From the Guidelines
For the treatment of seasonal allergic rhinitis, Flonase (fluticasone) is generally more effective than Astepro (azelastine) in reducing symptoms, especially when used regularly, as shown in studies such as 1.
Comparison of Azelastine and Fluticasone
Both Astepro (azelastine) and Flonase (fluticasone) are effective allergy medications, but they work differently and may be better suited for different situations.
- Astepro is an antihistamine nasal spray that works quickly to relieve allergy symptoms, typically within 30 minutes, making it good for immediate relief.
- It blocks histamine receptors to reduce sneezing, itching, and runny nose.
- The typical dose is 1-2 sprays per nostril twice daily.
- Flonase is a corticosteroid nasal spray that reduces inflammation and works best with regular daily use, taking several days to reach full effectiveness.
- The usual dose is 1-2 sprays per nostril once daily.
- Flonase is generally better for long-term management of chronic allergies, while Astepro provides faster relief for sudden symptoms. Some people find Astepro causes drowsiness or a bitter taste, while Flonase may cause nasal irritation or nosebleeds.
Combination Therapy
For severe allergies, these medications can sometimes be used together under medical supervision, with Astepro providing immediate relief while waiting for Flonase to take full effect, as suggested by studies such as 1 and 1.
- This combination may provide greater symptom reduction than using either agent alone.
- However, the decision to use combination therapy should be made on a case-by-case basis, considering the individual patient's needs and medical history. In general, the most effective treatment approach will depend on the severity and nature of the patient's allergies, as well as their individual response to different medications, as noted in 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Azelastine hydrochloride, a phthalazinone derivative, exhibits histamine H1 -receptor antagonist activity in isolated tissues, animal models, and humans. CLINICAL TRIALS A total of 13 randomized, double-blind, parallel-group, multicenter, vehicle placebo-controlled clinical trials were conducted in the United States in adults and pediatric patients (4 years of age and older) to investigate regular use of Fluticasone Propionate Nasal Spray, USP, in patients with seasonal or perennial allergic rhinitis
The FDA drug label does not answer the question.
From the Research
Comparison of Azelastine and Fluticasone
- Azelastine nasal spray has a faster onset of action and a better safety profile compared to intranasal corticosteroids, including fluticasone propionate 2.
- Azelastine nasal spray exhibits superior efficacy to oral antihistamines and other intranasal antihistamines, and comparable efficacy to fluticasone propionate 2, 3.
- Combination therapy with intranasal fluticasone propionate and azelastine nasal spray has been shown to enhance clinical benefit and reduce symptoms in allergic rhinitis patients more than either agent alone 2, 4, 3.
- Studies have found that azelastine and fluticasone nasal sprays have comparable efficacy in symptom control in patients with allergic rhinitis 5, 6.
- Azelastine may be considered a safer replacement to fluticasone for long-term use in patients with allergic rhinitis due to its lesser side effects 5.
Efficacy in Specific Symptoms
- Fluticasone propionate was found to be superior to azelastine in alleviating rhinorrhea in one study 6.
- Azelastine showed comparable efficacy to fluticasone propionate for all other nasal and ocular symptoms 6.
- Azelastine was found to have a faster onset of action and a better safety profile compared to fluticasone propionate in some studies 2, 3.
Patient Populations
- Azelastine nasal spray can be used in children, patients with glaucoma, and patients with cataract due to its safer side effect profile 5.
- Azelastine and fluticasone nasal sprays have been studied in various patient populations, including those with seasonal allergic rhinitis and perennial allergic rhinitis 2, 4, 3, 5, 6.