title: A randomized control trail of  stepwise treatment with fluticasone propionate nasal spray and  fexofenadine hydrochloride tablet  for seasonal allergic rhinitis.
abstract: BACKGROUND
  In Japan, oral antihistamines are frequently used as the initial treatment for seasonal allergic rhinitis (SAR), and intranasal steroids are added when nasal symptoms worsen. This study aimed to evaluate whether starting treatment with fluticasone propionate nasal spray (FP) from the beginning of pollinosis symptoms and adding fexofenadine hydrochloride tablet (FEX) when SAR is aggravated could achieve improved amelioration of nasal symptoms throughout the pollen season in comparison with a treatment that involves starting with FEX and later adding FP.
  
  
  METHODS
  In this pragmatic, randomized, open-label, parallel-group trial, 51 Japanese cedar pollinosis patients (age, 16-85 years) were randomly divided and administered FP 100 mcg twice daily as an initial drug with FEX 60 mg twice daily as an additional drug and the same treatment in the reverse order. Nasal symptoms were evaluated in a daily dairy using a 4-point scale. The primary outcome was area under curve of the line representing the daily total nasal symptom score in the pollen season on a graph.
  
  
  RESULTS
  Initial treatment with FP was significantly (P = 0.0015) more effective than initial treatment with FEX in improving the primary outcome. The average daily total nasal symptom score in the initial treatment with FP group was better than that in the initial treatment with FEX group throughout the pollen season.
  
  
  CONCLUSIONS
  Initiating treatment with FP and adding FEX might lead to improved outcomes for nasal symptoms in comparison with the same drugs administered in the reverse order.
authors.affiliation: Department of Otolaryngology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. gr−tkhs@umin.ac.jp
authors.forename: Goro
authors.initials: G
authors.lastname: Takahashi
authors.forename: Zensei
authors.initials: Z
authors.lastname: Matsuzaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okamoto
authors.forename: Eiko
authors.initials: E
authors.lastname: Ito
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Keisuke
authors.initials: K
authors.lastname: Masuyama
mesh_terms: D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018926:Anti-Allergic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D059085:Nasal Sprays; D011058:Pollen; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D013607:Tablets; D016593:Terfenadine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D018926:Anti-Allergic Agents; D059085:Nasal Sprays; D013607:Tablets; D016593:Terfenadine; D000068298:Fluticasone; C093230:fexofenadine