title: Efficacy and safety of azelastine nasal spray at a dose of 1 spray per nostril twice daily.
abstract: BACKGROUND
  Azelastine hydrochloride nasal spray is available worldwide for the treatment of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis. One spray per nostril twice daily is the most commonly recommended dose.
  
  
  OBJECTIVE
  To determine the efficacy and safety of azelastine nasal spray, 1 spray per nostril twice daily, in patients with SAR.
  
  
  METHODS
  In 2 studies conducted in the United States we assessed 554 patients with moderate-to-severe SAR who were still symptomatic after a 1-week placebo lead-in period. Patients were randomized to 2 weeks of double-blind treatment with azelastine nasal spray, 1 spray per nostril twice daily, or placebo nasal spray. The primary efficacy variable was change from baseline in total nasal symptom score, consisting of sneezing, itchy nose, runny nose, and nasal congestion.
  
  
  RESULTS
  Mean differences in total nasal symptom score between the azelastine and placebo groups were significant in both studies: 2.69 vs 1.31 (P = .01) in study 1 and 3.68 vs 2.50 (P = .02) in study 2. Bitter taste was reported by 8.3% of patients treated with 1 spray per nostril twice daily compared with the labeled incidence of 19.7% with 2 sprays per nostril twice daily. Somnolence was reported by 1 patient (0.4%) using the 1-spray regimen compared with the labeled incidence of 11.5% using the 2-spray regimen.
  
  
  CONCLUSIONS
  Azelastine nasal spray at a dose of 1 spray per nostril twice daily is effective and has improved tolerability compared with 2 sprays per nostril twice daily in patients with SAR.
authors.affiliation: AARA Research Center, Dallas, Texas 75231, USA. lumrymd@sbcglobal.net
authors.forename: William
authors.initials: W
authors.lastname: Lumry
authors.forename: Bruce
authors.initials: B
authors.lastname: Prenner
authors.forename: Jonathan
authors.initials: J
authors.lastname: Corren
authors.forename: William
authors.initials: W
authors.lastname: Wheeler
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010793:Phthalazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D013649:Taste / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents; D010793:Phthalazines; C020976:azelastine