Randomized placebo‐controlled trial comparing fluticasone aqueous nasal spray in mono‐therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis

Lorenzo, Gabriele Di; Pacor, Maria Luisa; Pellitteri, Maria Esposito; Morici, Giuseppe; Gregoli, A. Di; Bianco, Claudia Lo; Ditta, Vito; Martinelli, Nicola; Candore, Giuseppina; Mansueto, Pasquale; Rini, G. B.; Corrocher, Roberto; Caruso, Calogero

doi:10.1111/j.1365-2222.2004.01877.x

Cited by 150 publications

(65 citation statements)

References 35 publications

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“…Assessment symptoms were: sneezing, rhinorrhea, nasal pruritus and nasal obstruction. These were graded with the following scale: 0 = absent, 1 = mild (symptoms were present but not troublesome), 2 = moderate (symptoms were present but did not interfere with normal activity) and 3 = severe (symptoms were troublesome and interfered with normal activity) [7]. The severity of all nasal symptoms was evaluated by patients using a visual analog scale (VAS) [8] and was classified, in accordance with ARIA guideline, as severe if there was one or more of the following items: sleep disturbance; impairment of daily activities, leisure or sport; impairment of school or work; or troublesome symptoms.…”

Section: Methodsmentioning

confidence: 99%

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Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms

Lorenzo¹,

Pacor²,

Amodio³

et al. 2011

Int Arch Allergy Immunol

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Background: Allergic rhinitis (AR) and nonallergic rhinitis (NAR) may present with different clinical and laboratory characteristics. Methods: A total of 1,511 consecutive patients, aged 18–81 years, diagnosed with rhinitis, 56% females and 44% males, underwent complete allergic evaluation including skin prick test, blood eosinophil counts, nasal eosinophil counts, peak nasal inspiratory flow (PNIF) measurement and evaluation of nasal symptoms using a visual analog scale (VAS). Results: A total of 1,107 patients (73%)had AR, whereas 404 (27%) had NAR. Patients with NAR were older and predominantly female. A higher nasal eosinophils count was associated with AR and a lack of clinical response to antihistamines. AR patients had more sneezing and nasal pruritus, whereas NAR was characterized mainly by nasal obstruction and rhinorrhea. AR patients had more severe symptoms and recurrent conjunctivitis, whereas NAR patients had slightly more frequent episodes of recurring headaches as well as olfactory dysfunction. PNIF, blood eosinophil counts and VAS of nasal symptoms were higher in patients with AR. In a final logistic regression model, 10 variables were statistically different between AR and NAR: age [OR 0.97 (95% CI 0.96–0.98)], sneezing [OR 4.09 (95% CI 2.78–6.00)], nasal pruritus [OR 3.84 (95% CI 2.60–5.67)], mild symptoms [OR 0.21 (95% CI 0.09–0.49)], intermittent/severe nasal symptoms [OR 3.66 (95% CI 2.06–6.50)], VAS [OR 1.06 (95% CI 1.04–1.08)], clinical response to antihistamines [OR 22.59 (95% CI 13.79–37.00)], conjunctivitis [OR 4.49 (95% CI 2.86–7.05)], PNIF [OR 1.01 (95% CI 1.00–1.01)] and nasal eosinophil counts [OR 1.14 (95% CI 1.10–1.18)]. Receiver operating characteristic analysis showed high predictive accuracy for a model including these variables independently of the diagnosis of AR/NAR (cutoff <0.74). Conclusions: We showed that the several clinical and laboratory parameters reported above may help to reinforce or exclude the diagnosis of AR obtained with skin prick test.

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Section: Methodsmentioning

confidence: 99%

“…The slides were immediately fixed in 95% ethyl alcohol, dipped in Wright-Giemsa stain, and examined under oil immersion by light microscopy at a magnification of ×400. Eosinophils were expressed as a percentage of 300 cells counted [7,11,12]. …”

Section: Methodsmentioning

confidence: 99%

Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms

Lorenzo¹,

Pacor²,

Amodio³

et al. 2011

Int Arch Allergy Immunol

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“…MFNS was associated with a significant reduction in total nasal symptom scores (standardized mean difference (SMD), −0.49; 95% confidence interval (CI), −0.60 to −0.38; P<0.00001), total nonnasal symptom scores (−0.30; 95% CI, −0.43 to −0.18; P<0.00001), and rhinorrhea (SMD, −0.44; 95% CI, −0.66 to −0.21; P=0.0001), as well as the other individual nasal symptoms evaluated [46]. Specifically with regard to rhinorrhea, a number of individual clinical trials, as well as several meta-analyses, support the efficacy of INS for relief of this particularly bothersome AR symptom (Table 4) [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62].…”

Section: Clinical Efficacy Of Ins For Rhinorrhea In Armentioning

confidence: 78%

“…Clinical studies and several meta-analyses conclusively demonstrate that, in addition to being safe and well-tolerated, INS are more effective than other agents, including newergeneration oral and intranasal antihistamines and leukotriene receptor antagonists, for treating AR-induced rhinorrhea and the entire spectrum of AR symptoms, including nasal congestion [3,43,44,47,50,71,73].…”

Section: Discussionmentioning

confidence: 95%

“…Furthermore, monotherapy with MFNS was significantly more effective than loratadine in relieving rhinorrhea (mean change from baseline in rhinorrhea symptom score: −0.7 (−29%) vs. −0.4 (−16%); P ≤ 0.02) as well as nasal congestion, sneezing (P≤0.02 for each), and ocular tearing (P≤0.04) [47]. Similarly, the addition of cetirizine or montelukast to fluticasone propionate therapy failed to produce a substantial advantage over fluticasone propionate monotherapy for rhinorrhea and other AR nasal symptoms in a randomized, placebo-controlled trial in 100 patients with SAR [50]. Fluticasone propionate was also consistently superior to montelukast monotherapy with regard to reducing total and individual nasal symptom scores, including rhinorrhea, in two 15-day randomized studies of over 700 patients with SAR each [73,74].…”

Section: Clinical Trials In Ar Of Ins Compared With Other Classesmentioning

confidence: 94%

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Intranasal Steroids in the Treatment of Allergy-Induced Rhinorrhea

Nathan¹

2010

Clinic Rev Allerg Immunol

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While nasal congestion has been identified as one of the most bothersome and prevalent symptoms of allergic rhinitis, it is underappreciated that many patients find rhinorrhea also to be bothersome. Rhinorrhea as a symptom of allergic rhinitis virtually never occurs alone; about 97% of patients with allergic rhinitis suffer from at least two symptoms, a finding that underscores the advantage of treating a broad range of symptoms with a single medication. Along with sneezing and nasal obstruction, rhinorrhea is a classic acute symptom of allergic rhinitis; it appears as a late-phase symptom as well. In this review, the characterization and epidemiology of rhinorrhea, the pathophysiology of rhinorrhea in allergic rhinitis, the roles played by mediators in early- and late-phase rhinorrhea, the prevalence and impact of this symptom, and the efficacy and safety of available treatment options are all discussed in context of relevant literature. A review of the clinical studies assessing the efficacy of intranasal corticosteroids (INS) for rhinorrhea is presented. Many clinical studies and several meta-analyses conclusively demonstrate that, in addition to being safe and well-tolerated, INS are more effective than other agents (including oral and intranasal antihistamines) across the spectrum of AR symptoms, including rhinorrhea and nasal congestion.

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Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children

Nasser

Fedorowicz

Aljufairi

et al. 2010

Cochrane Database of Systematic Reviews

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Randomized placebo‐controlled trial comparing fluticasone aqueous nasal spray in mono‐therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis

Cited by 150 publications

References 35 publications

Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms

Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis Symptoms

Intranasal Steroids in the Treatment of Allergy-Induced Rhinorrhea

Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children

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