Intranasal Corticosteroids Versus Second-Generation Antihistamines for Allergic Rhinitis in Adolescents: A Prospective Cohort Study of Quality of Life and School Attendance

Abstract

Purpose: Allergic rhinitis (AR) in adolescents can negatively affect daily functioning, sleep, and school performance. This observational, non-randomized prospective cohort study compared the real-world effectiveness of intranasal corticosteroids (INCS) and second-generation oral antihistamines (OAH) on disease-specific quality of life and school attendance. Patients and Methods: This observational, non-randomized prospective cohort study included 80 adolescents aged 12-18 years with moderate-to-severe allergic rhinitis who were followed for one school term. Participants received either INCS monotherapy or OAH monotherapy according to routine clinical practice; treatment allocation was not randomized. Specific drug selection within each treatment class was determined by the treating clinician and was not fully standardized, reflecting real-world treatment heterogeneity. Primary outcomes were changes in Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) scores and school absenteeism. Secondary outcomes included classroom productivity, sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), adherence, and adverse events. Between-group comparisons and multivariable analyses were performed. Results: Both treatments were associated with improvement, but the magnitude of improvement was greater in the INCS group. Mean PRQLQ scores decreased by -1.0 +/- 0.4 in the INCS group and -0.6 +/- 0.5 in the OAH group; the between-group difference in mean change was -0.4 (95% confidence interval [CI], -0.7 to -0.1; p = 0.01). Clinically meaningful QoL improvement (>= 0.5 reduction) occurred in 65.0% of INCS users versus 37.5% of OAH users (p = 0.02). Median school absenteeism decreased in the INCS group (change, -2 days) but not in the OAH group (change, 0 days; between-group p = 0.03). INCS users also reported greater improvements in classroom productivity and sleep quality, and fewer participants had ESS scores >= 10 at follow-up (3% vs 18%). Conclusion: In this real-world adolescent cohort, INCS use was associated with greater short-term improvement in quality-of-life and school-attendance outcomes than OAH use. However, because the study was observational and non-randomized, and because treatment heterogeneity existed within both treatment groups, these findings should be interpreted as associations rather than definitive causal effects.