2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T782,Allergic rhinitis displays a relevant impact on quality of life. Medications used in the treatment of rhinitis have been assessed on their impact on rhinoconjunctivitis-related quality of life, but not on generic health-related quality of life metrics, such as utilities or EQ-5D visual analogue scale (VAS) levels. This study aimed to compare different medication classes and individual medications on utilities and EQ-5D VAS levels using data from a mobile app. We conducted an observational study using direct patient data from the MASK-air mobile application, collected between May 2015 and December 2024. We compared rhinitis medication classes and individual medications on health utilities (computed from the EQ-5D-5L questionnaire) and the EQ-5D VAS. To account for confounding, we employed inverse probability treatment weighting based on propensity scores, adjusting for demographics, baseline symptom control, and asthma status. The study analysed 69,973 observations with EQ-5D VAS data and 842 observations with utility data. At the medication class level, fixed combinations of intranasal antihistamines and corticosteroids were associated with improvements in EQ-5D VAS (mean difference = 1.900; 95% CI = 1.316-2.484) and utilities (mean difference = 0.022; 95% CI = -0.015 to 0.059) compared with oral antihistamines (OAH). Intranasal antihistamines were associated with lower EQ-5D VAS and utility scores than other intranasal treatments. For individual medications, mometasone was associated with a lower EQ-5D VAS than budesonide and fluticasone furoate, while fexofenadine and levocetirizine tended to be associated with lower VAS values than other OAH. Fixed combinations of intranasal antihistamines and corticosteroids were associated with better quality-of-life than oral antihistamines and intranasal antihistamines. These findings could support future cost-effectiveness analyses.31:Ta20,ABSTRACT Background Allergic rhinitis displays a relevant impact on quality of life. Medications used in the treatment of rhinitis have been assessed on their impact on rhinoconjunctivitis‐related quality of life, but not on generic health‐related quality of life metrics, such as utilities or EQ‐5D visual analogue scale (VAS) levels. This study aimed to compare different medication classes and individual medications on utilities and EQ‐5D VAS levels using data from a mobile app. Methods We conducted an observational study using direct patient data from the MASK‐air mobile application, collected between May 2015 and December 2024. We compared rhinitis medication classes and individual medications on health utilities (computed from the EQ‐5D‐5L questionnaire) and the EQ‐5D VAS. To account for confounding, we employed inverse probability treatment weighting based on propensity scores, adjusting for demographics, baseline symptom control, and asthma status. Results The study analysed 69,973 observations with EQ‐5D VAS data and 842 observations with utility data. At the medication class level, fixed combinations of intranasal antihistamines and corticosteroids were associated with improvements in EQ‐5D VAS (mean difference = 1.900; 95% CI = 1.316–2.484) and utilities (mean difference = 0.022; 95% CI = −0.015 to 0.059) compared with oral antihistamines (OAH). Intranasal antihistamines were associated with lower EQ‐5D VAS and utility scores than other intranasal treatments. For individual medications, mometasone was associated with a lower EQ‐5D VAS than budesonide and fluticasone furoate, while fexofenadine and levocetirizine tended to be associated with lower VAS values than other OAH. Conclusion Fixed combinations of intranasal antihistamines and corticosteroids were associated with better quality‐of‐life than oral antihistamines and intranasal antihistamines. These findings could support future cost‐effectiveness analyses. 32:T8ff,Limited pharmaceutical options exist for preexposure prophylaxis of COVID-19 beyond vaccination. Azelastine, an antihistamine nasal spray used for decades to treat allergic rhinitis, has in vitro antiviral activity against respiratory viruses, including SARS-CoV-2. To determine the efficacy and safety of azelastine nasal spray for prevention of SARS-CoV-2 infections in healthy adults. A phase 2, double-blind, placebo-controlled, single-center trial was conducted from March 2023 to July 2024. Healthy adults from the general population were enrolled at the Saarland University Hospital in Germany. Participants were randomly assigned 1:1 to receive azelastine, 0.1%, nasal spray or placebo 3 times daily for 56 days. SARS-CoV-2 rapid antigen testing (RAT) was conducted twice weekly, with positive results confirmed by polymerase chain reaction (PCR). Symptomatic participants with negative RAT results underwent multiplex PCR testing for respiratory viruses. The primary end point was the number of PCR-confirmed SARS-CoV-2 infections during the study. A total of 450 participants were randomized, with 227 assigned to azelastine and 223 to placebo; 299 (66.4%) were female, 151 (33.6%) male, with a mean (SD) age of 33.0 (13.3) years. Most were White (417 [92.7%]), with 4 (0.9%) African, 22 (4.9%) Asian, and 7 (1.6%) of other ethnicity. In the intention-to-treat (ITT) population, the incidence of PCR-confirmed SARS-CoV-2 infection was significantly lower in the azelastine group (n = 5 [2.2%]) compared with the placebo group (n = 15 [6.7%]) (OR, 0.31; 95% CI, 0.11-0.87). As secondary end points, azelastine demonstrated an increase in mean (SD) time to SARS-CoV-2 infection among infected participants (31.2 [9.3] vs 19.5 [14.8] days), a reduction of the overall number of PCR-confirmed symptomatic infections (21 of 227 participants vs 49 of 223 participants), and a lower incidence of PCR-confirmed rhinovirus infections (1.8% vs 6.3%). Adverse events were comparable between the groups. In this single-center trial, azelastine nasal spray was associated with reduced risk of SARS-CoV-2 respiratory infections. These findings support the potential of azelastine as a safe prophylactic approach warranting confirmation in larger, multicentric trials. EudraCT number: 2022-003756-13.33:Teb5, Importance Limited pharmaceutical options exist for preexposure prophylaxis of COVID-19 beyond vaccination. Azelastine, an antihistamine nasal spray used for decades to treat allergic rhinitis, has in vitro antiviral activity against respiratory viruses, including SARS-CoV-2. Objective To determine the efficacy and safety of azelastine nasal spray for prevention of SARS-CoV-2 infections in healthy adults. Design, Setting, and Participants A phase 2, double-blind, placebo-controlled, single-center trial was conducted from March 2023 to July 2024. Healthy adults from the general population were enrolled at the Saarland University Hospital in Germany. Interventions Participants were randomly assigned 1:1 to receive azelastine, 0.1%, nasal spray or placebo 3 times daily for 56 days. SARS-CoV-2 rapid antigen testing (RAT) was conducted twice weekly, with positive results confirmed by polymerase chain reaction (PCR). Symptomatic participants with negative RAT results underwent multiplex PCR testing for respiratory viruses. Main Outcome The primary end point was the number of PCR-confirmed SARS-CoV-2 infections during the study. Results A total of 450 participants were randomized, with 227 assigned to azelastine and 223 to placebo; 299 (66.4%) were female, 151 (33.6%) male, with a mean (SD) age of 33.0 (13.3) years. Most were White (417 [92.7%]), with 4 (0.9%) African, 22 (4.9%) Asian, and 7 (1.6%) of other ethnicity. In the intention-to-treat (ITT) population, the incidence of PCR-confirmed SARS-CoV-2 infection was significantly lower in the azelastine group (n = 5 [2.2%]) compared with the placebo group (n = 15 [6.7%]) (OR, 0.31; 95% CI, 0.11-0.87). As secondary end points, azelastine demonstrated an increase in mean (SD) time to SARS-CoV-2 infection among infected participants (31.2 [9.3] vs 19.5 [14.8] days), a reduction of the overall number of PCR-confirmed symptomatic infections (21 of 227 participants vs 49 of 223 participants), and a lower incidence of PCR-confirmed rhinovirus infections (1.8% vs 6.3%). Adverse events were comparable between the groups. Conclusions and Relevance In this single-center trial, azelastine nasal spray was associated with reduced risk of SARS-CoV-2 respiratory infections. These findings support the potential of azelastine as a safe prophylactic approach warranting confirmation in larger, multicentric trials. Trial registration EudraCT number: 2022-003756-13 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Intranasal Antihistamine: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Intranasal Antihistamine (modality). Clinician-written summaries and actionable practice insights. 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At the medication class level, fixed combinations of intranasal antihistamines and corticosteroids were associated with improvements in EQ-5D VAS (mean difference = 1.900; 95% CI = 1.316-2.484) and utilities (mean difference = 0.022; 95% CI = -0.015 to 0.059) compared with oral antihistamines (OAH). Intranasal antihistamines were associated with lower EQ-5D VAS and utility scores than other intranasal treatments. For individual medications, mometasone was associated with a lower EQ-5D VAS than budesonide and fluticasone furoate, while fexofenadine and levocetirizine tended to be associated with lower VAS values than other OAH.","abstract":"$30","keywords":[],"pubmed_id":"42087806","conclusions":"Fixed combinations of intranasal antihistamines and corticosteroids were associated with better quality-of-life than oral antihistamines and intranasal antihistamines. These findings could support future cost-effectiveness analyses.","publication_date":"2026-05-06T00:00:00"},"crossref":{"DOI":"10.1111/cea.70335","URL":"https://doi.org/10.1111/cea.70335","ISSN":["0954-7894","1365-2222"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/cea.70335","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/cea.70335","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/cea.70335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Comparison of Allergic Rhinitis Treatments on Utilities and Quality of Life: A\n MASK\n ‐air Study"],"author":[{"given":"Nuno","family":"Lourenço‐Silva","sequence":"first","affiliation":[{"name":"MEDCIDS – 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of Porto Porto Portugal"},{"name":"CINTESIS@RISE – Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Allergy Unit Instituto and Hospital CUF Porto Portugal"}]},{"given":"João","family":"Coutinho‐Almeida","sequence":"additional","affiliation":[{"name":"MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE – Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"given":"Rita","family":"Amaral","sequence":"additional","affiliation":[{"name":"MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE – Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Department of Cardiovascular and Respiratory Sciences, Porto Health School Polytechnic Institute of Porto Porto Portugal"},{"name":"Department of Women's and Children's Health, Paediatric Research Uppsala University Uppsala Sweden"}]},{"given":"Luisa","family":"Brussino","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Torino Torino Italy"},{"name":"Allergy and Clinical Immunology Unit Mauriziano Hospital Torino Italy"}]},{"given":"Mattia","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Allergy Unit Meyer Children's Hospital IRCCS Florence Italy"},{"name":"Department of Health Sciences University of Florence Florence Italy"}]},{"given":"Bilun","family":"Gemicioglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine Istanbul University‐Cerrahpaşa Istanbul Turkey"},{"name":"Department of Pulmonary Diseases, Institute of Pulmonology and Tuberculosis Istanbul University‐Cerrahpaşa Istanbul Turkey"}]},{"given":"Violeta","family":"Kvedariene","sequence":"additional","affiliation":[{"name":"Clinic of Chest Diseases and Allergology, Faculty of Medicine, Institute of Clinical Medicine Vilnius University Vilnius Lithuania"},{"name":"Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences Vilnius University Vilnius Lithuania"}]},{"given":"Desiree E.","family":"Larenas‐Linnemann","sequence":"additional","affiliation":[{"name":"Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico"}]},{"given":"Manuel","family":"Marques‐Cruz","sequence":"additional","affiliation":[{"name":"MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE – Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"given":"Nikolaos G.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Pediatric Clinic University of Athens Athens Greece"}]},{"given":"Nhân","family":"Pham‐Thi","sequence":"additional","affiliation":[{"name":"Ecole Polytechnique de Palaiseau Palaiseau France"},{"name":"IRBA (Institut de Recherche Bio‐Médicale des Armées) Bretigny sur Orge France"},{"name":"Université Paris Cité Paris France"},{"name":"Center for Allergy and Clinical Immunology, Alésia Paris France"}]},{"given":"Frederico S.","family":"Regateiro","sequence":"additional","affiliation":[{"name":"Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra Unidade Local de Saúde de Coimbra Coimbra Portugal"},{"name":"Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine University of Coimbra Coimbra Portugal"},{"name":"Faculty of Medicine, Institute of Immunology University of Coimbra Coimbra Portugal"},{"name":"UBIAir – Clinical & Experimental Lung Centre and CICS‐UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal"}]},{"given":"Sanna K.","family":"Toppila‐Salmi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology University of Eastern Finland and the North Savo Wellbeing Services County Kuopio Finland"},{"name":"Department of Allergy, Skin and Allergy Hospital, Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland"}]},{"given":"Boleslaw","family":"Samolinski","sequence":"additional","affiliation":[{"name":"Department of Prevention of Environmental Hazards, Allergology and Immunology Medical University of Warsaw Warsaw Poland"}]},{"given":"Joaquin","family":"Sastre","sequence":"additional","affiliation":[{"name":"Allergy Service, Fundacion Jimenez Diaz Universidad Autonoma de Madrid, CIBERES‐ISCIII Madrid Spain"}]},{"given":"Luís","family":"Taborda‐Barata","sequence":"additional","affiliation":[{"name":"RISE‐Health, Faculty of Health Sciences, and UBIAir‐Clinical & Experimental Lung Centre University of Beira Interior Covilhã Portugal"},{"name":"Department of Immunoallergology Unidade Local de Saúde, Cova da Beira Covilhã Portugal"}]},{"given":"Arunas","family":"Valiulis","sequence":"additional","affiliation":[{"name":"Clinic of Asthma, Allergy and Chronic Lung Diseases Vilnius Lithuania"},{"name":"Institute of Clinical Medicine and Institute of Health Sciences Medical Faculty of Vilnius University Vilnius Lithuania"}]},{"given":"Leticia de las","family":"Vecillas","sequence":"additional","affiliation":[{"name":"Department of Allergy Hospital La Paz Institute for Health Research (IdiPAZ) Madrid Spain"}]},{"given":"Maria Teresa","family":"Ventura","sequence":"additional","affiliation":[{"name":"University of Bari Medical School Bari Italy"},{"name":"Institute of Sciences of Food Production National Research Council (ISPA‐CNR) Bari 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& Experimental Allergy"],"reference-count":44,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,6]]},"references-count":44,"short-container-title":["Clin Experimental Allergy"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1111/cea.70335","is_oa":true,"title":"Comparison of Allergic Rhinitis Treatments on Utilities and Quality of Life: A\n MASK\n ‐air Study","updated":"2026-05-07T14:04:23+00:00","published_date":"2026-05-06","best_oa_location":{"url":"https://doi.org/10.1111/cea.70335","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1111/cea.70335"}}},"created_at":"2026-05-10T13:20:45.501Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1111/cea.70335","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"condition","value":"Allergic Rhinitis","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"condition","value":"Rhinoconjunctivitis","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"generic","value":"budesonide","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"generic","value":"fexofenadine","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"generic","value":"fluticasone furoate","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"generic","value":"levocetirizine","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"generic","value":"mometasone","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"modality","value":"Fixed Combination Intranasal Antihistamine/Corticosteroid","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"modality","value":"Intranasal Antihistamine","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"modality","value":"Intranasal Corticosteroid","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"modality","value":"Oral Antihistamine","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"sample_size","value":"n=69973","value_numeric":69973},{"paper_doi":"10.1111/cea.70335","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"study_design","value":"Observational Study","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"warning","value":"Individual drug comparisons (e.g., mometasone vs. fluticasone furoate) should be interpreted with caution given uncontrolled confounding in an app-based real-world dataset.","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"warning","value":"Study design is observational with propensity-score weighting; causal inference is limited. The sample_size tag reflects the larger VAS dataset; utility sample is much smaller.","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"warning","value":"The finding that fexofenadine and levocetirizine were associated with *lower* (worse) EQ-5D VAS values than other oral antihistamines is counterintuitive and may reflect confounding by indication rather than true inferiority.","value_numeric":null},{"paper_doi":"10.1111/cea.70335","tag_type":"warning","value":"The utility comparison (n=842) is substantially underpowered relative to the VAS comparison (n=69,973); the key utility result's 95% CI crosses zero, indicating uncertain clinical significance.","value_numeric":null}],"summaries":{"what_studied":"This observational study used real-world data from the MASK-air mobile app (May 2015–Dec 2024) to compare allergic rhinitis medication classes and individual drugs on generic health-related quality of life — specifically EQ-5D VAS scores and health utilities — using inverse probability treatment weighting to adjust for confounding.","key_result":"Fixed combinations of intranasal antihistamines + corticosteroids outperformed oral antihistamines on EQ-5D VAS (mean difference +1.900; 95% CI 1.316–2.484) and utilities (mean difference +0.022; 95% CI −0.015 to 0.059). Intranasal antihistamines alone scored lower than other intranasal treatments. Among oral antihistamines, fexofenadine and levocetirizine tended toward lower (worse) VAS values; among intranasal corticosteroids, mometasone was associated with lower EQ-5D VAS than budesonide or fluticasone furoate.","limitations":"- The utility dataset was very small (n=842), making utility comparisons underpowered and the confidence interval for the key utility result crossing zero.\n- Observational design with propensity-score weighting cannot fully eliminate confounding by indication (e.g., sicker patients may preferentially receive certain drugs).\n- App-based self-report data may not be representative of the broader allergic rhinitis population.","practice_takeaway":"Fixed intranasal antihistamine–corticosteroid combinations appear to offer the best generic quality-of-life benefit among rhinitis drug classes and may be preferred when patient-centered outcomes matter. Clinicians should interpret individual-drug comparisons (e.g., mometasone vs. fluticasone furoate) cautiously given the observational design and small utility sample."}},{"doi":"10.1111/all.70372","pmid":"42068093","title":"Treatment Dose Increase Versus Co‐Medication in Allergic Rhinitis: Systematic Review With Dose–Response Network Meta‐Analysis","journal_title":"Allergy","journal_issn":"0105-4538","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.1111/all.70372","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:50:52.299Z","updated_at":"2026-05-07T22:50:52.299Z","tags":[{"paper_doi":"10.1111/all.70372","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"condition","value":"Allergic Rhinitis","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"modality","value":"Intranasal Antihistamine","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"modality","value":"Intranasal Corticosteroid","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"modality","value":"Oral Antihistamine","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"sample_size","value":"n=262 studies","value_numeric":262},{"paper_doi":"10.1111/all.70372","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"study_design","value":"Systematic Review with Network Meta-Analysis","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"warning","value":"Dose-doubling comparisons are based on modeled dose–response projections rather than direct RCT evidence, which may affect confidence in specific estimates.","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"warning","value":"The sample size tag (n=262) refers to the number of included studies, not individual patients — total patient numbers are not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1111/all.70372","tag_type":"warning","value":"The study is intended to inform the ARIA-EAACI 2024-2025 guidelines; final guideline recommendations may differ from these NMA findings.","value_numeric":null}],"summaries":{"what_studied":"This systematic review with dose–response network meta-analysis (NMA) compared the efficacy and safety of increasing AR medication doses versus adding co-medications, using 262 RCTs in patients of all ages with seasonal or perennial allergic rhinitis.","key_result":"Adding INCS to standard-dose OAH improved nasal symptoms and quality of life more than doubling OAH dose. Conversely, doubling intranasal medication doses outperformed adding OAH to intranasal regimens. Doubling INCS also beat adding intranasal antihistamines. No meaningful safety differences were found between strategies.","limitations":"Projected estimates for double-dose comparisons relied on dose–response modeling rather than direct head-to-head trial data. Certainty of evidence was assessed via GRADE for NMA, which may be limited by indirect comparisons across 262 heterogeneous trials.","practice_takeaway":"When OAH alone is insufficient, add INCS rather than doubling the OAH dose. When intranasal therapy is insufficient, double the intranasal dose rather than adding an oral antihistamine."}},{"doi":"10.1001/jamainternmed.2025.4283","pmid":"40892398","title":"Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections","journal_title":"JAMA Internal Medicine","journal_issn":"2168-6106","published_at":"2025-09-02T00:00:00.000Z","url":"https://doi.org/10.1001/jamainternmed.2025.4283","source_score":2457,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-11-04","doi":"10.1001/jamainternmed.2025.4283","days":"30","issn":"2168-6106","rank":"1","field":"Clinical Medicine","score":"2457","category":"Medicine, General & Internal","categories":["Medicine, General & Internal"],"_categories":["Medicine, General & Internal"]},"pubmed":{"doi":"10.1001/jamainternmed.2025.4283","title":"Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial.","journal":"JAMA internal medicine","methods":"","results":"A total of 450 participants were randomized, with 227 assigned to azelastine and 223 to placebo; 299 (66.4%) were female, 151 (33.6%) male, with a mean (SD) age of 33.0 (13.3) years. Most were White (417 [92.7%]), with 4 (0.9%) African, 22 (4.9%) Asian, and 7 (1.6%) of other ethnicity. In the intention-to-treat (ITT) population, the incidence of PCR-confirmed SARS-CoV-2 infection was significantly lower in the azelastine group (n = 5 [2.2%]) compared with the placebo group (n = 15 [6.7%]) (OR, 0.31; 95% CI, 0.11-0.87). As secondary end points, azelastine demonstrated an increase in mean (SD) time to SARS-CoV-2 infection among infected participants (31.2 [9.3] vs 19.5 [14.8] days), a reduction of the overall number of PCR-confirmed symptomatic infections (21 of 227 participants vs 49 of 223 participants), and a lower incidence of PCR-confirmed rhinovirus infections (1.8% vs 6.3%). Adverse events were comparable between the groups.","abstract":"$32","keywords":[],"pubmed_id":"40892398","conclusions":"","publication_date":"2025-09-02T00:00:00"},"crossref":{"DOI":"10.1001/jamainternmed.2025.4283","URL":"https://doi.org/10.1001/jamainternmed.2025.4283","ISSN":["2168-6106"],"link":[{"URL":"https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2838335/jamainternal_lehr_2025_oi_250054_1761147096.81745.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"1309","type":"journal-article","issue":"11","score":1,"title":["Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections"],"author":[{"given":"Thorsten","family":"Lehr","sequence":"first","affiliation":[{"name":"Saarland University, Saarbruecken, Germany"}]},{"given":"Peter","family":"Meiser","sequence":"additional","affiliation":[{"name":"Ursapharm Arzneimittel GmbH, Saarbruecken, Germany"}]},{"given":"Dominik","family":"Selzer","sequence":"additional","affiliation":[{"name":"Saarland University, Saarbruecken, Germany"}]},{"given":"Torben","family":"Rixecker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine V, Saarland University Medical Center, Germany"}]},{"given":"Frank","family":"Holzer","sequence":"additional","affiliation":[{"name":"Ursapharm Arzneimittel GmbH, Saarbruecken, Germany"}]},{"given":"Ralph","family":"Mösges","sequence":"additional","affiliation":[{"name":"ClinCompetence Cologne GmbH, Cologne, Germany"},{"name":"Institute of Medical Statistics and Computational Biology, University of Cologne, Germany"}]},{"given":"Sigrun","family":"Smola","sequence":"additional","affiliation":[{"name":"Helmholtz Institute for Pharmaceutical Research Saarland, Germany"},{"name":"Institute of Virology, Saarland University Medical Center, 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