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Allergic rhinitis combined treatment with topical antihistamine and topical steroids

June 21, 2016 by ASK DR BLOOM

Paul Ratner etal recently published an article looking at how nasal sprays can be combined to better treat allergy symptoms. The most commonly used treatment for seasonal allergic rhinitis are oral antihistamines and topical nasal steroids. Both work but topical nasal steroids have been shown to work better and they have not been shown to have an additive affect. Recently, azelastine hydrochloride nasal spray, a topical nasal antihistamine, has been approved for use for allergic rhinitis.

Ratner’s study was a 2 week, randomized, multicenter, double-blind trial during the Texas mountain cedar season looking at 151 patients with moderate to severe allergies. They were randomized to (1) azelastine nasal spray, 2 sprays per nostril twice a day, (2) fluticasone nasal spray, 2 sprays per nostril once a day, (3) both of the above. The outcome that they looked at was the total nasal symptom score (TNSS) consisting of sneezing, itchy nose, runny nose and nasal congestion.

They found that all three groups had significant improvement from baseline. The TNSS improved 27.1% for fluticasone nasal spray, 24.8% for azalastine nasal spray and 37.9% with both fluticasone and azalastine nasal spray which was significantly better than either nasal spray alone.

Their concluded that azelastine nasal spray and fluticasone nasal spray in combination may provide a substantial therapeutic benefit in patients with seasonal allergic rhinitis compared with therapy with either agent alone.

Reference: PH Ratner etal. Combined therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy ASthma Immunol. 2008; 100(1): 74-81.


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