Comparative nasal airflow with loratadine-pseudoephedrine and fluticasone nasal spray for allergic rhinitis

Ann Allergy Asthma Immunol. 2021 Sep;127(3):342-348.e2. doi: 10.1016/j.anai.2021.05.001. Epub 2021 May 14.


Background: Although it is known that oral antihistamine-pseudoephedrine combination tablets have a faster onset than intranasal corticosteroid sprays in the treatment of allergic rhinitis after the first dose, the magnitude of change has not been measured in a comparative manner. Furthermore, the sensation of sprayed liquid in the nose may lead patients to mistakenly believe that intranasal steroid sprays work instantly.

Objective: To evaluate, numerically, nasal airflow changes provided by a single dose of loratadine-pseudoephedrine tablet (LP) and fluticasone propionate nasal spray (FP) in participants experiencing allergic rhinitis symptoms, including nasal congestion.

Methods: This single-center, double-blinded, placebo-controlled, crossover study evaluated objective nasal airflow changes in patients with a documented sensitivity to ragweed pollen. Participants were randomized to receive 1 of 4 treatment sequences, and their peak nasal inspiratory flow (PNIF) was measured in a span of 4 hours after pollen exposure in an environmental exposure unit.

Results: Average change in PNIF was 31% with LP in the course of the study, significantly greater than with placebo and FP (12% and 15%, respectively; P < .001). Nevertheless, FP did not produce a significant change compared with its placebo. At hour one post-dose, LP had a clinically significant 31% increase in PNIF, whereas FP only yielded an 8.6% increase (P < .001). Measurable nasal airflow improvements are associated with the opening of nasal passages, allowing congested patients to breathe more freely.

Conclusion: A single dose of LP quickly and significantly (P < .001) improved nasal airflow after ragweed pollen challenge in an environmental exposure unit. Comparatively, FP did not display this same benefit.

Trial registration: Identifier: NCT03443843.

Publication types

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

MeSH terms

  • Administration, Intranasal
  • Adult
  • Anti-Allergic Agents / administration & dosage*
  • Anti-Allergic Agents / adverse effects
  • Cross-Over Studies
  • Double-Blind Method
  • Drug Combinations
  • Female
  • Fluticasone / administration & dosage*
  • Fluticasone / adverse effects
  • Humans
  • Loratadine / administration & dosage*
  • Loratadine / adverse effects
  • Male
  • Middle Aged
  • Nasal Cavity / physiology
  • Nasal Decongestants / administration & dosage*
  • Nasal Decongestants / adverse effects
  • Nasal Sprays
  • Pseudoephedrine / administration & dosage*
  • Pseudoephedrine / adverse effects
  • Respiratory Physiological Phenomena
  • Rhinitis, Allergic / drug therapy*
  • Rhinitis, Allergic / physiopathology
  • Tablets
  • Young Adult


  • Anti-Allergic Agents
  • Drug Combinations
  • Nasal Decongestants
  • Nasal Sprays
  • Tablets
  • Loratadine
  • Pseudoephedrine
  • Fluticasone

Associated data