hormones / therapeutic use*
  • Chronic Disease
  • Drug Therapy, Combination*
  • Humans
  • Nasal Decongestants / therapeutic use*
  • Quality of Life
  • Rhinitis / drug therapy*


  • Adrenal Cortex Hormones
  • Nasal Decongestants