{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:39:01Z","timestamp":1777941541829,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100032827","name":"Advanced Research and Invention Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100032827","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Allergy"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n To achieve adequate symptom control, patients with allergic rhinitis (AR) often need to increase their medication dose or add other treatments (co\u2010medication). We aimed to perform a systematic review to compare the efficacy and safety of AR medications for increased dose versus co\u2010medication.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We searched four bibliographic databases and three trial databases for randomised controlled trials assessing the effect of intranasal and\/or oral medications in patients of all ages with seasonal or perennial AR. We performed pairwise meta\u2010analysis based on direct evidence to compare (i) non\u2010standard versus standard treatment doses, and (ii) co\u2010medication strategies versus monotherapy using standard doses. Furthermore, we fitted dose\u2013response network meta\u2010analysis (NMA) to obtain projected estimates for comparisons involving two times the standard dose of AR medications in monotherapy versus co\u2010medication with the standard dose of the same medications. We assessed the certainty of evidence using GRADE for NMA.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We included 262 studies. Co\u2010medication schemes involving oral antihistamines (OAH)\u2009+\u2009intranasal corticosteroids (INCS) resulted in higher improvements of nasal symptoms and quality of life than doubling the dose of OAH. However, doubling the dose of intranasal medications led to better results than having intranasal medications + OAH. Doubling the dose of INCS was associated with higher efficacy than adding intranasal antihistamines (INAH). No relevant safety differences were found between treatment strategies.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Results favoured (i) doubling the dose of intranasal medications versus adding OAH, and (ii) adding INCS to OAH over doubling the dose of OAH. This study will inform the ARIA\u2010EAACI 2024\u20132025 guidelines.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/all.70372","type":"journal-article","created":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T06:27:36Z","timestamp":1777703256000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Dose Increase Versus Co\u2010Medication in Allergic Rhinitis: Systematic Review With Dose\u2013Response Network Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-3401","authenticated-orcid":false,"given":"Bernardo","family":"Sousa\u2010Pinto","sequence":"first","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-3055","authenticated-orcid":false,"given":"Rafael Jos\u00e9","family":"Vieira","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"given":"Sara","family":"Gil\u2010Mata","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-0932","authenticated-orcid":false,"given":"Ana Margarida","family":"Pereira","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Allergy Unit, Instituto and Hospital CUF Porto Portugal"}]},{"given":"V\u00edtor Henrique","family":"Duarte","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine University of Porto Porto Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0128-903X","authenticated-orcid":false,"given":"Antonio","family":"Bognanni","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Research Center (CERC) Humanitas University and Humanitas Research Hospital Milan Italy"},{"name":"Department of Health Research Methods, Evidence, and Impact & Department of Medicine, Evidence in Allergy Group McMaster University Hamilton Ontario Canada"}]},{"given":"Manuel","family":"Marques\u2010Cruz","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}]},{"given":"Pawe\u0142","family":"Jemio\u0142o","sequence":"additional","affiliation":[{"name":"AGH (Akademia Gorniczo\u2010Hutnicza) University of Krakow Krakow Poland"},{"name":"Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics Faculty of Medicine Jagiellonian University Medical College Krakow Poland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-6882","authenticated-orcid":false,"given":"Mattia","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Allergy Unit, Meyer Children's Hospital IRCCS Florence Italy"},{"name":"Department of Health Sciences University of Florence Florence Italy"}]},{"given":"Danilo","family":"di Bona","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Science University of Foggia Foggia Italy"}]},{"given":"Arnav","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine University of Alberta Edmonton Alberta Canada"},{"name":"Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada"}]},{"given":"Mark S.","family":"Dykewicz","sequence":"additional","affiliation":[{"name":"Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri USA"}]},{"given":"Mohamed H.","family":"Shamji","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute (NHLI) Imperial College London UK"},{"name":"NIHR Imperial Biomedical Research Centre London UK"}]},{"given":"Maria Jose","family":"Torres","sequence":"additional","affiliation":[{"name":"Allergy Unit, Regional University Hospital of M\u00e1laga Malaga University, ARADyAL Malaga Spain"}]},{"given":"Torsten","family":"Zuberbier","sequence":"additional","affiliation":[{"name":"Institute of Allergology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t Zu Berlin Berlin Germany"},{"name":"Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2455-0192","authenticated-orcid":false,"given":"Ludger","family":"Klimek","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head & Neck Surgery Universit\u00e4tsmedizin Mainz Mainz Germany"},{"name":"Center for Rhinology and Allergology Wiesbaden Germany"}]},{"given":"Alexandro W. L.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-8479","authenticated-orcid":false,"given":"Holger J.","family":"Sch\u00fcnemann","sequence":"additional","affiliation":[{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Clinical Epidemiology and Research Center (CERC) Humanitas University and Humanitas Research Hospital Milan Italy"},{"name":"Department of Health Research Methods, Evidence, and Impact & Department of Medicine, Evidence in Allergy Group McMaster University Hamilton Ontario Canada"},{"name":"Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6214-9087","authenticated-orcid":false,"given":"Guido","family":"Schwarzer","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Statistics Faculty of Medicine and Medical Center \u2010 University of Freiburg Freiburg Germany"}]},{"given":"Jo\u00e3o A.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE\u2014Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Allergy Unit, Instituto and Hospital CUF Porto Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4061-4766","authenticated-orcid":false,"given":"Jean","family":"Bousquet","sequence":"additional","affiliation":[{"name":"Institute of Allergology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t Zu Berlin Berlin Germany"},{"name":"Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany"},{"name":"ARIA (Allergic Rhinitis and Its Impact on Asthma) Montpellier France"}]},{"name":"the ARIA 2024\u20132025 systematic reviews group","sequence":"additional","affiliation":[]}],"member":"311","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.70131"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","unstructured":"R. J.Vieira B.Sousa\u2010Pinto J.Bousquet et\u00a0al. Allergic Rhinitis and its Impact on Asthma (ARIA)\u2010EAACI guidelines\u20142024\u20102025 Revision: Part II\u2014Guidelines on Oral and Ocular Treatments. Allergy (2026) https:\/\/doi.org\/10.1111\/all.70305.","DOI":"10.1111\/all.70305"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.70210"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15275"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15574"},{"issue":"12","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.1111\/all.70055","article-title":"Comparison of Allergic Rhinitis Treatments on Patient Satisfaction: A MASK\u2010Air and EAACI Methodological Committee Report","volume":"80","author":"Sousa\u2010Pinto B.","year":"2025","journal-title":"Allergy"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2025.07.004"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.16384"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2024.04.016"},{"key":"e_1_2_10_11_1","unstructured":"T.Thomander S.Gil\u2010Mata P.Riera\u2010Serra et\u00a0al. Efficacy and Safety of Oral Treatments for Allergic Rhinitis in Children: A Systematic Review and Network Meta\u2010Analysis. 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