Seasonal rhinitis and azelastine: long- or short-term treatment?
BACKGROUND
Azelastine is a topical antihistamine, clinically demonstrated to be effective in allergic rhinitis.


OBJECTIVE
We evaluated the clinical efficacy and the antiallergic activity of azelastine nasal spray, administered 0.56 mg per day, 0.28 mg per day, or on demand over a 3-month period during natural allergen exposure, in a double-blind, placebo-controlled fashion.


METHODS
Thirty patients, sensitized to grass or Parietaria pollen, were allocated to three treatment groups: those receiving the standard dosage (0.14 mg/nostril two times a day), half the dosage (0.07 mg/nostril two times a day), or placebo daily for 3 months. All patients were allowed to take additional doses of azelastine when needed. Evaluation parameters were as follows: clinical symptoms recorded on a diary card, number of additional, on-demand azelastine puffs, nasal inflammatory cell count, intercellular adhesion molecule-1 expression on nasal epithelial cells, and pollen count.


RESULTS
This study showed the following: (1) the half dose (0.28 mg/day) and the standard dose (0.56 mg/day) were equally effective in reducing clinical symptoms (p = NS), although the standard dosage required fewer additional puffs during times of peak pollen counts (p < 0.05); (2) both dosages were able to reduce the allergic inflammation (p < 0.05 vs placebo); and (3) on-demand use achieved acceptable clinical control but did not significantly reduce allergic inflammation.


CONCLUSIONS
Continuous treatment was more effective than on-demand use as assessed by both clinical evaluation and antiinflammatory action.
Ciprandi
G
G
Department of Internal Medicine, Genoa University, Italy.
Ricca
V
V
Passalacqua
G
G
Truffelli
T
T
Bertolini
C
C
Fiorino
N
N
Riccio
A M
AM
Bagnasco
M
M
Canonica
G W
GW
D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D004847:Epithelial Cells; D004848:Epithelium / Q000276:immunology; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D007958:Leukocyte Count; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009297:Nasal Mucosa / Q000166:cytology / Q000187:drug effects / Q000276:immunology; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology; D010793:Phthalazines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011058:Pollen / Q000276:immunology; D011852:Radioallergosorbent Test; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D012882:Skin Tests
D006634:Histamine H1 Antagonists; D010793:Phthalazines; D018799:Intercellular Adhesion Molecule-1; C020976:azelastine