Short-term nasal decongestant as bridge therapy with intranasal corticosteroids in children with persistent allergic rhinitis: A randomized controlled trial.
Necmi Can Yüksel, Özlem Sancaklı, Figen Çelebi Çelik et al.
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In 30 seconds
This prospective, open-label, single-centre randomised trial compared intranasal corticosteroid (INS) alone with INS plus five days of oxymetazoline in children aged 4–17 years with moderate-to-severe persistent allergic rhinitis. Of 76 randomised participants, 71 completed follow-up. Both groups improved by Week 4, while the combination group had a greater reduction in total nasal symptom score (2.9 ± 1.0 vs 1.5 ± 1.3 points; p < 0.001) and greater improvements in nasal airflow, quality of life, and reported adherence. No rebound congestion or treatment-related adverse events were reported.
Key findings
- At Week 4, total nasal symptom score reduction was greater with the five-day oxymetazoline bridge: 2.9 ± 1.0 vs 1.5 ± 1.3 points; p < 0.001.
- Peak nasal inspiratory flow increased by 34.6 ± 16.7 vs 12.8 ± 14.5 L/min; p < 0.001, with combination therapy versus INS alone.
- Quality-of-life improvement was 18.0 ± 9.1 vs 5.3 ± 7.3 points, and MARS adherence scores were 22.8 ± 2.3 vs 19.7 ± 2.2; both p < 0.001.
- No participant reported oxymetazoline use beyond five days, rebound congestion, or a treatment-related adverse event.
Why it matters
INS are first-line treatment, but their delayed onset may affect early adherence. In this trial, a brief decongestant bridge was associated with better symptom, airflow, and quality-of-life outcomes at Week 4, alongside higher reported adherence. These findings are relevant to early treatment experience, while the trial design and setting warrant caution in generalising the results.
What to keep in mind
The trial was open-label and single-centre, with 71 participants completing follow-up. Nasal nitric oxide results came from an exploratory subgroup of 17 children.