A Randomized Control Trail of Stepwise Treatment with Fluticasone Propionate Nasal Spray and Fexofenadine Hydrochloride Tablet for Seasonal Allergic Rhinitis

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  • Takahashi Goro
    Department of Otolaryngology, Hamamatsu University School of Medicine Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University
  • Matsuzaki Zensei
    Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University
  • Okamoto Atsushi
    Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University
  • Ito Eiko
    Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University
  • Matsuoka Tomokazu
    Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University
  • Nakayama Takeo
    Department of Health Informatics, School of Public Health, Kyoto University Graduate School of Medicine
  • Masuyama Keisuke
    Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Yamanashi University

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Background: In Japan, oral antihistamines are frequently used as the initial treatment for seasonal allergic rhinitis (SAR), and intranasal steroids are added when nasal symptoms worsen. This study aimed to evaluate whether starting treatment with fluticasone propionate nasal spray (FP) from the beginning of pollinosis symptoms and adding fexofenadine hydrochloride tablet (FEX) when SAR is aggravated could achieve improved amelioration of nasal symptoms throughout the pollen season in comparison with a treatment that involves starting with FEX and later adding FP.<br> Methods: In this pragmatic, randomized, open-label, parallel-group trial, 51 Japanese cedar pollinosis patients (age, 16-85 years) were randomly divided and administered FP 100 mcg twice daily as an initial drug with FEX 60mg twice daily as an additional drug and the same treatment in the reverse order. Nasal symptoms were evaluated in a daily dairy using a 4-point scale. The primary outcome was area under curve of the line representing the daily total nasal symptom score in the pollen season on a graph.<br> Results: Initial treatment with FP was significantly (P = 0.0015) more effective than initial treatment with FEX in improving the primary outcome. The average daily total nasal symptom score in the initial treatment with FP group was better than that in the initial treatment with FEX group throughout the pollen season.<br> Conclusions: Initiating treatment with FP and adding FEX might lead to improved outcomes for nasal symptoms in comparison with the same drugs administered in the reverse order.<br>

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