Answering Your Questions on Combination Pharmacotherapy for AR

FAQ 1: Can combining oral H1-receptor blockers with LRTAs enhance the effectiveness of treating allergic rhinitis (AR)?
Answer: It is known that oral antihistamines (H1 receptor blockers) effectively reduce sneezing, rhinorrhea, and nasal itching but are not as effective against nasal congestion in patients with AR. On the contrary, leukotriene receptor antagonists (LRTAs) effectively reduce nasal resistance in AR. Therefore, a combination of LRTAs and H1 receptor blockers holds substantial potential against all symptoms of AR.
A recent meta-analysis compared the efficacy of the combination of LRTAs and H1 receptor blockers versus H1 receptor blockers alone, in treating AR. Results showed that combination therapy more effectively reduces the daytime and composite nasal symptoms, such as, rhinorrhea, sneezing, and itching. Additionally, treatment outcomes of combination therapy were better in patients with perennial AR than those with seasonal AR. However, its efficacy against nasal congestion, nighttime nasal symptoms, and eye symptoms remains uncertain.1 Therefore, further large-scale studies are warranted to bridge the gaps in the current data. Nevertheless, combination therapy is currently recommended by the European Forum for Research and Education in Allergy and Airway Diseases – Allergic Rhinitis and its Impact on Asthma (EUFOREA – ARIA) Guidelines on the medical management of AR.2.