Vasomotor rhinitis: Clinical efficacy of azelastine nasal spray in comparison with placebo

The H-1 antagonist azelastine is used in nasal sprays for the treatment of allergic rhinitis, but its therapeutic efficacy in vasomotor rhinitis is un known. We performed a multicenter randomized double-blind placebo-controlle d study of the efficacy and tolerance of azelastine nasal spray in 89 adult patients with vasomotor rhinitis (confirmed by negative Phadiatop). Follow ing a washout period, patients were treated for 15 days with one puff three times daily per nostril of azelastine (n = 44) or placebo (n = 45) nasal s pray. Efficacy was evaluated by the reduction in symptomatology and by rhin oscopy. Intent-to-treat analysis revealed better results in the azelastine group for all assessed symptoms; the significance level was reached for nas al obstruction on day 15 (p = 0.042). Using per protocol analysis (in 85 pa tients complying with the protocol), the significance level was reached for nasal obstruction on day 15 (p = 0.017) and for the percentage of success in rhinorrhea (p = 0.023). In the azelastine group, rhinoscopy examination showed a significantly higher reduction in the inflammatory level and edema of the nasal mucosa (p = 0.03 and 0.02 for VAS on day 15 respectively, per protocol analysis). General efficacy assessment by the physician and the p atient was in favor of azelastine (with significance levels <0.01). No drow siness or serious adverse event was reported, and the frequency of mouth dr yness and headaches was similar in the two treatment groups. The present st udy demonstrates the efficacy of azelastine nasal spray in the treatment of vasomotor rhinitis. The best achieved results were a decrease in nasal obs truction and mucosal edema. Further studies are required to investigate if this therapeutic benefit results from H-1 antagonism or from another, not w ell-characterized pharmacological action of azelastine. Copyright (C) 2001 S. Karger AG, Basel.