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

David J. Amrol, MD

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For patients with moderate-to-severe SAR that is uncontrolled on nasal steroids alone, the treatment of choice should be a combination intranasal steroid and intranasal antihistamine. For patients with severe symptoms, the combination could be started as first-line therapy, but azelastine has a bitter taste, and two different sprays increase treatment cost and complexity. (A combination product is not yet available commercially.) We don't know if the combination is superior to intranasal steroids alone when used for longer than 2 weeks, but it is worth a try in patients with uncontrolled chronic symptoms.

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