Clinical inquiries. Intranasal steroids vs antihistamines: which is better for seasonal allergies and conjunctivitis?

Intranasal steroids provide better relief for adult sufferers, according to nonstandardized, nonclinically validated scales. Steroids reduce subjective total nasal symptom scores (TNSS)--representing sneezing, itching, congestion, and rhinorrhea--by about 25% more than placebo, whereas oral antihistamines decrease TNSS by 5% to 10% (strength of recommendation [SOR]: B, systematic review of randomized controlled trials [RCTs], most without clinically validated or standardized outcome measures). Intranasal steroids improve subjective eye symptom scores as well as (or better than) oral antihistamines in adults who also have allergic conjunctivitis (

SOR:

A, systematic review, RCTs).