Therapeutics and Drugs Briefs

Fluticasone and Loratadine for Seasonal Allergic Rhinitis Treatment

Source: Ratner PH, et al. J Fam Pract 1998;47:118-125.

Intranasal corticosteroids and oral antihista-mines are both popular choices for the treatment of allergic rhinitis. Though the former are generally acceded to possess a more favorable effect on nasal blockage than the latter, eye symptoms are typically more favorably affected by systemic antihistamines. This placebo-controlled, randomized, double-blind study compared once daily fluticasone nasal spray (FNS), once daily oral loratadine (LOR), or the combination (FNS/LOR), in 600 seasonal allergic rhinitis sufferers.

On a daily basis, patients recorded nasal symptom scores including nasal blockage, rhinorrhea, sneezing, and nasal itching. After two weeks of treatment, the FNS (and FNS/LOR) recipients had significantly more favorable symptom scores than LOR or placebo. Surprisingly, LOR did not surpass placebo aqueous vehicle spray, and the FNS/LOR group was no better than FNS alone.

The results of this trial are in accord with several other trials that demonstrate the superiority of FNS over LOR. Indeed, a trial of mometasone nasal spray monotherapy compared to LOR alone or in combination also failed to show a favorable effect of LOR.

Ratner and colleagues conclude that FNS is superior to LOR for management of seasonal allergic rhinitis, and that adding LOR to FNS does not enhance benefits.