Effects of monotherapy with intra-nasal corticosteroid or combined oral histamine and leukotriene receptor antagonists in seasonal allergic rhinitis.
BACKGROUND
The combination of a leukotriene receptor antagonist with an antihistamine may have beneficial effects in seasonal allergic rhinitis (SAR).


OBJECTIVE
To determine how combined oral mediator blockade compares to monotherapy with intranasal corticosteroid in the treatment of SAR.


METHODS
Twenty-two patients with seasonal allergic rhinitis were enrolled in a placebo controlled crossover study comparing 2 weeks therapy of either (a) 200 microg intranasal mometasone furoate (MF) once daily or (b) 10 mg oral montelukast plus 10 mg oral cetirizine once daily (MON/CZ), with a 7-10 day placebo period prior to each treatment period. Domiciliary measures of symptoms and nasal flow were recorded daily. Measurements of posterior rhinomanometry, acoustic rhinometry and nasal nitric oxide were made after all treatment and placebo periods.


RESULTS
There were significant (P < 0.05) improvements in domiciliary peak nasal flow (l/min) with both MF (133 (3.8)) and MON/CZ (124 (3.8)) compared to pooled placebo (110 (4.0). Both treatments also showed significant improvement in terms of nasal blockage (units) (PL: 1.1(0.1), MF: 0.5 (0.1), MON/CZ 0.7 (0.1); and total nasal symptoms (units) (PL: 3.5 (0.3), MF 1.6 (0.3), MON/CZ 1.7 (0.3)), although there was no significant difference between the two active treatments. There were no significant differences between placebo and treatment for rhinomanometry, acoustic rhinometry or nitric oxide.


CONCLUSIONS
Both intranasal mometasone furoate as monotherapy and oral cetirizine plus montelukast as cotherapy were equally effective for objective and subjective measures of treatment response in SAR. Domiciliary measurements of symptoms and peak flow were more sensitive than laboratory measurements of rhinomanometry, acoustic rhinometry and nasal nitric oxide.
Wilson
A M
AM
Asthma & Allergy Research Group, Department of Clinical Pharmacology & Therapeutics, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland.
Orr
L C
LC
Sims
E J
EJ
Lipworth
B J
BJ
D000085:Acetates / Q000627:therapeutic use; D000281:Administration, Intranasal; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D017332:Cetirizine / Q000627:therapeutic use; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D016037:Single-Blind Method; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D006634:Histamine H1 Antagonists; D020024:Leukotriene Antagonists; D011244:Pregnadienediols; D011804:Quinolines; D013440:Sulfides; D000068656:Mometasone Furoate; C093875:montelukast; D017332:Cetirizine