Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis

Otolaryngol Head Neck Surg. 2019 Sep;161(3):412-418. doi: 10.1177/0194599819841883. Epub 2019 Apr 9.


Objective: Combination therapy with intranasal azelastine and fluticasone propionate is an option for treatment of allergic rhinitis. This systematic review and meta-analysis examines existing literature to determine efficacy in treating allergic rhinitis compared to monotherapy.

Data sources: The PubMed, EMBASE, Cochrane, and MEDLINE databases were systematically searched for randomized controlled trials using AzeFlu nasal spray.

Review methods: Randomized, controlled trials that reported symptom relief of allergic rhinitis in males and females of all ages were included. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard.

Results: Systematic review identified 8 articles suitable for review. The risk of bias was generally low. All studies exhibited a greater decrease in patient-reported symptom scores in patients treated with combination therapy compared to monotherapy or placebo. Meta-analysis revealed superiority of combination therapy in reducing Total Nasal Symptom Score compared to placebo (mean change from baseline: -2.41; 95% confidence interval [CI], -2.82 to -1.99; P < .001; I2 = 60%), azelastine (mean change from baseline: -1.40; 95% CI, -1.82 to -0.98; P < .001; I2 = 0%), and fluticasone (mean change from baseline: -0.74; 95% CI, -1.17 to -0.31; P < .001; I2 = 12%).

Conclusion: Current evidence supports both efficacy and superiority of combination intranasal azelastine and fluticasone in reducing patient-reported symptom scores in patients with allergic rhinitis. Combination nasal spray should be considered as second-line therapy in patients with allergic rhinitis that is not controlled with monotherapy.

Keywords: allergic rhinitis; azelastine; fluticasone; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Administration, Intranasal
  • Anti-Allergic Agents / administration & dosage*
  • Drug Combinations
  • Fluticasone / administration & dosage*
  • Humans
  • Phthalazines / administration & dosage*
  • Randomized Controlled Trials as Topic
  • Rhinitis, Allergic / drug therapy*


  • Anti-Allergic Agents
  • Drug Combinations
  • Phthalazines
  • Fluticasone
  • azelastine