From the Guidelines
Loratadine is not generally advised for acute sinusitis.
Rationale
- The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1 found that antihistamines, including loratadine, do not significantly reduce total symptom scores or rhinorrhoea symptoms in patients with acute bacterial rhinosinusitis.
- A study by Braun and colleagues, as cited in the position paper 1, evaluated the use of loratadine (10mg) in 139 patients with acute bacterial rhinosinusitis and found that it significantly decreased nasal obstruction, but did not reduce total symptom scores or rhinorrhoea symptoms.
- The study found that the addition of loratadine to antibiotics and corticosteroids resulted in decreased nasal obstruction, but this benefit was limited to this specific symptom, and did not translate to overall symptom improvement.
- Key findings from the study include:
- Decreased nasal obstruction at the end of treatment (MD=−0.58; 95% CI =−0.85- −0.31, p<0.01)
- No reduction in total symptom scores (MD=−1.25; 95% CI=−2.77-0.27, p=0.11)
- No reduction in rhinorrhoea symptoms (MD=−0.06; 95% CI=−0.37-0.25, p=0.71)
- Based on this evidence, loratadine is not recommended as a primary treatment for acute sinusitis, and its use should be considered on a case-by-case basis, taking into account the individual patient's symptoms and medical history.
The FDA Drug Labels for loratadine (PO) do not address this question.
From the Research
Loratadine for Acute Sinusitis
- Loratadine may be beneficial in relieving some symptoms of acute sinusitis, particularly in patients with allergic rhinitis 2, 3.
- A study found that loratadine decreased nasal obstruction in allergic rhinitis patients with acute rhinosinusitis, but had no benefit on total symptom score or rhinorrhoea symptoms 2.
- Another study showed that loratadine in addition to standard therapy improved the control of some symptoms of sinusitis, including sneezing and nasal obstruction, in patients with allergic rhinitis 3.
- The efficacy of loratadine in relieving nasal congestion has also been demonstrated in patients with seasonal allergic rhinitis, with loratadine-montelukast treatment resulting in greater improvement in nasal congestion score compared to placebo and phenylephrine 4.
- However, the use of antibiotics in treating acute sinusitis is not always beneficial, and simple management algorithms and patient information can aid primary care physicians in offering appropriate therapeutic measures 5.
- Acute bacterial rhinosinusitis can cause hyperresponsiveness to histamine challenge in mice, suggesting a potential role for antihistamines like loratadine in treating acute sinusitis 6.