Table CSummary of findings and strength of evidence for harms in 13 treatment comparisons: Key Question 2—adults and adolescents

ComparisonHeadacheSedationNosebleedsNasal DiscomfortBitter AftertasteBurningAnxietyInsomniaPalpitationsDrynessHypertensionNasal CandidiasisNasal AtrophyOdor AbnormalityStinging
1. Oral S-AH vs. oral nS-AHInsuffaInsuffa
2. Oral S-AH vs. nasal AHInsuffaInsuffInsuffaInsuffa
3. Oral S-AH vs. INCSInsuffa
4. Oral S-AH vs. oral DInsuffInsuffInsuffOral S-AH: moderateb
5. Oral S-AH vs. LRAInsuffa
6. INCS vs. nasal AHInsuffaInsuffaInsuffaInsuffaInsuffa
7. INCS vs. nasal CInsuffInsuffaInsuffInsuffaInsuff
8. INCS vs. LRAInsuffaInsuffa
9. Oral S-AH + INCS vs. oral S-AHInsuffaInsuffaInsuffaInsuffa
10. Oral S-AH + INCS vs. INCSInsuffaInsuffaInsuffaInsuffa
11. INCS + nasal AH vs. INCSInsuffaInsuffaInsuffaInsuffaInsuffa
12. INCS + nasal AH vs. nasal AHInsuffaInsuffaInsuffaInsuffaInsuffa
13. Oral S-AH + oral D vs. oral S-AHInsuffInsuffInsuffOral S-AH: moderateb

Based on trials that studied less than 50% of the drugs in at least 1 drug class compared.


Moderate-strength evidence indicates fewer insomnia events at approximately 2 weeks with oral selective antihistamine.

Note: Entries indicate comparative efficacy conclusions supported by the evidence or insufficient evidence to form a conclusion. Empty cells indicate outcomes that were not assessed.

Conclusions are indicated by Conclusion: strength of evidence (SOE):

  • “Oral S-AH” indicates sufficient evidence to support conclusions of superiority of oral selective antihistamine over its respective comparators to avoid the indicated harm.
  • SOE is indicated by low, moderate, and high.

“Insuff” indicates insufficient evidence to form a conclusion.

AH = antihistamine; C = cromolyn; D = decongestant; INCS = intranasal corticosteroid; Insuff = insufficient; LRA = leukotriene receptor antagonist; nS-AH = nonselective antihistamine; S-AH = selective antihistamine.

From: Executive Summary

Cover of Treatments for Seasonal Allergic Rhinitis
Treatments for Seasonal Allergic Rhinitis [Internet].
Comparative Effectiveness Reviews, No. 120.
Glacy J, Putnam K, Godfrey S, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.