A Clinical Study of Comparative Efficacy of Nasal Steroid Spray versus Steroid in Combination with an Antihistamine Spray in Allergic Rhinitis

BACKGROUND \nAllergic rhinitis is a common and debilitating disease that has a major effect on \nhealth related quality of life. In recent years, studies have been going on to \ndetermine if greater efficacy could be achieved with the intranasal antihistamine \nazelastine and the intranasal corticosteroid fluticasone propionate used \nconcurrently compared with the efficacy of each agent alone in allergic rhinitis. \nAccording to ARIA guidelines intranasal corticosteroids are the first line treatment \nof choice in allergic rhinitis. Hence, this study was undertaken to clinically evaluate \nthe efficacy of combination steroid and antihistamine nasal spray with nasal steroid \nspray alone in allergic rhinitis. \nMETHODS \n100 subjects aged between 12-65 years with symptoms of allergic rhinitis were \nchosen among outpatients attending Department of ENT. Patients who were \nwilling to participate in the study were evaluated by means of proper history taking \nwith the help of a proforma, clinical examination, diagnostic nasal endoscopy and \nrelevant laboratory investigations. Patients were given a simple questionnaire for \neasy gradation of complaints and individual symptoms are graded using four-point \nscale symptom evaluation score. Patients were sequentially randomized to receive \neither fluticasone in combination with azelastine nasal spray (group 1) and \nfluticasone nasal spray alone (group II). They were advised to use the spray with \na single sniff in each nostril twice a day. Patients were evaluated after one month \nand symptom chart was then filled using four-point scale symptom evaluation \nscore. \nRESULTS \nPercentage change of total symptom score in group I was superior (81%) \ncompared to only 75% in group II and there was statistically significant difference \nbetween two groups compared (0.004). Significant reduction in severity of \nindividual symptoms in group I compared to group II. \nCONCLUSIONS \nCombination nasal spray is superior in relieving moderate to severe symptoms in \npatients with allergic rhinitis compared to steroid nasal spray alone. \n