Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-17T17:48:13.220Z Has data issue: false hasContentIssue false
  • English
  • Français

Intranasal corticosteroid and oxymetazoline for chronic rhinitis: a systematic review

Published online by Cambridge University Press:  27 October 2021

C L Neighbors ,
C Fernandez Salvador ,
B Zhu ,
M Camacho  and
P Tsai
C L Neighbors*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Tripler Army Medical Center, Honolulu, USA
C Fernandez Salvador
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Fort Bragg Medical Center, USA
B Zhu
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Tripler Army Medical Center, Honolulu, USA
M Camacho
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Tripler Army Medical Center, Honolulu, USA
P Tsai
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Tripler Army Medical Center, Honolulu, USA
*
Author for correspondence: Dr C L Neighbors, Department of Otolaryngology – Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu 96859, Hawaii, USA E-mail: cindy.neighbors.md@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study aimed to summarise the evidence for efficacy of combination treatment of intranasal corticosteroid spray with oxymetazoline hydrochloride nasal spray for chronic rhinitis.

Method

Nine databases were systematically searched from study inception in September 2016 to 1 June 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed.

Results

A total of 130 studies were screened, and 4 randomised controlled trials comprising 838 patients met inclusion criteria. The study found superior improvement of nasal congestion from onset of treatment to completion in intranasal corticosteroid spray and oxymetazoline hydrochloride groups compared with control groups. Intranasal corticosteroid spray and oxymetazoline hydrochloride use resulted in higher nasal volume (standard error of mean 1, 15.8 + 1.1 ml; p < .03) compared with either placebo (12.1 + 0.9 ml) or oxymetazoline hydrochloride (12.4 + 0.8 ml) alone (p = 0.003).

Conclusion

Intranasal corticosteroid spray and oxymetazoline hydrochloride combination treatment may be superior in reducing rhinitis symptoms compared with either intranasal corticosteroid spray or oxymetazoline hydrochloride alone, without inducing rhinitis medicamentosa.

Keywords

OxymetazolineRhinitis MedicamentosaNasal Corticosteroid
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 1 , January 2022 , pp. 8 - 16
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr C L Neighbors takes responsibility for the integrity of the content of the paper

Presented at the American Academy of Otolaryngology Head and Neck Society Annual Meeting, 10 September 2017, Chicago, Illinois, USA.

References

Meltzer, EO, Orgel, HA, Bronsky, EA, Furukawa, CT, Grossman, J, LaForce, CF et al. A dose-ranging study of fluticasone propionate aqueous nasal spray for seasonal allergic rhinitis assessed by symptoms, rhinomanometry, and nasal cytology. J Allergy Clin Immunol 1990;86:221–30CrossRefGoogle ScholarPubMed
Baroody, FM, Brown, D, Gavanescu, L, DeTineo, M, Naclerio, RM. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 2011;127:927–34CrossRefGoogle Scholar
Hallen, H, Enerdal, J, Graf, P. Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in rhinitis medicamentosa. Clin Experiment Allergy 1997;27:552–8CrossRefGoogle Scholar
Wallace, DV, Dykewicz, MS, Bernstein, DI, Blessing-Moore, J, Cox, L, Khan, DA et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008;122:S1–84CrossRefGoogle Scholar
Thongngarm, T, Assanasen, P, Pradubpongsa, P, Tantilipikorn, P. The effectiveness of oxymetazoline plus intranasal steroid in the treatment of chronic rhinitis: a randomised controlled trial. Asian Pac J allergy Immunol 2016;34:30–7Google ScholarPubMed
Meltzer, EO, Bernstein, DI, Prenner, BM, Berger, WE, Shekar, T, Teper, AA. Mometasone furoate nasal spray plus oxymetazoline nasal spray: short-term efficacy and safety in seasonal allergic rhinitis. Am J Rhinol Allergy 2013;27:102–8CrossRefGoogle ScholarPubMed
Rael, EL, Ramey, J, Lockey, RF. Oxymetazoline hydrochloride combined with mometasone nasal spray for persistent nasal congestion (pilot study). WAO Journal 2011;3:65–7Google Scholar
Lockey, RF. Rhinitis medicamentosa and the stuffy nose J Allergy Clin Immunol 2006;118:1017–18CrossRefGoogle ScholarPubMed
Passàli, D, Salerni, L, Passàli, GC, Passàli, FM, Bellussi, L. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf 2006;5:783–90CrossRefGoogle ScholarPubMed
Zucker, SM, Barton, BM, McCoul, ED. Management of rhinitis medicamentosa: a systematic review. Otolaryngol Head Neck Surg 2019;160: 429–38CrossRefGoogle ScholarPubMed
Ferguson, BJ, Paramaesvaran, S, Rubinstein, E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Otolaryngol Head Neck Surg 2001;125:253–60CrossRefGoogle ScholarPubMed
Vaidyanathan, S, Williamson, P, Clearie, K, Khan, F, Lipworth, B. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med 2010;182:19–24CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med 2009;151:264–9CrossRefGoogle ScholarPubMed
Bickford, L, Shakib, S, Taverner, D. The nasal airways response in normal subjects to oxymetazoline spray: randomized double-blind placebo-controlled study Br J Clin Pharmacol 1999;48:53–6CrossRefGoogle Scholar
Graf, P, Enerdal, J, Hallén, H. Ten days' use of oxymetazoline nasal spray with or without benzalkonium chloride in patients with vasomotor rhinitis. Arch Otolaryngol Head Neck Surg 1999;125:1128–32CrossRefGoogle ScholarPubMed
Bousquet, J, Lund, VJ, van Cauwenberge, P, Bremard-Oury, C, Mounedji, N, Stevens, MT et al. Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial. Allergy 2003;58:733–41CrossRefGoogle ScholarPubMed
Cingi, C, Ozdoganoglu, T, Songu, M. Nasal obstruction as a drug side effect. Ther Adv Respir Dis 2011;5:175–82CrossRefGoogle ScholarPubMed
Invanz. (2012). In: PDR3D Digital Drug Database Retrieved. In: http://www.pdr3d.com/ [17 October 2021]Google Scholar
Liu, W, Zhou, L, Zeng, Q and Luo, R. Combination of mometasone furoate and oxymetazoline for the treatment of adenoid hypertrophy concomitant with allergic rhinitis: a randomized controlled trial. Sci Rep 2017;7:40425CrossRefGoogle ScholarPubMed
Tas, A, Yagiz, R, Yalcin, O, Uzun, C, Huseyinova, G, Adali, MK et al. Use of mometasone furoate aqueous nasal spray in the treatment of rhinitis medicamentosa: an experimental study. Otolaryngol Head Neck Surg 2005;132:608–12CrossRefGoogle ScholarPubMed
Watanabe, H, Foo, TH, Djazaeri, B, Duncombe, P, Mackay, IS, Durham, SR. Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis. Rhinology 2003;41:167–74Google ScholarPubMed
Yoo, JK, Seikaly, H, Calhoun, KH. Extended use of topical nasal decongestants. Laryngoscope 1997;107:40–3CrossRefGoogle ScholarPubMed
Fuller, JC, Gadkaree, SK, Levesque, PA, Lindsay, RW. Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty. Laryngoscope 2019;129:594–601CrossRefGoogle ScholarPubMed
Debbaneh, PM, Bareiss, AK, Wise, SK, McCoul, ED. Intranasal azelastine and fluticasone as combination therapy for allergic rhinitis: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2019;161:412–18CrossRefGoogle ScholarPubMed
Ratner, PH, Hampel, F, Van Bavel, J, Amar, NJ, Daftary, P, Wheeler, W et al. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2008;100:74–81CrossRefGoogle ScholarPubMed
Eskiizmir, G, Hircin, Z, Ozyurt, B, Unlu, H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol 2011;67:19–23CrossRefGoogle ScholarPubMed
Bridgeman, MB. Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis. Integr Pharm Res Pract 2017;6:109–19CrossRefGoogle ScholarPubMed
Penttilä, M, Poulsen, P, Hollingworth, K, Holmström, M. Dose-related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo-controlled randomized study in adult patients Clin Exp Allergy 2000;30:94–102CrossRefGoogle ScholarPubMed