A comparative study of fluticasone propionate nasal spray and the combination of loratadine and montelukast in the treatment of seasonal allergic rhinitis

Abstract

8 1 1 0 Nasal Blockage in Allergic Rhinitis Patients Treated With a Nasal II, I U Steroid, Aatileukotriene or Combined Aatileukotriene+Antihistamine Teet Pullerits*, Lea Praks§, Jan L6tvall* *Lung Pharmacology Group, Gothenburg, Sweden §University Lung Clinic, Tartu, Estonia Nasal blockage is one of the most bothersome symptoms in allergic rhinitis patients. Intranasal administration of leukotrienes is known to primarily cause nasal blockage with little effect on other rhinitis symptoms. It has therefore been suggested that treatment with antileukotrienes might have beneficial anti-blockage effect in allergic rhinitis patients. We evaluated how treatment with antileukotriene alone or in combination with antihistamine affects nasal blockage compared to the treatment with a nasal steroid. In a double-blind, double-dummy, placebo-controlled study, 62 patients with grass-pollen induced allergic rhinitis were randomized to receive nasal steroid (fluticasone propionate; FP, 200 ktg/day), oral antileukotriene montelukast (10 rag/day), combination of montelukast + the antihistamine loratadine (10 mg/day), or placebo. Treatment started two weeks prior to the expected beginning of the grass-pollen season and lasted for 50 days. Patients recorded their nasal blockage symptoms as well as symptoms for nasal itch, rhinorrhea and sneezing separately for dayand night-time on a scale from 0 to 4. At 5 clinic visits before, during, and after the treatment, peak nasal inspiratory flow (PNIF) was measured using InCheck PNIF meter. Interestingly, compared to treatment with montelukast, FP provided significantly better relief for nasal blockage (p=0.025 for day-time and 0.04 for night-time blockage), but not for other rhinitls subsymptoms. This despite the fact that the study was not powered to detect differences for each individual subsymptom. No statistically significant differences were found in PNIF measurements at any of the clinic visits, implying that PNIF measurement on random basis is of limited use for assessment of dynamics of nasal blockage. We conclude that treatment with nasal fluticasone propionate is more effective than treatment with montelukast for relief of nasal blockage in allergic rhinitis patients during a pollen season.