SEASONAL RHINITIS AND AZELASTINE - LONG-TERM OR SHORT-TERM TREATMENT

Background: Azelastine is a topical antihistamine, clinically demonstr ated to be effective in allergic rhinitis. Objective: We evaluated the clinical efficacy and the antiallergic activity of azelastine nasal s pray, administered 0.56 mg per day, 0.28 mg per day, or on demand over a 3-month period during natural allergen exposure, in a double-blind, placebo-controlled fashion. Methods: Thirty patients, sensitized to g rass or Parietaria pollen, were allocated to three treatment groups: t hose receiving the standard dosage (0.14 mg/nostril two times a day), half the dosage (0.07 mg/nostril two times a day), or placebo daily fo r 3 months. All patients were allowed to take additional doses of azel astine when needed. Evaluation parameters were as follows: clinical sy mptoms recorded on a diary card, number of additional, on-demand azela stine puffs, nasal inflammatory cell count, intercellular adhesion mol ecule-1 expression on nasal epithelial cells, and pollen count. Result s: This study showed the following: (1) the half dose (0.28 mg/day) an d the standard dose (0.56 mg/day) were equally effective in reducing c linical symptoms (p = NS), although the standard dosage required fewer additional puffs during times of peak pollen counts (p < 0.05); (2) b oth dosages were able to reduce the allergic inflammation (p < 0.05 vs placebo); and (3) on-demand use achieved acceptable clinical control but did not significantly reduce allergic inflammation. Conclusion: Co ntinuous treatment was more effective than on-demand use as assessed b y both clinical evaluation and antiinflammatory action.