Effects of monotherapy with intra‐nasal corticosteroid or combined oral histamine and leukotriene receptor antagonists in seasonal allergic rhinitis

Abstract

Both intranasal mometasone furoate as monotherapy and oral cetirizine plus montelukast as cotherapy were equally effective for objective and subjective measures of treatment response in SAR. Domiciliary measurements of symptoms and peak flow were more sensitive than laboratory measurements of rhinomanometry, acoustic rhinometry and nasal nitric oxide.

The diagnosis and management of rhinitis: An updated practice parameter

“…In most studies, intranasal corticosteroids are more effective than the combined use of an antihistamine and a LT antagonist. [375][376][377][378][379] The clinical response does not appear to vary significantly between intranasal corticosteroids that are currently available (Table VIII). 53,[380][381][382] The onset of therapeutic effect of intranasal corticosteroid occurs between 3 and 12 hours.…”

“…Although the concomitant administration of a LTRA and an antihistamine can have an additive effect, in general this approach is less efficacious than administering intranasal corticosteroids as monotherapy. 48,375,377,379 However, such combination therapy may provide an alternative treatment for patients who are unresponsive to or not compliant with intranasal corticosteroids.…”

“…929,930 In most studies, intranasal corticosteroids were shown to be more effective than the combined use of an antihistamine and LT antagonist in the treatment of seasonal allergic rhinitis. [375][376][377][378][379] However, for patients who are unresponsive to or noncompliant with intranasal corticosteroids, combination therapy using an antihistamine in combination with an anti-LT or a decongestant may provide a viable alternative. In 2 systematic reviews of randomized controlled studies, intranasal corticosteroids were significantly more effective than oral and intranasal antihistamines in relieving symptoms of sneezing, nasal congestion, discharge, and itching, and were not significantly different for the relief of eye symptoms.…”

“…Although the concomitant administration of a LTRA and an antihistamine can have an additive effect, in general, this approach is less efficacious than administering intranasal corticosteroids. 348,375,377,379 Oral decongestants, such as pseudoephedrine or phenylephrine, help reduce symptoms of nasal congestion in both allergic and nonallergic rhinitis and are beneficial for use in combination with antihistamines. However, they can cause insomnia, loss of appetite, irritability, and palpitations.…”

Leukotriene antagonists attenuate late phase nitric oxide production during the hypersensitivity response in the conjunctiva

“…Currently, anti-LT therapies are approved only for patients with asthma [11], though recent reportrs support the clinical efficacy of cysLT receptor antagonists in patients with rhinitis [12]. However, the efficacy of these agents as a therapeutic option for allergic conjunctivitis has not been evaluated.…”