From the Guidelines
For maximal management of seasonal allergic rhinitis, a combination of an intranasal corticosteroid and an intranasal antihistamine is recommended for initial treatment in persons aged 12 years or older with moderate to severe symptoms. This approach is based on the latest guidance from the 2017 Joint Task Force on Practice Parameters 1. The recommended regimen includes:
- A nasal corticosteroid spray such as fluticasone propionate (Flonase) or mometasone furoate (Nasonex), using 1-2 sprays in each nostril once or twice daily
- An intranasal antihistamine, which can be used in conjunction with the nasal corticosteroid for additive benefit
- Optional addition of a second-generation antihistamine like cetirizine (Zyrtec) 10mg, fexofenadine (Allegra) 180mg, or loratadine (Claritin) 10mg taken daily for systemic symptoms
- Antihistamine eye drops like ketotifen (Zaditor) or olopatadine (Pataday) for eye symptoms, applying 1 drop to each affected eye twice daily
- Consideration of montelukast (Singulair) 10mg daily if symptoms persist, which blocks leukotrienes that contribute to allergic inflammation
Key considerations in managing seasonal allergic rhinitis include:
- Starting the regimen 2-4 weeks before the typical allergy season starts and continuing throughout the season
- Using environmental measures to limit exposure to allergens, such as keeping windows closed during high pollen days, showering after outdoor activities, using air purifiers with HEPA filters, and tracking local pollen counts
- Monitoring symptoms and adjusting the treatment regimen as needed to achieve optimal control and minimize side effects.
From the FDA Drug Label
Adults The recommended starting dosage in is 2 sprays (50 mcg of fluticasone propionate each) in each nostril once daily (total daily dose, 200 mcg). The same dosage divided into 100 mcg given twice daily (e.g., 8 a.m. and 8 p.m.) is also effective. Maximum total daily doses should not exceed 2 sprays in each nostril (total dose, 200 mcg/day).
The maximal regimen for seasonal allergic rhinitis is 200 mcg/day, which can be administered as:
From the Research
Maximal Regimen for Seasonal Allergic Rhinitis
- A maximal regimen for seasonal allergic rhinitis may involve the use of intranasal corticosteroids, such as fluticasone propionate aqueous nasal spray, as a first-line treatment 3, 4, 5.
- The efficacy of fluticasone propionate aqueous nasal spray has been demonstrated in several studies, with significant improvements in nasal symptom scores and quality of life compared to placebo 3, 4, 5.
- The use of fluticasone propionate aqueous nasal spray in combination with other medications, such as cetirizine or montelukast, may not offer substantial advantages over monotherapy 4.
- Other intranasal corticosteroids, such as mometasone furoate nasal spray, have also been shown to be effective in reducing nasal symptoms in patients with seasonal allergic rhinitis 6.
- As-needed use of fluticasone propionate nasal spray has also been demonstrated to be effective in reducing symptoms of seasonal allergic rhinitis 7.
Treatment Options
- Fluticasone propionate aqueous nasal spray 200 micrograms once daily 3, 4, 5
- Mometasone furoate nasal spray 200 micrograms once daily 6
- As-needed use of fluticasone propionate nasal spray 7
- Combination therapy with fluticasone propionate aqueous nasal spray and other medications, such as cetirizine or montelukast 4
Efficacy of Treatment Options
- Fluticasone propionate aqueous nasal spray has been shown to be effective in reducing nasal symptom scores and improving quality of life in patients with seasonal allergic rhinitis 3, 4, 5.
- Mometasone furoate nasal spray has been shown to be effective in reducing nasal symptoms in patients with seasonal allergic rhinitis, with equivalent effects to oral corticosteroids 6.
- As-needed use of fluticasone propionate nasal spray has been demonstrated to be effective in reducing symptoms of seasonal allergic rhinitis 7.