Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis

Figures & data

Table 1 Summary of ARIA allergic rhinitis management guidelines

Rhinitis severity	ARIA recommendation
Mild intermittent	Oral/intranasal antihistamines OR Decongestants (10 days maximum)
Moderate/severe intermittent	Intranasal antihistamines Oral antihistamines AND/OR Decongestants Intranasal corticosteroids Cromones
Mild persistent	Intranasal antihistamines Oral antihistamines AND/OR Decongestants Intranasal corticosteroids Cromones
	A stepwise approach is advised with reassessment after 2 weeks. If symptoms are controlled and the patient is on intranasal corticosteroid, the dose should be reduced, but otherwise treatment continued. If symptoms persist and the patient is on antihistamines or cromones, a change should be made to an intranasal corticosteroid.
Moderate/severe persistent	Intranasal corticosteroid (first line treatment)
	If symptoms are uncontrolled after 2–4 weeks, medication should be added depending on the persistent symptom, eg, add an antihistamine if the major symptom is rhinorrhea, pruitis, or sneezing, double the dose of intranasal steroid for persistent nasal blockage and add ipratropium for prominent complaint of rhinorrhea.

Figure 1 Number needed to treat a global assessment of efficacy as an outcome for azelastine nasal spray compared with oral agents for the treatment of allergic rhinitis. Reprinted with permission from Lee T, Pickard S. 2007. Meta-analysis of azelastine nasal spray for the treatment of allergic rhinitis. Pharmcotherapy, 27:852–9. Copyright © 2007 Pharmcotherapy Publications.

Abbreviations: CI, confidence interval; NNT, number needed to treat.

Figure 2 Onset of action of azelastine hydrochloride nasal spray in relieving nasal symptoms of seasonal allergic rhinitis. *p < 0.001 azelastine vs placebo; *p ≤ 0.001 azelastine vs mometasone; mometasone vs placebo = not significant. Reprinted with permission from Patel P, D’Andrea C, Sacks HJ. 2007. Onset of action of azelastine nasal spray compared with mometasone nasal spray and placebo in subjects with seasonal allergic rhinitis evaluated in an environmental exposure chamber. Am J Rhinol, 21:499–503.

Copyright © 2007 Oceanside Publications.

Figure 3 Effect of azelastine nasal spray or fluticasone propionate nasal spray on Rhinitis Quality of Life Questionnaire (RQLQ) scores in geriatric patients with either allergic or non-allergic rhinitis. Reprinted with permission from Behncke VB, Alemar GO, Kaufman DA, et al 2006. Azelastine nasal spray and fluticasone nasal spray in the treatment of geriatric patients with rhinitis. J Allergy Clin Immunol, 117:263. Copyright © 2006 Elsevier.

Abbreviations: AZ, azelastine; FP, fluticasone.

Figure 4 Effect of azelastine nasal spray or fluticasone propionate nasal spray on Total Daily Symptom Score (TDSS) in geriatric patients with either allergic or non-allergic rhinitis. Reprinted with permission from Behncke VB, Alemar GO, Kaufman DA, et al 2006. Azelastine nasal spray and fluticasone nasal spray in the treatment of geriatric patients with rhinitis. J Allergy Clin Immunol, 117:263. Copyright © 2006 Elsevier.

Figure 5 Major nasal symptom scores averaged over treatment and time for the per protocol population after administration of azelastine (1 spray per nostril), desloratadine (5 mg), or placebo in patients with SAR. Reprinted with permission from Horak F, Zieglmayer UP, Zidglmayer R, et al 2006. Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy. Curr Med Res Opion, 22:151–7. Copyright © 2006 LibraPharm.

Figure 6 Major nasal symptom and mean nasal symptom scores after administration of azelastine nasal spray (1 spray per nostril), desloratadine (5 mg) or placebo in patients with SAR: absolute changes of last value (6 hours after the start of challenge) compared to predose (ie, 2 hours after the start of the challenge). Reprinted with permission from Horak F, Zieglmayer UP, Zidglmayer R, et al 2006. Azelastine nasal spray and desloratadine tablets in pollen-induced seasonal allergic rhinitis: a pharmacodynamic study of onset of action and efficacy. Curr Med Res Opion, 22:151–7. Copyright © 2006 LibraPharm.

Figure 7 Mean daily improvements from baseline to day 14 in combined morning and evening 12-hour reflective total nasal symptom scores (TNSSs). *p < 0.05 versus cetirizine. Reprinted with permission from Berger W, Hampel F, Bernstein J, et al 2006. Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol, 97:375–81. Copyright © 2006 American College of Allergy, Asthma and Immunology.

Figure 8 Mean improvement from baseline to day 14 in overall Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score and individual RQLQ domain scores (intention-to-treat population). *p ≤ 0.05 vs cetirizine; **p < 0.01 vs cetirizine. Reprinted with permission from Berger W, Hampel F, Bernstein J, et al 2006. Impact of azelastine nasal spray on symptoms and quality of life compared with cetirizine oral tablets in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol, 97:375–81. Copyright © 2006 American College of Allergy, Asthma and Immunology.

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