Antihistamine/decongestant combo tablet trumps nasal spray in rapid relief of rhinitis

A single dose of loratadine/pseudoephedrine combination tablet provides over twice as much nasal relief within an hour compared with fluticasone nasal spray in patients with allergic rhinitis, according to a head-to-head comparison study presented at ACAAI 2020 Meeting.

In the double-blind, crossover study, 84 patients with allergic rhinitis and nasal congestion were randomized to one of four treatments after undergoing a ragweed pollen challenge in an environmental exposure unit. [ACAAI 2020, abstract A070]

The four treatments were either a combination tablet comprising loratadine 5 mg plus pseudoephedrine 120 mg (LRT/PSE), a placebo tablet, fluticasone propionate nasal spray (50 μg two sprays per nostril), or placebo nasal spray. Each treatment was given during a 1-day visit, with a 14-day interval between each treatment. An objective measure of peak nasal inspiratory flow (PNIF) was used to assess how fast each treatment delivered relief to patients, recorded over 4 hours.

Within an hour of treatment, decline in PNIF was more than twofold greater during treatment with the combination tablet than with the nasal spray (31 percent vs 8.6 percent; p<0.001).

By contrast, the difference in PNIF reduction was not significant between the nasal spray vs the placebo spray (14.8 percent vs 9.7 percent; p=0.195).

Over 4 hours, PNIF dropped by an average of 31.3 percent with the combination tablet, compared with a 14.8 percent decrease with the nasal spray (p<0.001) and a 11.6 percent decrease with the placebo tablet (p<0.001).

“A single dose of LRT/PSE significantly improved PNIF during the four-hour study, showing early onset of nasal airflow changes, but fluticasone spray did not,” reported presenting author Dr Anne Ellis from Queen's University in Kingston, Ontario, Canada.

“Measurable nasal airflow changes correlate with the opening of nasal passages, allowing freer breathing,” she explained.

While it has been known that intranasal steroid sprays have slower onset and thus, take a long time to show effect, there have been no head-to-head comparisons between nasal spray and oral antihistamine/pseudoephedrine combination tablet to date.

“When instructing patients to treat their allergy symptoms with a steroid nasal spray, it is important to clarify that the sensation of nasally-sprayed liquid does not equate to relief,” said the researchers.

The findings from the study also means that patients need to use an antihistamine/pseudoephedrine combination tablet if they expect rapid relief for their rhinitis.

“Don’t expect rapid benefit from a nasal spray,” said Ellis, who pointed out that the benefit of nasal spray will only start showing after 3 to 5 days.