Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis.
BACKGROUND
Allergic rhinitis requires active intervention for symptom relief. A combination of antileukotriene and antihistamine drugs has been suggested to provide additive treatment benefits for patients with allergic rhinitis.


OBJECTIVE
We evaluated how such a combination treatment would affect symptoms and local mucosal eosinophilia in comparison with a nasal glucocorticoid.


METHODS
In a double-blind, randomized study 62 patients with grass pollen-induced allergic rhinitis received a nasal glucocorticoid (fluticasone propionate aqueous nasal spray [FPANS], 200 microg/d), an antileukotriene (montelukast, 10 mg/d), a combination of montelukast with an antihistamine (loratadine, 10 mg/d), or placebo throughout the season. Cromoglycate eyedrops and a limited amount of loratadine were allowed as rescue medication for severe symptoms. Patients recorded their symptoms for nasal blockage, itching, rhinorrhea, and sneezing. Before and during the season, nasal biopsy specimens were obtained from patients for evaluation of local eosinophilic inflammation.


RESULTS
During the peak season, both FPANS and combined montelukast-loratadine were significantly more effective than placebo and montelukast alone for daytime symptom prevention. For nighttime symptoms, FPANS was significantly more effective compared with all other treatments, whereas combined montelukast-loratadine and montelukast alone did not provide significant symptom prevention compared with placebo. The pollen-induced increase in the numbers of epithelial eosinophils was significantly lower for FPANS-treated patients compared with that seen in all other treatment groups.


CONCLUSIONS
In patients with seasonal allergic rhinitis, intranasal glucocorticoids are more effective than an antileukotriene drug or combined antileukotriene-antihistamine for the reduction of pollen-induced nasal eosinophilic inflammation and for control of nasal symptoms.
Pullerits
Teet
T
Lung Pharmacology Group, Department of Respiratory Medicine and Allergology, Institute of Internal Medicine, Göteborg University, Gothenburg, Sweden.
Praks
Lea
L
Ristioja
Vahur
V
Lötvall
Jan
J
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000281:Administration, Intranasal; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D002940:Circadian Rhythm; D003521:Cyclopropanes; D004311:Double-Blind Method; D004804:Eosinophils; D005260:Female; D000068298:Fluticasone; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D017336:Loratadine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D011058:Pollen; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D012220:Rhinitis / Q000473:pathology; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D013440:Sulfides
D000085:Acetates; D000730:Androstadienes; D003521:Cyclopropanes; D006634:Histamine H1 Antagonists; D011804:Quinolines; D013440:Sulfides; D017336:Loratadine; D000068298:Fluticasone; C093875:montelukast