A controlled study on the effectiveness of loratadine in combination with flunisolide in the treatment of nonallergic rhinitis with eosinophilia (NARES)

Background Nonallergic rhinitis with eosinophilia (NARES), accounting for s ome 15% of perennial rhinitis, is a nasal disorder whose main features are eosinophil counts in nasal smear higher than 10% and negative IgE tests. Th e mainstay of treatment is topical corticosteroids. Objective To evaluate the adjunctive effect of loratadine, a non-sedating a ntihistamine with anti-allergic activity, on nasal symptoms and eosinophil counts in nasal secretions in patients with NARES. Methods Thirty patients with NARES were divided in two groups, half receivi ng flunisolide two 25 mu g puffs per nostril morning and night plus loratad ine 10 mg u.i.d. and half the same doses of flunisolide plus placebo, accor ding to a double-blind fashion, for 3 weeks. The effectiveness of the treat ment in the two groups was evaluated by comparing symptom scores and eosino phil counts, and safety was assessed by comparing the adverse effects. Results The loratadine treated group had better results both in nasal sympt oms, with a decrease in sneezing (P < 0.000001) and rhinorrhoea (P < 0.006) , respectively, corresponding with 73.4% and 66.7% with respect to 46.6% an d 26.7% in the control group, and in eosinophil counts which decreased by 2 0% compared with 14.3% in patients treated with placebo and flunisolide. As to safety, only nasal irritation in two patients, one in each group, was r eported. Conclusion Loratadine improves the effectiveness of flunisolide in treatmen t of NARES with no change in safety, and with no sedation.