Efficacy of antihistamines in children with allergic rhinitis: the impact of polymorbidity

Background. Foreign and domestic clinical guidelines do not describe approaches to the personalized selection of antihistamines (AH) in the treatment of allergic rhinitis (AR). The comparative efficacy of AHs in patients with different phenotypes of AR has not been adequately studied.

Objective. Comparative assessment of the clinical efficacy of initial pharmacotherapy with rupatadine, bilastine, or cetirizine for persistent seasonal moderate AR in children.

Methods. A 4-week open, prospective, randomized, comparative study in parallel groups (n=32 – rupatadine, 10 mg; n=32 – bilastine, 20 mg; n=31 – cetirizine 10 mg, 1 tablet once a day) among children over 12 years old with persistent seasonal AR of moderate severity was conducted. Therapy was initiated within 48 hours after the onset of the first symptoms of exacerbation of the disease with a total severity of symptoms according to VAS <5 points. Clinical efficacy was assessed using the r-TNSS and VAS scales on the day of patient inclusion in the study (initial), as well as on the 3rd, 7th, 14th, 21st, and 28th days of therapy or until exclusion from the study due to therapy inefficiency.

Results. No significant differences were found in the assessment of clinical parameters between the groups initially and during the study. They were identified only among patients with concomitant bronchial asthma (BA): when comparing the assessment of the severity of symptoms on the VAS scale depending on the AHs, statistically significant differences were found between patients receiving rupatadine and cetirizine on the 21st day: rupatadine – 3.25 (3.10–6.68) points, cetirizine – 7.50 (4.20–8.05) (P=0.038), and on the 28th day: rupatadine – 3.15 (2.55–6.68), cetirizine – 7.50 (4.60–8.05) points (p=0.034). When assessing the dynamics of maintaining AR monotherapy without the need for STEP-UP therapy during the study, statistically significant differences were noted on the 7th day of the study (rupatadine and cetirizine – 100% of patients, bilastine – 58.3% (7/12) (P=0.006).

Conclusion. No differences in the effectiveness of antihistamines were found among all patients, while the advantage of rupatadine compared to bilastine and cetirizine as a starting therapy at the onset of the first symptoms of AR in children over 12 years old with polymorbid AR (AR + BA) can be noted.