Wirach Chitsuthipakorn | Rangsit University (original) (raw)

Papers by Wirach Chitsuthipakorn

The Laryngoscope

BackgroundEndoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients ... more BackgroundEndoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.MethodsThai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22‐items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL‐5 Dimension‐5 level (EQ‐5D‐5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade‐off (TTO); at baseline, three months and six months post‐operation.ResultsData from 60 patients were analyzed. The mean baseline HUS scores by EQ‐5D‐5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postopera...

Asian Pacific Journal of Allergy and Immunology

Background: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.Kö... more Background: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr. (Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident. Objective: We sought to assess the efficacy and safety of Phlai for treating AR. Methods: A phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events. Results: Two hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD)-0.62; 95%CI-1.22,-0.03; p = 0.039], rhinorrhea (aMD-0.19; 95%CI-0.37, 0.002; p = 0.048), itchy nose (aMD-0.24; 95%CI-0.43,-0.05; p = 0.011), and itchy eyes (aMD-0.19; 95%CI-0.36,-0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups. Conclusion: Phlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.

Rhinology journal

Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with al... more Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with allergic rhinitis (AR) who have suboptimal symptom control. This systematic review aimed to assess the effectiveness of as-needed INCS for treating AR. Methodology: Systematic searches for randomized controlled trials studying the effects of as-needed INCS compared to regular INCS, as-needed antihistamine, or placebo were performed. Primary outcomes were total nasal symptom score (TNSS) and disease-specific quality of life (DSQoL). Results: Eight studies (882 participants) met the criteria. Regular use of INCS showed greater improvements than as-needed INCS in TNSS, DSQoL, nasal peak inspiratory flow, sneezing, and nasal congestion scores with small effect sizes. There were no differences between regular and as-needed INCS usage for ocular symptoms, symptom-free days, nasal itching, and rhinorrhea scores. As-needed INCS was superior to as-needed antihistamine and placebo with medium effect...

ABSTRACTBackgroundThe prevalence of chronic rhinosinusitis (CRS) has been reported to range from ... more ABSTRACTBackgroundThe prevalence of chronic rhinosinusitis (CRS) has been reported to range from 5% to 12% in different parts of the world. However, the prevalence of CRS in Thailand has not been investigated. Our objective was to determine the prevalence of CRS among hospital workers and identify any potential problems encountered during the survey.MethodAdult workers (>18 years) of Rajavithi Hospital, a tertiary hospital in Bangkok, Thailand, were recruited. This cross-sectional survey was conducted from September 2021 to September 2022. The participants were given a link to online questionnaires asking if they had nasal obstruction, discharge, decreased smell sensation, or facial pain and their respective duration. Phone numbers and email were asked for contact when needed. The participants who fulfilled the symptom and duration according to the European position paper on rhinosinusitis and nasal polyp 2020 were counted as symptom-based CRS patients. These patients were then c...

05.03 - Allergy and immunology, Sep 4, 2022

Current Allergy and Asthma Reports

Rhinology journal, 2021

Background: Local allergic rhinitis (LAR) is a phenotype of chronic rhinitis exhibiting a local T... more Background: Local allergic rhinitis (LAR) is a phenotype of chronic rhinitis exhibiting a local Th2-driven inflammation without positive clinical markers of atopy. Immunomodulatory effects of allergen-specific immunotherapy (AIT) induce allergen-specific tolerance. However, AIT is not well-recognized as a treatment for LAR. Methodology: Systematic search on six electronic databases and registries was performed. Experimental and observational studies of AIT for LAR patients were retrieved. The primary outcomes were symptom score, medication score, combined symptom medication score, and disease-specific quality of life. Secondary outcomes were serum specific(s) IgG4, sIgE, and adverse events. Results: Four double-blind randomized controlled trials (156 patients) from two research units assessed the effects of subcutaneous immunotherapy (SCIT). Compared with placebo, SCIT showed significant reductions in symptom score, medication score, combined symptom medication score, disease-specif...

OTO Open

Objective This review aimed to systematically determine the optimal nasal saline regimen for diff... more Objective This review aimed to systematically determine the optimal nasal saline regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov. The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled trials and meta-analyses were included. The effects of nasal saline treatment through various devices, saline tonicities, and buffer statuses were evaluated in patients with allergic and nonallergic rhinitis, acute and chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were effective for treating adults, while low-volume devices (5-59 mL) were effective for children. Isotonic saline was preferred o...

International Forum of Allergy & Rhinology

BACKGROUND Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for ... more BACKGROUND Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for patients with allergic rhinitis (AR). When monotherapy of either primary treatment fails to control symptoms, combined medical therapy is an option. This meta-analysis aimed to assess the additional effects of different medical combinations compared with primary treatments. METHODS Systematic searches on Pubmed and EMBASE were updated on November 4th , 2021. Randomized controlled trials comparing the effects of combinations with monotherapy were included. There were seven comparisons: (1) ATH-decongestant versus ATH, (2) ATH-Leukotriene receptor antagonist (LTRA) versus ATH, (3) INCS-ATH versus INCS, (4) INCS-LTRA versus INCS, (5) INCS-decongestion versus INCS, (6) INCS-saline irrigation versus INCS, and (7) ATH-saline irrigation versus ATH. Data were pooled for meta-analysis. Outcomes were composite nasal symptom score, composite ocular symptom score, quality of life (QoL), and adverse events. RESULTS Fifty-three studies were included. Compared with ATH alone, the ATH-decongestant combination improved composite nasal symptoms; ATH-LTRA improved nasal symptoms in patients with perennial AR; ATH-nasal saline improved both symptoms and QoL. Compared with INCS alone, the INCS-intranasal ATH combination improved nasal symptoms, ocular symptoms and QoL; INCS-LTRA improved ocular symptoms but not nasal symptoms; INCS-nasal saline improved QoL but not symptoms. There were no additional effects from adding oral ATH or topical decongestant to INCS. CONCLUSION After ATH monotherapy fails to control symptoms, addition of decongestant, saline, or LTRA can improve the outcomes. When INCS monotherapy is ineffective, addition of intranasal ATH can improve nasal symptoms; LTRA can improve ocular symptoms; and saline irrigation can improve QoL. This article is protected by copyright. All rights reserved.

International Forum of Allergy & Rhinology, 2021

BACKGROUND Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS... more BACKGROUND Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS), the evidence in adult patients is inconclusive. Our objective was to assess the add-on benefits of saline treatment in adult with ARS. METHODS Literature searches were performed (updated May 9th , 2021). Randomized controlled trials studying the effects of nasal saline treatment in adults with ARS were included. Data were pooled for meta-analysis. Outcomes were composite symptoms score (CSS), disease-specific quality of life (DS-QoL) score, individual symptom score, endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. RESULTS Eleven studies (718 patients) were included. Nasal discharge was the only symptom improved [standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.66 to -0.05]. Saline as an add-on treatment brought no benefits in: CSS and DS-QoL score at both time points (3-10 days and at the end of the study). Other outcomes also showed no benefits of saline, including endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. Subgroup analyses showed improvement in viral ARS patients in CSS (SMD -0.60, 95% CI -1.12 to -0.08) and DS-QoL score (mean difference -15.90, 95% CI -31.78 to -0.02), and patients using large-volume saline in CSS (SMD -0.42, 95% CI -0.78 to -0.06). CONCLUSIONS Nasal saline as an add-on treatment improved rhinorrhea. There was no improvement in CSS and DS-QoL except the subgroup of viral ARS when using large-volume saline. There were no differences in adverse events between the saline and non-saline treatments. This article is protected by copyright. All rights reserved.

Current Allergy and Asthma Reports, 2021

To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effect... more To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effects of HM separately by mechanism of action in the treatment of allergic rhinitis (AR). Thirty-two studies were included (2,697 patients, mean age 34.6 years). For the ≤ 4 weeks of treatment duration, HM brought greater benefits over placebo in reduction of total nasal symptoms score (standardized mean difference (SMD) −0.68; 95% confidence interval (CI) −0.98, −0.38; p <0.01) and improvement in Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.53; 95% CI −0.81, −0.25; p <0.01). For the 4–12 weeks duration, total nasal symptoms score (SMD −0.22; 95%CI −0.4, −0.05; p =0.01) and Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.48; 95% CI −0.89, −0.06; p =0.03) favored the HM. However, HM therapy for longer than 12 weeks was related to tachyphylaxis and showed no benefit over placebo in any outcomes. There was no difference between the HM and standard treatment on symptoms improvement. Anti-allergic effect, anti-inflammatory effect, anti-leukotriene effect, and anti-histaminic effect of HM were revealed. HM was safe and their adverse effects were comparable placebo. HM therapy is safe and provides better results than placebo in improving nasal symptoms and disease-specific quality of life in patients with AR. Its beneficial effects are demonstrated only in less than 12 weeks of treatment. PROSPERO ID: CRD42020168367

Clinical Otolaryngology, 2021

We assessed associations of potential factors with orbital complications in acute rhinosinusitis ... more We assessed associations of potential factors with orbital complications in acute rhinosinusitis (ARS) patients.

วตถประสงค : เพอรายงานผลการรกษาและผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatineผานกลองเอ... more วตถประสงค : เพอรายงานผลการรกษาและผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatineผานกลองเอนโดสโคป ในผปวย เลอดกำเดาไหลจากโพรงจมกสวนหลง สถานทศกษา : แผนก โสต ศอ นาสก โรงพยาบาลสวรรคประชารกษ รปแบบงานวจย : การศกษาเชงพรรณนา กลมตวอยาง : ผปวยเลอดกำเดาไหลจากโพรงจมกสวนหลงทกคนทไดรบการผาตดจหยดหลอดเลอดsphenopalatine ผานกลอง เอนโดสโคป ระหวางป 2557 ถง 2561 จำนวน 21 คน วธการศกษา : รวบรวมขอมลจากเวชระเบยนยอนหลงเกยวกบ ขอมลทสำคญทางคลนก ผลการผาตด และผลขางเคยง โดยนยามผล สำเรจของการรกษา คอ ภาวะปราศจากเลอดกำเดาไหลซำอยางนอย 7 วนหลงการผาตด ผลการศกษา : ผปวยเปนชาย รอยละ 66.7 ทกคนเคยลมเหลวจากการใสวสดหามเลอดทางดานหนาหรอดานหลง เมอตดตามผล สำเรจของการรกษาพบวา ผปวยรอยละ 95.2 ไมมเลอดกำเดาไหลซำ อยางไรกตามพบผปวย 1 คน มเลอดกำเดาไหล ซำซงหายขาดเมอไดรบการผาตดครงทสอง ผลขางเคยงพบอาการชาทฟนหนา 1 คน และชาทเพดานแขงดานเดยวกบ การผาตด 1 คนอาการของผปวยทงสองคนหายไดเองหลงการผาตด 2 สปดาห วจารณและสรป : การผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยเลอดกำเดาไหลจากโพรงจมก...

วตถประสงค : เพอรายงานผลการรกษา, ผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatine ผานกลอง... more วตถประสงค : เพอรายงานผลการรกษา, ผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยเลอดกำเดาไหลจากโพรงจมกสวนหลง สถานทศกษา : โรงพยาบาลสวรรคประชารกษ จงหวดนครสวรรค รปแบบงานวจย : รายงานกลมผปวย วธศกษา : รวบรวมขอมลจากเวชระเบยนยอนหลงเกยวกบ ผลสำเรจของการผาตดจหยดหลอดเลอดsphenopalatineผานกลองเอนโดสโคปผลขางเคยง รวมถงขอมลทสำคญทางคลนกของผปวยโรคเลอดกำเดาจากโพรงจมกสวนหลงทไดรบการผาตดระหวางปพทธศกราช 2557-2561 โดยผลสำเรจของการรกษานยามโดยภาวะปราศจากเลอดกำเดาไหลซำอยางนอย 7 วนหลงการผาตด ผลการศกษา : มผปวย 21 ราย เปนชาย 14 ราย และหญง 7 รายผปวยทกรายเคยลมเหลวจากการใสวสดหามเลอดทางดานหนาหรอดานหลงหลง เมอตดตามผลของการรกษาพบวาผปวย 20 ราย (รอยละ95.2) ไมมเลอดกำเดาไหลซำและพบผปวย 1 รายมเลอดกำเดาไหลซำซงหายขาดเมอไดรบการผาตดครงทสองในดานผลขางเคยงพบอาการชาทฟนหนา 1 ราย และชาทเพดานแขงดานเดยวกบการผาตด 1 ราย อาการของผปวยทงสองหายไดเองหลงการผาตด 2 สปดาห วจารณและสรป : การผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยภาวะเลอดกำเดาไหลจากโพรงจมกสวนห...

Rhinology journal, 2021

BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy... more BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy. Data confirming its effect is restricted to a small number of studies. METHODOLOGY: A systematic review with meta-analysis was conducted. The short-term (less than 24 weeks), medium-term (24-52 weeks), and long-term (more than 52 weeks) effects of ILIT in patients with allergic rhinoconjunctivitis (ARC) were assessed. The outcomes were combined symptom and medication scores (CSMS), symptoms visual analog scale (VAS), disease-specific quality of life (QOL), specific IgG4 level, specific IgE level, and adverse events. RESULTS: Eleven randomized controlled trials and 2 cohorts (483 participants) were included. Compared with placebo, short term benefits of ILIT for seasonal ARC improved CSMS, improved VAS and increased specific IgG4 level but did not change QOL or specific IgE level. Medium-term effect improved VAS. Data on the long-term benefit of ILIT remain unavailable and require longe...

European Archives of Oto-Rhino-Laryngology, 2020

Purpose Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for ... more Purpose Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for posterior epistaxis. Anatomical variations of the intranasal branching may result in long operative time and possible inadequate cauterization. A modification of ESPAL by cauterization at the sphenopalatine foramen (SPF), has been performed by our group. Our study assessed the clinical benefit of endoscopic sphenopalatine foramen cauterization (ESFC) and compared it to ESPAL. Method A retrospective study was conducted. Patients who received ESFC for posterior epistaxis from 2016 to 2018 at a tertiary hospital were recruited. Middle meatal antrostomy was done. After ethmoidal crest was identified and nipped, pterygopalatine fossa was entered through the SPF. Sphenopalatine artery (SPA) and its branches within the SPF were cauterized without identification of any SPA distal branches in the nasal cavity. Patients receiving conventional ESPAL by the same surgeon were recruited and compared as control. Patients were followed-up for 3 months. Success rate, operative time, and complication were assessed. Results Thirty-four patients were identified. Recurrent epistaxis was absent in 90.0% and 100% of patients receiving ESPAL (9/10 patients) and ESFC (24/24 patients) respectively, p = 0.294. Median operative time was 115 and 60 min, respectively, p < 0.001. Ipsilateral hard palatal or anterior palatal numbness were found in one and three patients, respectively. All resolved spontaneously within 2 weeks. Conclusion ESFC is effective in treating posterior epistaxis. It requires significantly less amount of time while the success rate was comparable to conventional ESPAL.

International Forum of Allergy & Rhinology, 2018

Background: A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commo... more Background: A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH-INCS) for treating AR. Methods: Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH-INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease-specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events. Results: Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH-INCS decreased total nasal symptom scores (standardized mean difference [SMD], −0.13; 95% confidence interval [CI], −0.19 to −0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, −0.12, 95% CI, −0.20 to −0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH-INCS combination but did show benefit with intranasal AH-INCS (SMD, −0.18; 95% CI, −0.27 to −0.09; p < 0.001). There were no significant differences with regard to disease-specific quality of life (SMD, −0.07; 95% CI, −0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, −0.03 L/min; 95% CI, −0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events. Conclusion: Intranasal AH-INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH-INCS is not recommended. C 2018 ARS-AAOA, LLC.

Rhinology journal, 2019

Background: The extent of endoscopic sinus surgery (ESS) required for optimal outcomes in chronic... more Background: The extent of endoscopic sinus surgery (ESS) required for optimal outcomes in chronic rhinosinusitis (CRS) is undefined. We evaluated whether concordance between the extent of surgery and degree of radiographic disease influences postoperative outcomes. Methods: 247 CRS patients who underwent ESS were retrospectively assigned a concordance score reflecting the similarity between the extent of surgery and degree of radiographic disease. 0 points were assigned when sinusotomy was performed on a diseased sinus, or no sinusotomy was performed on a nondiseased sinus; +1 for sinusotomy on a nondiseased sinus; and-1 for a diseased sinus left unopened. The total possible score ranged from-10 to +10. Patients were divided into 5 subgroups according to variance from complete concordance. SNOT-22 scores and revision rates were compared at 6 and 24 months. Results: All five subgroups had similar preoperative SNOT-22 scores and improved at 6 months postoperatively. At 6 months postoperatively, the most conservatively operated and most extensively operated subgroups each achieved equivalent improvements in SNOT-22 as the completely concordant subgroup. At 24 months, the most extensively operated subgroup had a 12.5-point smaller improvement in SNOT-22 scores compared to the completely concordant subgroup. Multivariate analysis showed no association between concordance score and revision rate. Conclusions: Symptom improvement and revision rates after ESS do not appear to correlate with the degree of concordance between extent of surgery and radiographic disease. More extensive surgery than indicated by CT confers neither greater symptomatic improvement nor long-term detriment.

The Laryngoscope, 2017

Objective: Patients frequently are advised to abstain from nose blowing following endoscopic sinu... more Objective: Patients frequently are advised to abstain from nose blowing following endoscopic sinus surgery (ESS), despite a lack of evidence supporting this recommendation. This randomized study assessed whether nose blowing in the first postoperative week affects subjective and objective clinical outcomes. Methods: Forty patients undergoing ESS were randomized into an interventional arm in which patients blew their nose at least twice daily for the first 7 postoperative days, or a control arm in which patients refrained from nose blowing. All patients were allowed to blow their nose after 7 days. The frequency and degree of epistaxis was documented by daily diary and visual analog scale (VAS). At 1 and 4 weeks postoperatively, Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) were collected, and endoscopies were recorded for blinded Lund-Kennedy scale scoring. Results: There were no differences between the two groups in terms of frequency and duration of bleeding events, VAS epistaxis scores, SNOT-22 scores, and NOSE scores at every postoperative timepoint. Lund-Kennedy scores also were similar at the 1-week (P 5 0.0762) and 4-week (P 5 0.2340) postoperative visits, but the nose-blowing group had improved nasal discharge subscores at the first (P 5 0.0075) and second (P 5 0.0298) postoperative visits. Conclusion: Nose blowing after ESS does not appear to measurably improve symptoms of nasal congestion or general sinonasal quality of life, nor does it seem to adversely affect the frequency or severity of postoperative epistaxis during the first postoperative week. Judicious nose blowing may be permissible immediately after uncomplicated ESS.

American Journal of Rhinology & Allergy, 2019

Background Histamine and leukotriene are released after being triggered by allergen exposure. The... more Background Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH...

The Laryngoscope

BackgroundEndoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients ... more BackgroundEndoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.MethodsThai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22‐items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL‐5 Dimension‐5 level (EQ‐5D‐5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade‐off (TTO); at baseline, three months and six months post‐operation.ResultsData from 60 patients were analyzed. The mean baseline HUS scores by EQ‐5D‐5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postopera...

Asian Pacific Journal of Allergy and Immunology

Background: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.Kö... more Background: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr. (Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident. Objective: We sought to assess the efficacy and safety of Phlai for treating AR. Methods: A phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events. Results: Two hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD)-0.62; 95%CI-1.22,-0.03; p = 0.039], rhinorrhea (aMD-0.19; 95%CI-0.37, 0.002; p = 0.048), itchy nose (aMD-0.24; 95%CI-0.43,-0.05; p = 0.011), and itchy eyes (aMD-0.19; 95%CI-0.36,-0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups. Conclusion: Phlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.

Rhinology journal

Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with al... more Background: As-needed intranasal corticosteroid spray (INCS) is commonly used by patients with allergic rhinitis (AR) who have suboptimal symptom control. This systematic review aimed to assess the effectiveness of as-needed INCS for treating AR. Methodology: Systematic searches for randomized controlled trials studying the effects of as-needed INCS compared to regular INCS, as-needed antihistamine, or placebo were performed. Primary outcomes were total nasal symptom score (TNSS) and disease-specific quality of life (DSQoL). Results: Eight studies (882 participants) met the criteria. Regular use of INCS showed greater improvements than as-needed INCS in TNSS, DSQoL, nasal peak inspiratory flow, sneezing, and nasal congestion scores with small effect sizes. There were no differences between regular and as-needed INCS usage for ocular symptoms, symptom-free days, nasal itching, and rhinorrhea scores. As-needed INCS was superior to as-needed antihistamine and placebo with medium effect...

ABSTRACTBackgroundThe prevalence of chronic rhinosinusitis (CRS) has been reported to range from ... more ABSTRACTBackgroundThe prevalence of chronic rhinosinusitis (CRS) has been reported to range from 5% to 12% in different parts of the world. However, the prevalence of CRS in Thailand has not been investigated. Our objective was to determine the prevalence of CRS among hospital workers and identify any potential problems encountered during the survey.MethodAdult workers (>18 years) of Rajavithi Hospital, a tertiary hospital in Bangkok, Thailand, were recruited. This cross-sectional survey was conducted from September 2021 to September 2022. The participants were given a link to online questionnaires asking if they had nasal obstruction, discharge, decreased smell sensation, or facial pain and their respective duration. Phone numbers and email were asked for contact when needed. The participants who fulfilled the symptom and duration according to the European position paper on rhinosinusitis and nasal polyp 2020 were counted as symptom-based CRS patients. These patients were then c...

05.03 - Allergy and immunology, Sep 4, 2022

Current Allergy and Asthma Reports

Rhinology journal, 2021

Background: Local allergic rhinitis (LAR) is a phenotype of chronic rhinitis exhibiting a local T... more Background: Local allergic rhinitis (LAR) is a phenotype of chronic rhinitis exhibiting a local Th2-driven inflammation without positive clinical markers of atopy. Immunomodulatory effects of allergen-specific immunotherapy (AIT) induce allergen-specific tolerance. However, AIT is not well-recognized as a treatment for LAR. Methodology: Systematic search on six electronic databases and registries was performed. Experimental and observational studies of AIT for LAR patients were retrieved. The primary outcomes were symptom score, medication score, combined symptom medication score, and disease-specific quality of life. Secondary outcomes were serum specific(s) IgG4, sIgE, and adverse events. Results: Four double-blind randomized controlled trials (156 patients) from two research units assessed the effects of subcutaneous immunotherapy (SCIT). Compared with placebo, SCIT showed significant reductions in symptom score, medication score, combined symptom medication score, disease-specif...

OTO Open

Objective This review aimed to systematically determine the optimal nasal saline regimen for diff... more Objective This review aimed to systematically determine the optimal nasal saline regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov. The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled trials and meta-analyses were included. The effects of nasal saline treatment through various devices, saline tonicities, and buffer statuses were evaluated in patients with allergic and nonallergic rhinitis, acute and chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were effective for treating adults, while low-volume devices (5-59 mL) were effective for children. Isotonic saline was preferred o...

International Forum of Allergy & Rhinology

BACKGROUND Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for ... more BACKGROUND Antihistamines (ATH) and intranasal corticosteroids (INCS) are primary treatments for patients with allergic rhinitis (AR). When monotherapy of either primary treatment fails to control symptoms, combined medical therapy is an option. This meta-analysis aimed to assess the additional effects of different medical combinations compared with primary treatments. METHODS Systematic searches on Pubmed and EMBASE were updated on November 4th , 2021. Randomized controlled trials comparing the effects of combinations with monotherapy were included. There were seven comparisons: (1) ATH-decongestant versus ATH, (2) ATH-Leukotriene receptor antagonist (LTRA) versus ATH, (3) INCS-ATH versus INCS, (4) INCS-LTRA versus INCS, (5) INCS-decongestion versus INCS, (6) INCS-saline irrigation versus INCS, and (7) ATH-saline irrigation versus ATH. Data were pooled for meta-analysis. Outcomes were composite nasal symptom score, composite ocular symptom score, quality of life (QoL), and adverse events. RESULTS Fifty-three studies were included. Compared with ATH alone, the ATH-decongestant combination improved composite nasal symptoms; ATH-LTRA improved nasal symptoms in patients with perennial AR; ATH-nasal saline improved both symptoms and QoL. Compared with INCS alone, the INCS-intranasal ATH combination improved nasal symptoms, ocular symptoms and QoL; INCS-LTRA improved ocular symptoms but not nasal symptoms; INCS-nasal saline improved QoL but not symptoms. There were no additional effects from adding oral ATH or topical decongestant to INCS. CONCLUSION After ATH monotherapy fails to control symptoms, addition of decongestant, saline, or LTRA can improve the outcomes. When INCS monotherapy is ineffective, addition of intranasal ATH can improve nasal symptoms; LTRA can improve ocular symptoms; and saline irrigation can improve QoL. This article is protected by copyright. All rights reserved.

International Forum of Allergy & Rhinology, 2021

BACKGROUND Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS... more BACKGROUND Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS), the evidence in adult patients is inconclusive. Our objective was to assess the add-on benefits of saline treatment in adult with ARS. METHODS Literature searches were performed (updated May 9th , 2021). Randomized controlled trials studying the effects of nasal saline treatment in adults with ARS were included. Data were pooled for meta-analysis. Outcomes were composite symptoms score (CSS), disease-specific quality of life (DS-QoL) score, individual symptom score, endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. RESULTS Eleven studies (718 patients) were included. Nasal discharge was the only symptom improved [standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.66 to -0.05]. Saline as an add-on treatment brought no benefits in: CSS and DS-QoL score at both time points (3-10 days and at the end of the study). Other outcomes also showed no benefits of saline, including endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. Subgroup analyses showed improvement in viral ARS patients in CSS (SMD -0.60, 95% CI -1.12 to -0.08) and DS-QoL score (mean difference -15.90, 95% CI -31.78 to -0.02), and patients using large-volume saline in CSS (SMD -0.42, 95% CI -0.78 to -0.06). CONCLUSIONS Nasal saline as an add-on treatment improved rhinorrhea. There was no improvement in CSS and DS-QoL except the subgroup of viral ARS when using large-volume saline. There were no differences in adverse events between the saline and non-saline treatments. This article is protected by copyright. All rights reserved.

Current Allergy and Asthma Reports, 2021

To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effect... more To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effects of HM separately by mechanism of action in the treatment of allergic rhinitis (AR). Thirty-two studies were included (2,697 patients, mean age 34.6 years). For the ≤ 4 weeks of treatment duration, HM brought greater benefits over placebo in reduction of total nasal symptoms score (standardized mean difference (SMD) −0.68; 95% confidence interval (CI) −0.98, −0.38; p <0.01) and improvement in Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.53; 95% CI −0.81, −0.25; p <0.01). For the 4–12 weeks duration, total nasal symptoms score (SMD −0.22; 95%CI −0.4, −0.05; p =0.01) and Rhinoconjunctivitis Quality of Life Questionnaire score (SMD −0.48; 95% CI −0.89, −0.06; p =0.03) favored the HM. However, HM therapy for longer than 12 weeks was related to tachyphylaxis and showed no benefit over placebo in any outcomes. There was no difference between the HM and standard treatment on symptoms improvement. Anti-allergic effect, anti-inflammatory effect, anti-leukotriene effect, and anti-histaminic effect of HM were revealed. HM was safe and their adverse effects were comparable placebo. HM therapy is safe and provides better results than placebo in improving nasal symptoms and disease-specific quality of life in patients with AR. Its beneficial effects are demonstrated only in less than 12 weeks of treatment. PROSPERO ID: CRD42020168367

Clinical Otolaryngology, 2021

We assessed associations of potential factors with orbital complications in acute rhinosinusitis ... more We assessed associations of potential factors with orbital complications in acute rhinosinusitis (ARS) patients.

วตถประสงค : เพอรายงานผลการรกษาและผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatineผานกลองเอ... more วตถประสงค : เพอรายงานผลการรกษาและผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatineผานกลองเอนโดสโคป ในผปวย เลอดกำเดาไหลจากโพรงจมกสวนหลง สถานทศกษา : แผนก โสต ศอ นาสก โรงพยาบาลสวรรคประชารกษ รปแบบงานวจย : การศกษาเชงพรรณนา กลมตวอยาง : ผปวยเลอดกำเดาไหลจากโพรงจมกสวนหลงทกคนทไดรบการผาตดจหยดหลอดเลอดsphenopalatine ผานกลอง เอนโดสโคป ระหวางป 2557 ถง 2561 จำนวน 21 คน วธการศกษา : รวบรวมขอมลจากเวชระเบยนยอนหลงเกยวกบ ขอมลทสำคญทางคลนก ผลการผาตด และผลขางเคยง โดยนยามผล สำเรจของการรกษา คอ ภาวะปราศจากเลอดกำเดาไหลซำอยางนอย 7 วนหลงการผาตด ผลการศกษา : ผปวยเปนชาย รอยละ 66.7 ทกคนเคยลมเหลวจากการใสวสดหามเลอดทางดานหนาหรอดานหลง เมอตดตามผล สำเรจของการรกษาพบวา ผปวยรอยละ 95.2 ไมมเลอดกำเดาไหลซำ อยางไรกตามพบผปวย 1 คน มเลอดกำเดาไหล ซำซงหายขาดเมอไดรบการผาตดครงทสอง ผลขางเคยงพบอาการชาทฟนหนา 1 คน และชาทเพดานแขงดานเดยวกบ การผาตด 1 คนอาการของผปวยทงสองคนหายไดเองหลงการผาตด 2 สปดาห วจารณและสรป : การผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยเลอดกำเดาไหลจากโพรงจมก...

วตถประสงค : เพอรายงานผลการรกษา, ผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatine ผานกลอง... more วตถประสงค : เพอรายงานผลการรกษา, ผลขางเคยง ของการผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยเลอดกำเดาไหลจากโพรงจมกสวนหลง สถานทศกษา : โรงพยาบาลสวรรคประชารกษ จงหวดนครสวรรค รปแบบงานวจย : รายงานกลมผปวย วธศกษา : รวบรวมขอมลจากเวชระเบยนยอนหลงเกยวกบ ผลสำเรจของการผาตดจหยดหลอดเลอดsphenopalatineผานกลองเอนโดสโคปผลขางเคยง รวมถงขอมลทสำคญทางคลนกของผปวยโรคเลอดกำเดาจากโพรงจมกสวนหลงทไดรบการผาตดระหวางปพทธศกราช 2557-2561 โดยผลสำเรจของการรกษานยามโดยภาวะปราศจากเลอดกำเดาไหลซำอยางนอย 7 วนหลงการผาตด ผลการศกษา : มผปวย 21 ราย เปนชาย 14 ราย และหญง 7 รายผปวยทกรายเคยลมเหลวจากการใสวสดหามเลอดทางดานหนาหรอดานหลงหลง เมอตดตามผลของการรกษาพบวาผปวย 20 ราย (รอยละ95.2) ไมมเลอดกำเดาไหลซำและพบผปวย 1 รายมเลอดกำเดาไหลซำซงหายขาดเมอไดรบการผาตดครงทสองในดานผลขางเคยงพบอาการชาทฟนหนา 1 ราย และชาทเพดานแขงดานเดยวกบการผาตด 1 ราย อาการของผปวยทงสองหายไดเองหลงการผาตด 2 สปดาห วจารณและสรป : การผาตดจหยดหลอดเลอด sphenopalatine ผานกลองเอนโดสโคป ในผปวยภาวะเลอดกำเดาไหลจากโพรงจมกสวนห...

Rhinology journal, 2021

BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy... more BACKGROUND: Intralymphatic immunotherapy (ILIT) is a new route of allergen-specific immunotherapy. Data confirming its effect is restricted to a small number of studies. METHODOLOGY: A systematic review with meta-analysis was conducted. The short-term (less than 24 weeks), medium-term (24-52 weeks), and long-term (more than 52 weeks) effects of ILIT in patients with allergic rhinoconjunctivitis (ARC) were assessed. The outcomes were combined symptom and medication scores (CSMS), symptoms visual analog scale (VAS), disease-specific quality of life (QOL), specific IgG4 level, specific IgE level, and adverse events. RESULTS: Eleven randomized controlled trials and 2 cohorts (483 participants) were included. Compared with placebo, short term benefits of ILIT for seasonal ARC improved CSMS, improved VAS and increased specific IgG4 level but did not change QOL or specific IgE level. Medium-term effect improved VAS. Data on the long-term benefit of ILIT remain unavailable and require longe...

European Archives of Oto-Rhino-Laryngology, 2020

Purpose Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for ... more Purpose Endoscopic sphenopalatine artery ligation (ESPAL) is known as an effective treatment for posterior epistaxis. Anatomical variations of the intranasal branching may result in long operative time and possible inadequate cauterization. A modification of ESPAL by cauterization at the sphenopalatine foramen (SPF), has been performed by our group. Our study assessed the clinical benefit of endoscopic sphenopalatine foramen cauterization (ESFC) and compared it to ESPAL. Method A retrospective study was conducted. Patients who received ESFC for posterior epistaxis from 2016 to 2018 at a tertiary hospital were recruited. Middle meatal antrostomy was done. After ethmoidal crest was identified and nipped, pterygopalatine fossa was entered through the SPF. Sphenopalatine artery (SPA) and its branches within the SPF were cauterized without identification of any SPA distal branches in the nasal cavity. Patients receiving conventional ESPAL by the same surgeon were recruited and compared as control. Patients were followed-up for 3 months. Success rate, operative time, and complication were assessed. Results Thirty-four patients were identified. Recurrent epistaxis was absent in 90.0% and 100% of patients receiving ESPAL (9/10 patients) and ESFC (24/24 patients) respectively, p = 0.294. Median operative time was 115 and 60 min, respectively, p < 0.001. Ipsilateral hard palatal or anterior palatal numbness were found in one and three patients, respectively. All resolved spontaneously within 2 weeks. Conclusion ESFC is effective in treating posterior epistaxis. It requires significantly less amount of time while the success rate was comparable to conventional ESPAL.

International Forum of Allergy & Rhinology, 2018

Background: A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commo... more Background: A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH-INCS) for treating AR. Methods: Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH-INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease-specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events. Results: Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH-INCS decreased total nasal symptom scores (standardized mean difference [SMD], −0.13; 95% confidence interval [CI], −0.19 to −0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, −0.12, 95% CI, −0.20 to −0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH-INCS combination but did show benefit with intranasal AH-INCS (SMD, −0.18; 95% CI, −0.27 to −0.09; p < 0.001). There were no significant differences with regard to disease-specific quality of life (SMD, −0.07; 95% CI, −0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, −0.03 L/min; 95% CI, −0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events. Conclusion: Intranasal AH-INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH-INCS is not recommended. C 2018 ARS-AAOA, LLC.

Rhinology journal, 2019

Background: The extent of endoscopic sinus surgery (ESS) required for optimal outcomes in chronic... more Background: The extent of endoscopic sinus surgery (ESS) required for optimal outcomes in chronic rhinosinusitis (CRS) is undefined. We evaluated whether concordance between the extent of surgery and degree of radiographic disease influences postoperative outcomes. Methods: 247 CRS patients who underwent ESS were retrospectively assigned a concordance score reflecting the similarity between the extent of surgery and degree of radiographic disease. 0 points were assigned when sinusotomy was performed on a diseased sinus, or no sinusotomy was performed on a nondiseased sinus; +1 for sinusotomy on a nondiseased sinus; and-1 for a diseased sinus left unopened. The total possible score ranged from-10 to +10. Patients were divided into 5 subgroups according to variance from complete concordance. SNOT-22 scores and revision rates were compared at 6 and 24 months. Results: All five subgroups had similar preoperative SNOT-22 scores and improved at 6 months postoperatively. At 6 months postoperatively, the most conservatively operated and most extensively operated subgroups each achieved equivalent improvements in SNOT-22 as the completely concordant subgroup. At 24 months, the most extensively operated subgroup had a 12.5-point smaller improvement in SNOT-22 scores compared to the completely concordant subgroup. Multivariate analysis showed no association between concordance score and revision rate. Conclusions: Symptom improvement and revision rates after ESS do not appear to correlate with the degree of concordance between extent of surgery and radiographic disease. More extensive surgery than indicated by CT confers neither greater symptomatic improvement nor long-term detriment.

The Laryngoscope, 2017

Objective: Patients frequently are advised to abstain from nose blowing following endoscopic sinu... more Objective: Patients frequently are advised to abstain from nose blowing following endoscopic sinus surgery (ESS), despite a lack of evidence supporting this recommendation. This randomized study assessed whether nose blowing in the first postoperative week affects subjective and objective clinical outcomes. Methods: Forty patients undergoing ESS were randomized into an interventional arm in which patients blew their nose at least twice daily for the first 7 postoperative days, or a control arm in which patients refrained from nose blowing. All patients were allowed to blow their nose after 7 days. The frequency and degree of epistaxis was documented by daily diary and visual analog scale (VAS). At 1 and 4 weeks postoperatively, Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) were collected, and endoscopies were recorded for blinded Lund-Kennedy scale scoring. Results: There were no differences between the two groups in terms of frequency and duration of bleeding events, VAS epistaxis scores, SNOT-22 scores, and NOSE scores at every postoperative timepoint. Lund-Kennedy scores also were similar at the 1-week (P 5 0.0762) and 4-week (P 5 0.2340) postoperative visits, but the nose-blowing group had improved nasal discharge subscores at the first (P 5 0.0075) and second (P 5 0.0298) postoperative visits. Conclusion: Nose blowing after ESS does not appear to measurably improve symptoms of nasal congestion or general sinonasal quality of life, nor does it seem to adversely affect the frequency or severity of postoperative epistaxis during the first postoperative week. Judicious nose blowing may be permissible immediately after uncomplicated ESS.

American Journal of Rhinology & Allergy, 2019

Background Histamine and leukotriene are released after being triggered by allergen exposure. The... more Background Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH...