Comparative nasal airflow with loratadine-pseudoephedrine and fluticasone nasal spray for allergic rhinitis

Charlene C Ng,Daniel Romaikin,Lisa M Steacy,David A Stevens,Terry J Walker,Daniel E Adams,Anne K Ellis

doi:10.1016/j.anai.2021.05.001

Abstract

BackgroundAlthough it is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Furthermore, the sensation of sprayed liquid in the nose may lead patients to mistakenly believe that intranasal steroid sprays work instantly. ObjectiveTo evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion. MethodsThis single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen. Participants were randomized to receive 1 of 4 treatment sequences, and their peak nasal inspiratory flow (PNIF) was measured in a span of 4 hours after pollen exposure in an environmental exposure unit. ResultsAverage change in PNIF was 31% with LP in the course of the study, significantly greater than with placebo and FP (12% and 15%, respectively; P < .001). Nevertheless, FP did not produce a significant change compared with its placebo. At hour one post-dose, LP had a clinically significant 31% increase in PNIF, whereas FP only yielded an 8.6% increase (P < .001). Measurable nasal airflow improvements are associated with the opening of nasal passages, allowing congested patients to breathe more freely. ConclusionA single dose of LP quickly and significantly (P < .001) improved nasal airflow after ragweed pollen challenge in an environmental exposure unit. Comparatively, FP did not display this same benefit. Trial RegistrationClinicalTrials.gov Identifier: NCT03443843.

Highlights

intranasal corticosteroid (INCS) sprays have a slower initial onset after the first dose and full effect of therapy may not be apparent for several days of regular use,[15,16,17,18] they have a critical role in the management of allergic rhinitis symptoms
Ambulatory adults aged 18 to 65 years, with a 2-year minimum history of self-reported seasonal allergic rhinitis and a documented positive skin prick test response to common ragweed, were eligible to participate in the study
The first participant completed their initial visit in February 2018, and the last participant completed their final visit in May 2018

Summary

Introduction

C.C. Ng et al / Ann Allergy Asthma Immunol 127 (2021) 342−348 nasal congestion in particular has been identified as one of the most bothersome symptoms in individuals with allergic rhinitis.[9]. It is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Objective: To evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion. Methods: This single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen.

Objectives

Methods

Results