Co-Medication Linked to Lower Treatment Satisfaction in Allergic Rhinitis

A recent study found that co-medication use in patients with allergic rhinitis was associated with lower treatment satisfaction, with oral antihistamines rated less favorably than intranasal corticosteroids or fixed intranasal antihistamine-corticosteroid combinations. Among individual oral antihistamines, desloratadine and rupatadine showed the greatest satisfaction.

The satisfaction of treatments may impact medication adherence and use patterns, including the use of co-medication. Those unsatisfied with their medication may switch to another or increase their dose.2 Investigators sought to compare the satisfaction and co-medication frequently for different allergic rhinitis medications, including oral antihistamines, intranasal corticosteroids, intranasal antihistamines, and fixed combinations of intranasal antihistamines and intranasal corticosteroids (INAH + INCS).

“We hypothesized that the two most important factors determining [allergic rhinitis] medication use patterns are... baseline disease severity…and periodic fluctuations of disease symptoms (patients tend to use medication more often when feeling less well controlled),” study investigator Bernardo Sousa-Pinto, MD, PhD, from University of Porto in Portugal, and colleagues wrote.

The team built multivariable regression models using data from 1691 users (57.2% females; mean age 42.2 years) of the mHealth app MASK-air across 28,177 days. The models compared both medication classes and individual classes. Investigators measured medication satisfaction using a specific daily visual analogue scale (VAS satisfaction) and calculated the odds of these medications being use alongside other ones.

More than half of users received monotherapy (59.5%), and 40.5% received co-medication. The most frequently used medications included oral antihistamines (17,927 days; 63.6%), followed by intranasal corticosteroids (12,961; 46%), and INAH + INCS) (6188 days; 22%).

Across all medication classes, after adjusting for the previous day’s CSMS and symptom severity, co-medication was associated with lower treatment satisfaction than monotherapy. The largest reduction in satisfaction was observed with intranasal antihistamines (−8.8; 95% CI, –14.6 to –3.08; P =.003), followed by intranasal corticosteroids (−2.3; 95% CI, –3.19 to –1.39; P <.001), INAH+INCS (−2.3; 95% CI, –3.5 to –1.1; P <.001), and oral antihistamines (−1.3; 95% CI, –2.0 to –0.5; P =.001)

“It is unlikely that these results can be explained by co-medication being less effective than monotherapy,” investigators wrote. “It is more likely that patients use co-medication because of low satisfaction with monotherapy. Alternative explanations, such as the increased medication burden or the higher risk of side effects with co-medication resulting in lower satisfaction, cannot be excluded.”

When comparing medication classes used in monotherapy, oral antihistamines were associated with lower VAS satisfaction than intranasal corticosteroids (-1.7 points; 95% confidence interval [CI], -2.7 to -0.7) and INAH + INCS (-2.1 points; 95% CI, -3.5 to -0.7). Intranasal corticosteroids showed greater odds of being used in co-medication than oral antihistamines (odds ratio [OR], 1.3; 95% CI, 1.0 to 1.6) or INAH + INCS (OR, 1.3; 95% CI, 0.8 to 1.8).

Moreover, when comparing individual intranasal medications, co-medication more frequently included fluticasone furoate and fluticasone propionate. When examining individual oral antihistamines, desloratadine and rupatadine were associated with greater satisfaction, while fexofenadine was more frequently used in co-medication.

The team wrote that the study faced several limitations. The analysis lacked data on allergic rhinitis control immediately before medication use, so researchers used the previous day’s CSMS as a proxy, though symptoms can fluctuate daily with factors like pollen or pollution. A relatively small sample limited observations for some medications and challenged model convergence, though the team noted that any reporting bias in MASK-air is unlikely to affect comparisons between treatments.

“…considering that the use of co-medication may reflect (at least in part) treatment satisfaction, these results suggest that—among all compared classes—INAH+INCS is the class with the highest acceptability to people with AR, while INAH is the class with the lowest acceptability,” investigators wrote. “However, there are other aspects that should be considered (e.g., patients' preferences on the route of administration and physicians' acceptability in prescribing medications of the different classes) for further investigation. In addition, treatment satisfaction may influence not only the use of co-medication but also medication adherence and switching…assessment of these aspects requires longitudinal studies.”

References

1. Sousa-Pinto B, Vieira RJ, Bognanni A, et al. Comparison of Allergic Rhinitis Treatments on Patient Satisfaction: A MASK-air and EAACI Methodological Committee Report. Allergy. Published online September 26, 2025. doi:10.1111/all.70055

2. Sousa-Pinto B, Schünemann HJ, Sá-Sousa A, et al. Consistent trajectories of rhinitis control and treatment in 16,177 weeks: The MASK-air® longitudinal study. Allergy. 2023;78(4):968-983. doi:10.1111/all.15574