The efficacy and safety of H1-antihistamine versus Montelukast for allergic rhinitis: A systematic review and meta-analysis

Purpose: In order to verify the differences of effectiveness and safety between SAHs and Montelukast, and to find out potential uncared-for problems, we performed a systematic review and Meta-analysis to proceed a qualitative describe and quantitative assessment. Methods: We searched the databases of Pubmed, the Cochrane Library, Nature and Science as well as Wanfang data and CNKI from 2000 to March 2016, using key words Montelukast SAH or H1antihistamine Montelukast, or Loratadine Montelukast, or Desloratadine Montelukast, or Levocetirizine Montelukast, or Cetirizen Montelukast, or Fexofenadine Montelukast. And also we included studies through relevant citations in related literature. Meta-analysis and bias of risk were performed. We analyzed Heterogeneity and publish bias as well. Result: Montelukast seems more effective in nighttime symptoms compare with SAHs (P = 0.008, MD = 0.04, 95% CI: - 0.08, 0.01). No significant difference was found between Montelukast and SAHs in CSS (P = 0.10, MD = 0.03, 95% CI: -0.01, 0.07). Montelukast and SAHs combined therapy was more effective than Montelukast DNSS (P = 0.0006, MD = 0.15, 95% CI: 0.07, 0.24) but not in CSS (P = 0.04, MD = 0.08, 95% CI: 0.00, 0.15; Bonferroni correction a = 0.017). Conclusion: Montelukast has a significant influence in improving patients' nasal symptoms quality of live but is not as effective as SAHs, and may have a slight advantage over SAHs in relieving nighttime symptoms significantly. Combined therapy is more effective in improving patients' day time symptom than Montelukast. Probably, patients might have a lower asthenia incidence rate when using Montelukas. (C) 2016 Elsevier Masson SAS. All rights reserved.