Combination Nasal Steroid–Antihistamine Is More Effective Than Either Agent Alone

David J. Amrol, MD


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In This Article

Abstract and Introduction


For patients with allergic rhinitis, twice-daily azelastine plus fluticasone cut nasal symptoms.


Intranasal steroids are the most effective pharmacologic treatment for seasonal allergic rhinitis (SAR), but they can take several days to take effect, and some patients don't achieve full relief of symptoms. Add-on oral antihistamines or montelukast (Singulair) do not add much benefit.

In three separate trials, researchers randomized 3398 adolescent and adult patients with moderate-to-severe SAR (without regard to previous SAR therapies) to twice-daily azelastine (an intranasal antihistamine), fluticasone propionate, the combination of the two, or placebo for 2 weeks during the allergy season; all treatments were administered as one spray twice daily to preserve blinding. The studies were sponsored by a company that manufactures azelastine and the investigational combination product. The onset of action for combination therapy was 30 minutes. On all study days, combination-therapy recipients showed significantly greater improvement in morning and evening total nasal symptom scores than did patients who received azelastine or fluticasone individually; all active treatments were significantly better than placebo.


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