Superiority of an intranasal corticosteroid compared with an oral antihistamine in the as-needed treatment of seasonal allergic rhinitis

Background: The daily use of either intranasal corticosteroids or histamine (1) (H-1) receptor antagonists has proved to be efficacious in the treatmen t of seasonal allergic rhinitis. Most patients, however, use these medicati ons as needed. Our objective was to compare the effectiveness of as-needed use of H-1 receptor antagonists with that of intranasal corticosteroids. in the treatment of seasonal allergic rhinitis. Methods: We performed a randomized, open-label, parallel-group study compar ing the as-needed use of an H-1 receptor antagonist (loratadine) with that of an intranasal corticosteroid (fluticasone propionate) in the management of fall seasonal allergic rhinitis in the fall of 1999. Subjects kept a dia ry of their daily symptoms and were examined at enrollment into the study a nd biweekly for 4 weeks during treatment. Outcome measures were the Rhinoco njunctivitis Quality of Life Questionnaire score, daily symptom diary score s, and the number of eosinophils and the levels of eosinophilic cationic pr otein in nasal lavage samples. Results: Patients in the fluticasone-treated group reported significantly b etter scores in the activity, sleep, practical, nasal, and overall domains (P < .05) of the Rhinoconjunctivitis Quality of Life Questionnaire. The med ian total symptom score in the fluticasone-treated group was significantly lower than that in the loratadine-treated group (4.0 vs 7.0; P < .01). Afte r treatment, the number of eosinophils was significantly smaller in the flu ticasone-treated group compared with the loratadine-treated group (P=.001). Eosinophilic cationic protein levels followed the same pattern, with a sig nificant correlation between the levels of eosinophilic cationic protein an d the number of eosinophils (r(s)=0.70, P < .01). Conclusion: As-needed intranasal corticosteroids reduce allergic inflammati on and are more effective than as-needed H-1 receptor antagonists in the tr eatment of seasonal allergic rhinitis.