Azelastine and olopatadine in the treatment of allergic rhinitis.
OBJECTIVE
To review the literature supporting current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis.


METHODS
Published articles in the peer-reviewed medical literature.


METHODS
Clinical trials focusing on the efficacy, safety, and recommended uses of the currently approved nasal antihistamines in the United States: azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%.


RESULTS
Azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%, have rapid onsets of action, are well tolerated, and have clinical efficacy for treating allergic rhinitis that is equal or superior to oral second-generation antihistamines. Both also have a clinically significant effect on nasal congestion. Azelastine is also approved for nonallergic rhinitis. Although older data suggest that intranasal steroids have greater clinical efficacy than nasal antihistamines, more recent comparisons in patients with mild to moderate disease have shown equal or noninferior efficacy. In addition, in contrast to oral antihistamines or leukotriene antagonists, the combination of a nasal antihistamine and intranasal steroid may provide additive benefits for treating patients with more severe disease.


CONCLUSIONS
The data support current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis. Future studies should address possible as needed use, the use of premixed antihistamine-steroid combinations, and the treatment of mixed rhinitis.
Kaliner
Michael A
MA
Institute for Asthma and Allergy, Chevy Chase, Maryland 20815, USA. makaliner@aol.com
D000281:Administration, Intranasal; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003990:Dibenzoxepins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000069605:Olopatadine Hydrochloride; D010793:Phthalazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D016896:Treatment Outcome
D018926:Anti-Allergic Agents; D003990:Dibenzoxepins; D010793:Phthalazines; D000069605:Olopatadine Hydrochloride; C020976:azelastine