What is the preferred initial treatment between intranasal fluticasone (fluticasone propionate) and intranasal mometasone for allergic rhinitis?

Intranasal Mometasone vs Fluticasone Propionate for Allergic Rhinitis

Both intranasal fluticasone propionate and mometasone furoate are equally effective first-line treatments for allergic rhinitis, with no significant clinical differences between them in efficacy. 1

Efficacy Comparison

• Intranasal corticosteroids are the most effective medication class for treating allergic rhinitis, superior to antihistamines and leukotriene receptor antagonists 1
• The clinical response does not appear to vary significantly between available intranasal corticosteroids, including fluticasone propionate and mometasone furoate 1
• Both medications effectively control all four major symptoms of allergic rhinitis: sneezing, itching, rhinorrhea, and nasal congestion 1
• Onset of therapeutic effect for intranasal corticosteroids occurs between 3-12 hours after administration 1, 2

Safety Profile

• Both fluticasone propionate and mometasone furoate have excellent safety profiles when used at recommended doses 1
• Studies with both fluticasone propionate and mometasone furoate have shown no effect on growth at recommended doses compared to placebo 1
• Neither medication has demonstrated clinically significant effects on:
  • Hypothalamic-pituitary-adrenal (HPA) axis function 1
  • Ocular pressure or cataract formation 1
  • Bone density 1

Administration Considerations

• Both medications can be administered once daily, improving convenience and potentially enhancing compliance 1, 3
• As-needed dosing of fluticasone propionate has been shown to be effective for seasonal allergic rhinitis, though continuous use may be more efficacious 1
• A patent nasal airway is necessary for optimal delivery of either medication; a nasal decongestant may be beneficial for several days when initiating therapy 1, 2

Special Populations

• Both medications are effective for non-allergic rhinitis, especially NARES and vasomotor rhinitis 1
• In children, both fluticasone propionate and mometasone furoate have demonstrated safety at recommended doses 1, 4
• Growth suppression has only been reported with long-term use of beclomethasone dipropionate that exceeded recommended doses, not with either fluticasone or mometasone 1

Common Pitfalls and Caveats

• Local side effects such as nasal irritation and bleeding are rare with both medications but can be minimized with proper administration technique 1
• Preparations containing propylene glycol and benzalkonium chloride may cause local irritation or ciliary dysfunction 1
• For patients with inadequate response to monotherapy, adding an oral antihistamine may provide additional benefit for some symptoms, particularly pruritus 1, 2
• Approximately 50% of patients with seasonal allergic rhinitis may require both intranasal corticosteroids and oral antihistamines for adequate symptom control 1, 2

Comparative Efficacy vs Other Treatments

• Both fluticasone and mometasone are more effective than oral antihistamines for controlling nasal symptoms 1, 5, 6
• Intranasal corticosteroids are generally more effective than the combined use of an antihistamine and a leukotriene antagonist 1
• PRN use of fluticasone propionate has been shown to be superior to PRN use of oral antihistamines for seasonal allergic rhinitis 1