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Montelukast (Singulair) Added to Antihistamine or Corticosteroid Equally Effective for Allergies: Presented at ACAAI

By Crystal Phend

ANAHEIM, CA -- November 11, 2005 -- Antihistamines appear to have similar efficacy to corticosteroid nasal sprays for poorly controlled seasonal allergic rhinitis when combined with montelukast (Singulair), according to research presented here at the American College of Allergy, Asthma and Immunology (ACAAI).

This finding suggests a way to achieve good symptom control without the adverse events associated with steroidal drugs, said lead author Safa M. Nsouli, MD, director, Danville Asthma and Allergy Clinic, Danville, California.

"We now have a way to treat patients' seasonal allergic rhinitis with a combination of drugs that are safer [than corticosteroids]," he said in his presentation November 5^th.

Montelukast (Singulair) is a leukotriene receptor antagonist often used as an add-on to other therapy when allergies are not well controlled.

In their open-label study, Dr. Nsouli and colleagues compared the antihistamine nasal spray azelastine (Astelin) in combination with montelukast to corticosteroid mometasone furoate (Nasonex) with montelukast.

Forty patients who remained symptomatic while using azelastine at the approved dose of 274 mcg per nostril twice daily or mometasone at the recommended 100 mcg per nostril dose once daily were enrolled in the study. Patients were randomized to receive azelastine or mometasone at the same recommended doses in addition to 10 mg of montelukast for the 14-day study period.

Efficacy was assessed every 5 days with rhinomanometry and patients recorded nasal symptoms scored on a 4-point scale to reflect changes from the previous period.

Both treatment groups improved significantly for all of the efficacy measures compared with baseline, reflecting an improvement in symptoms from adding montelukast.

Rhinomanometry, which measures nasal airflow blockage, improved in both treatment groups over the study period, but the azelastine group had significantly better scores at day 14 than the mometasone group. "Rhinomanometry is very objective, so this has a lot of value," Dr. Nsouli said.

Subjective symptom scores also improved for rhinorrhea, sneezing, postnasal drip, and nasal itching but without significant differences between treatment groups.

Nasal congestion was the only symptom score to show statistically better outcomes for the azelastine group compared with the mometasone group at days 10 and 14.

The researchers concluded that because azelastine was at least as beneficial as mometasone and had a better safety profile, azelastine plus montelukast may be the better choice.

Many clinicians think a corticosteroid spray is superior to a nasal antihistamine, but that was not supported by this study, Dr. Nsouli said.

"You can stay away from nasal corticosteroids," he said.

No supporting grants were reported, but Dr. Nsouli disclosed that he is a speaker for Merck and MedPointe.


[Presentation title: Azelastine Plus Montelukast Vs. Mometasone Plus Montelukast for the Treatment of Seasonal Allergic Rhinitis for Patients Not Currently Controlled Using Monotherapy Intranasal Antihistamine or Intranasal Corticosteroid. Abstract P103]

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