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

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. The infographic compares intranasal corticosteroids (INCS) and second-generation antihistamines (OAH) for treating allergic rhinitis in adolescents. It is based on a prospective cohort study involving 80 adolescents. The comparison covers three areas: Quality of Life (PRQLQ), School Absenteeism and Sleep & Alertness. INCS shows greater improvement in quality of life, fewer missed school days and better sleep with less daytime sleepiness. In contrast, OAH results in moderate improvement in quality of life, more missed school days and more daytime sleepiness. The conclusion states that intranasal corticosteroids are superior for quality of life and school attendance.Image of a prospective cohort study comparing intranasal corticosteroids with second-generation oral antihistamines in eighty adolescents with allergic rhinitis. Intranasal corticosteroids are associated with greater improvement in quality of life, fewer missed school days, better sleep, and less daytime sleepiness than oral antihistamines, which show moderate improvement and more daytime sleepiness.