Short-term nasal decongestant as bridge therapy with intranasal corticosteroids in children with persistent allergic rhinitis: A randomized controlled trial

Background: Intranasal corticosteroids (INS) are first-line therapy for pediatric allergic rhinitis (AR), but their delayed onset may undermine early adherence. We evaluated a 5-day topical decongestant “bridge” added to INS in children with persistent AR. Methods: In this prospective, open-label, single-center randomized trial, 76 children aged 4–17 years with moderate-to-severe persistent AR received INS monotherapy or INS plus oxymetazoline during the first five treatment days; 71 completed follow-up (n = 30 and n = 41). Total Nasal Symptom Score (TNSS), peak nasal inspiratory flow (PNIF), Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and nasal nitric oxide (nNO; subgroup n = 17) were assessed at baseline and Week 4. Adherence was assessed at Month 1 using the Medication Adherence Report Scale (MARS). Results: Both groups showed improvements in TNSS, PNIF, and PRQLQ from baseline to Week 4. The combined group showed greater TNSS reduction (2.9 ± 1.0 vs 1.5 ± 1.3 points; p < 0.001), greater PNIF increase (34.6 ± 16.7 vs 12.8 ± 14.5 L/min; p < 0.001), greater PRQLQ improvement (18.0 ± 9.1 vs 5.3 ± 7.3 points; p < 0.001), and higher MARS scores (22.8 ± 2.3 vs 19.7 ± 2.2; p < 0.001). In the exploratory nNO subgroup, mean reduction was greater with combined therapy (212.8 vs 87.8 ppb; p = 0.030). No participant reported use beyond five days, rebound congestion, or a treatment-related adverse event. Conclusion: A 5-day oxymetazoline bridge added to INS was associated with greater improvements in symptoms, nasal airflow, and quality of life at Week 4, together with higher medication adherence. The nNO findings are exploratory. Trial registration: ClinicalTrials.gov (NCT07593898; retrospectively registered). © 2026 Elsevier Ireland Ltd