Aqueous Versus Aerosol Intranasal Corticosteroid Spray for Allergic Rhinitis: Systematic Review and Meta-Analysis

Abstract

Background: Allergic rhinitis (AR) affects millions of people worldwide, impacting quality of life and causing economic burden. Intranasal corticosteroids (INCs) are the mainstay treatment for AR, delivered via aerosol or aqueous sprays. Objective: This systematic review and meta-analysis investigate the comparative efficacy and safety of aerosol and aqueous delivery methods in AR treatment. Methods: Two independent reviewers searched 4 databases (Embrace, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science) for English-language, prospective randomized controlled trial (RCT), comparing aqueous and aerosol INCs for AR treatment. Studies were excluded for specific reasons (wrong comparisons, full text unavailable, insufficient data for extraction, wrong patient population, incorrect route of administration (non-intranasal), unverifiable inclusion criteria). Primary outcomes were Total Nasal Symptom Score (TNSS) and subset scores; secondary outcome was adverse event (AEs). Results: No significant difference in overall TNSS was found between the delivery methods. However, aqueous sprays showed a slight edge in reducing specific symptoms like congestion, itching, sneezing, and rhinorrhea. AEs did not differ significantly. Conclusion: Our findings suggest no significant difference in efficacy or safety between aerosol and aqueous INCs for AR treatment. Patient preference should be a primary consideration when choosing a delivery method to optimize adherence and symptom control.