Fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis

Arch Otolaryngol Head Neck Surg. 2003 May;129(5):557-62. doi: 10.1001/archotol.129.5.557.


Objective: To compare the effectiveness of an intranasal steroid treatment with that of the combination of a histamine1 receptor antagonist and a leukotriene D receptor antagonist in the treatment of seasonal allergic rhinitis.

Design: A 2-week, parallel, randomized, double-blind, double-dummy study with rolling enrollment.

Setting: Tertiary care medical center. Subjects A total of 63 adults with a 2-year history of ragweed sensitivity in the Chicago, Ill, area and a positive skin-prick reaction to ragweed pollen. Intervention Subjects were randomized to receive either 100 micro g of fluticasone propionate aqueous nasal spray in each nostril or 10 mg of loratadine and 10 mg of montelukast sodium by mouth once daily in the evening for 2 weeks. At visits 1 and 2, subjects completed a quality-of-life questionnaire and underwent nasal lavage to determine total eosinophil count and eosinophil cationic protein (ECP) measurements. Daily symptom diaries were kept for 2 weeks.

Main outcome measures: Questionnaire answers, daily nasal symptom scores, eosinophil counts, and ECP levels.

Results: Median total nasal symptom scores were lower in the fluticasone group (4.5 vs 6), but the difference was not statistically significant. The questionnaire answers showed dramatic improvement in overall and individual domains for both groups (P<.01 vs visit 1) with significantly greater reduction in nasal symptoms in the fluticasone group (P<.05). Eosinophil counts and ECP levels were significantly reduced in the fluticasone group.

Conclusion: Both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate.

Publication types

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

MeSH terms

  • Acetates / therapeutic use*
  • Adult
  • Androstadienes / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Fluticasone
  • Histamine H1 Antagonists, Non-Sedating / therapeutic use*
  • Humans
  • Leukotriene Antagonists / therapeutic use*
  • Loratadine / therapeutic use*
  • Male
  • Middle Aged
  • Quinolines / therapeutic use*
  • Rhinitis, Allergic, Seasonal / drug therapy*


  • Acetates
  • Androstadienes
  • Anti-Inflammatory Agents
  • Histamine H1 Antagonists, Non-Sedating
  • Leukotriene Antagonists
  • Quinolines
  • Loratadine
  • Fluticasone
  • montelukast