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Supinda Saengpanich, MD; Marcy deTineo, BSN; Robert M. Naclerio, MD; Fuad M. Baroody, MD

Arch Otolaryngol Head Neck Surg. 2003;129:557-562.

Objective  To compare the effectiveness of an intranasal steroid treatment with that of the combination of a histamine₁ receptor antagonist and a leukotriene D receptor antagonist in the treatment of seasonal allergic rhinitis.

Design  A 2-week, parallel, randomized, double-blind, double-dummy study with rolling enrollment.

Setting  Tertiary care medical center.

Subjects  A total of 63 adults with a 2-year history of ragweed sensitivity in the Chicago, Ill, area and a positive skin-prick reaction to ragweed pollen.

Intervention  Subjects were randomized to receive either 100 µg of fluticasone propionate aqueous nasal spray in each nostril or 10 mg of loratadine and 10 mg of montelukast sodium by mouth once daily in the evening for 2 weeks. At visits 1 and 2, subjects completed a quality-of-life questionnaire and underwent nasal lavage to determine total eosinophil count and eosinophil cationic protein (ECP) measurements. Daily symptom diaries were kept for 2 weeks.

Main Outcome Measures  Questionnaire answers, daily nasal symptom scores, eosinophil counts, and ECP levels.

Results  Median total nasal symptom scores were lower in the fluticasone group (4.5 vs 6), but the difference was not statistically significant. The questionnaire answers showed dramatic improvement in overall and individual domains for both groups (P<.01 vs visit 1) with significantly greater reduction in nasal symptoms in the fluticasone group (P<.05). Eosinophil counts and ECP levels were significantly reduced in the fluticasone group.

Conclusion  Both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.

From the Section of Otolaryngology–Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, Chicago, Ill. The authors have no relevant financial interest in this article.

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