Antihistamines as an addition to topical nasal steroids for allergic rhinitis in children

Allergic rhinitis is a very common chronic illness affecting 10% to 40% of children worldwide. Seasonal allergic rhinitis (hay fever) is most common around springtime. The symptoms are mostly sneezing, a runny nose and watery eyes. We looked for trials that compared antihistamines (either oral or topical) in addition to a topical nasal steroid with a topical nasal steroid alone in children who had allergic rhinitis. We wanted to know whether adding antihistamines (oral or topical) in the therapy of children with allergic rhinitis who already use topical nasal steroids would have additional benefits for them. We found one trial that had been carried out in children comparing oral antihistamines in addition to topical nasal steroids with topical nasal steroids alone but it did not provide sufficient data to draw any conclusions. Most of the trials focused only on adults or included a small number of children. Unfortunately, the trials which included children along with adults did not report whether there were any differences in the effect of treatment or adverse effects in children in comparison with adults. We are therefore unable to draw a conclusion as to whether or not this combination therapy has beneficial effect in children with allergic rhinitis or whether the benefits are acceptable in terms of the adverse effects.

Authors' conclusions: 

In view of the lack of evidence for the benefit or lack of benefit of antihistamine add-on therapy with topical nasal steroids for children with intermittent or persistent allergic rhinitis, it is important that clinicians are mindful of the adverse effects of antihistamines and the additional costs that may be incurred.

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Allergic rhinitis is a very common chronic illness affecting 10% to 40% of children worldwide and its prevalence among children has significantly increased over the last two decades. Prevalence and severity are related to age, with children of school age most commonly affected.


To assess the effectiveness and adverse event profile of antihistamines (oral or topical) used as an adjunct to topical nasal steroids for intermittent and persistent allergic rhinitis in children.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 21 September 2009.

Selection criteria: 

Randomised controlled trials (RCTs) in children under the age of 18 with a history of allergic rhinitis, with or without allergic conjunctivitis or asthma, comparing topical nasal steroids with antihistamines to topical nasal steroids only.

Data collection and analysis: 

Two review authors independently screened studies, extracted data and assessed risk of bias.

Main results: 

One study including 24 participants met the inclusion criteria for this review. This study compared the administration of topical nasal steroids with oral antihistamines to topical nasal steroids only in children, but it did not provide sufficient data to address the clinical question of this review.