Combination Intranasal Antihistamine and Corticosteroid Products
The combination intranasal antihistamine and corticosteroid products available are: azelastine/fluticasone propionate (brand name: Dymista) and olopatadine/mometasone furoate (brand name: Ryaltris). 1
Generic and Brand Name Details
Azelastine/Fluticasone Propionate
- Generic name: Azelastine hydrochloride 137 mcg + Fluticasone propionate 50 mcg per spray
- Brand name: Dymista
- Dosing: The studied formulation used azelastine 548 mcg + fluticasone propionate 200 mcg daily 1
- FDA approval: For moderate to severe seasonal and perennial allergic rhinitis in adults and adolescents 2
Olopatadine/Mometasone Furoate
- Generic name: Olopatadine hydrochloride 665 mcg + Mometasone furoate 25-50 mcg per spray
- Brand name: Ryaltris (also referred to as GSP301 in studies)
- Dosing options: Available as once-daily or twice-daily formulations 3
- Registration: Currently registered in Australia 4
Clinical Context and Evidence
The 2017 Joint Task Force guidelines specifically studied fluticasone propionate plus azelastine as a single combination spray in four major trials, demonstrating superior symptom reduction compared to either monotherapy 1. This combination showed:
- Greatest symptom reduction among all treatment groups (placebo, azelastine alone, fluticasone alone, and combination)
- Reductions in total nasal symptom scores of -5.31 to -5.7 out of 24 points
- Greater than 40% relative improvement compared to either agent alone 1
The combination is recommended for moderate-to-severe seasonal allergic rhinitis in persons aged 12 years or older as initial treatment, though this is a weak recommendation due to concerns about cost, potential for increased adverse effects, and study design limitations 1.
Common Adverse Effects
Both combination products share similar adverse event profiles:
- Dysgeusia (bad taste): Most common, occurring in 2.1-13.5% of patients 1
- Epistaxis: Similar to or lower than placebo groups 1
- Somnolence: 0.4-1.1% in treatment groups 1
Recent real-world evidence suggests that patients using olopatadine/mometasone report significantly higher satisfaction with sensory attributes (taste, smell, nasal irritation) compared to azelastine/fluticasone 4.