This meta-analysis looked at the reported efficacy for allergic rhinitis control of various topical sprays, particularly comparative studies. There were fewer ‘head to head’ studies than we would have hoped to exist. This review included intranasal anti-histamines, intranasal steroids and a combined spray (azelastine hydrochloride and fluticasone propionate). Twenty studies (four of which were on children) were included.
The combination spray was well tolerated and superior in efficacy, with onset beginning 30 minutes after the spray.
The combination spray appears to have an additive effect in patients with moderate to severe rhinitis, compared to the individual agents alone. Predictably, the order of efficacy (best to worst) was combined spray: topical steroid: topical anti-histamine. The point is made that compliance is a major factor and that a single agent is likely to be accepted better than multiple agents.
