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

Arch Intern Med. 2001 Nov 26;161(21):2581-7. doi: 10.1001/archinte.161.21.2581.


Background: The daily use of either intranasal corticosteroids or histamine(1) (H(1)) receptor antagonists has proved to be efficacious in the treatment of seasonal allergic rhinitis. Most patients, however, use these medications 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 comparing 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 diary of their daily symptoms and were examined at enrollment into the study and biweekly for 4 weeks during treatment. Outcome measures were the Rhinoconjunctivitis Quality of Life Questionnaire score, daily symptom diary scores, and the number of eosinophils and the levels of eosinophilic cationic protein in nasal lavage samples.

Results: Patients in the fluticasone-treated group reported significantly better scores in the activity, sleep, practical, nasal, and overall domains (P<.05) of the Rhinoconjunctivitis Quality of Life Questionnaire. The median 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). After treatment, the number of eosinophils was significantly smaller in the fluticasone-treated group compared with the loratadine-treated group (P =.001). Eosinophilic cationic protein levels followed the same pattern, with a significant correlation between the levels of eosinophilic cationic protein and the number of eosinophils (r(s) = 0.70, P<.01).

Conclusion: As-needed intranasal corticosteroids reduce allergic inflammation and are more effective than as-needed H(1) receptor antagonists in the treatment of seasonal allergic rhinitis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Intranasal
  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / therapeutic use
  • Androstadienes / administration & dosage
  • Androstadienes / therapeutic use
  • Anti-Allergic Agents / administration & dosage
  • Anti-Allergic Agents / therapeutic use
  • Eosinophils / drug effects
  • Fluticasone
  • Histamine H1 Antagonists / administration & dosage*
  • Histamine H1 Antagonists / therapeutic use
  • Humans
  • Loratadine / administration & dosage
  • Loratadine / therapeutic use
  • Nasal Lavage Fluid / chemistry
  • Nasal Provocation Tests
  • Quality of Life
  • Rhinitis, Allergic, Seasonal / drug therapy*
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Androstadienes
  • Anti-Allergic Agents
  • Histamine H1 Antagonists
  • Loratadine
  • Fluticasone