Combination therapy with nasal steroid and oral antihistamine versus monotherapy in treatment of persistent allergic rhinitis

Background: Intranasal corticosteroids and antihistamines, used singly or in combination, are common treatment for allergic rhinitis.  Objective: This study aimed to determine if combination therapy with intranasal corticosteroid and oral antihistamine is superior to monotherapy in patients with moderate-severe persistent allergic rhinitis (PAR) for symptom relief during treatment and prevention of relapse after cessation of therapy. Methods: In this prospective, randomised parallel-group study, 44 patients with moderate-severe PAR were randomised into 3 treatment groups to receive intranasal triamcinolone acetonate, fexofenadine or a combination of both for 4 weeks. Outcome measures were nasal symptom scores, disease severity, Rhinoconjunctivitis Quality of Life Questionnaire score (RQLQ), nasal patency measurements and patient-rated global efficacy of treatment.  Results: There were no significant differences between the 3 groups in symptom relief or nasal patency measurements. A high relapse rate (>70%) was observed in all groups after cessation of therapy. Conclusion: A one-month treatment for moderate-severe PAR resulted in suboptimal symptom control with a high relapse rate. All 3 therapeutic strategies demonstrated comparable efficacy in terms of symptom relief during treatment and relapse rate after cessation of therapy.