Fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis

Objective: To compare the effectiveness of an intranasal steroid treatment with that of the combination of a histamine(1) receptor antagonist and a leukotriene D receptor antagonist in the treatment of seasonal allergic rhinitis. Design: A 2-week, parallel, randomized, double-blind, double-dummy study with rolling enrollment. Setting: Tertiary care medical center. Subjects: A total of 63 adults with a 2-year history of ragweed sensitivity in the Chicago, Ill, area and a positive skin-prick reaction to ragweed pollen. Intervention: Subjects were randomized to receive either 100 mug of fluticasone propionate aqueous nasal spray in each nostril or 10 mg of loratadine and 10 mg of montelukast sodium by mouth once daily in the evening for 2 weeks. At visits 1 and 2, subjects completed a quality-of-life questionnaire and under-went nasal lavage to determine total eosinophil count and eosinophil cationic protein (ECP) measurements. Daily symptom diaries were kept for 2 weeks. Main Outcome Measures: Questionnaire answers, daily nasal symptom scores, eosinophil counts, and ECP levels. Results: Median total nasal symptom scores were lower in the fluticasone group (4.5 vs 6), but the difference was not statistically significant. The questionnaire answers showed dramatic improvement in overall and individual domains for both groups (P<.01 vs visit 1) with significantly greater reduction in nasal symptoms in the fluticasone group (P<.05). Eosinophil counts and ECP levels were significantly reduced in the fluticasone group. Conclusion: Both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.