Onset of action of the fixed combination intranasal azelastine-fluticasone propionate in an allergen exposure chamber

Jean Bousquet (Corresponding Author), Eli Meltzer, Peter Couroux, Arkady Koltun, Ferdinand Kopietz, Ullrich Munzel, Hans Christian Kuhl, Duc Tung Nguyen, Anne Marie Salapatek, David Price

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50 Citations (Scopus)


BACKGROUND: A fixed-dose combination of intranasal azelastine hydrochloride-fluticasone propionate (MP-AzeFlu) is the most effective treatment of allergic rhinitis (AR), but its onset of action requires further investigation.

OBJECTIVES: This study compared onset of action of MP-AzeFlu with the free combination of oral loratadine and intranasal fluticasone propionate (LORA/INFP).

METHODS: In this single-center randomized, placebo-controlled, double-blind, double-dummy, three-period crossover trial, AR symptoms were induced in asymptomatic patients by ragweed pollen challenge in an allergen environmental exposure chamber. Patients received single-dose MP-AzeFlu, LORA/INFP, or placebo and were monitored for 4 hours. The primary outcome was onset of action measured by total nasal symptom score (TNSS). Secondary measures were total ocular symptom score (TOSS), total score of the seven nasal and ocular symptoms (T7SS), and the global visual analogue scale (VAS).

RESULTS: The full analysis set included 82 patients; 78 completed all treatments. TNSS was significantly reduced versus placebo from 5 minutes for MP-AzeFlu and 150 minutes for LORA/INFP onward (both P<0.05) until the end of assessment (0 to 4 hours). MP-AzeFlu reduced TNSS to a greater extent at each time point from 5 to 90 minutes (P<0.05) and over the entire assessment interval (P≤0.005) versus LORA/INFP or placebo. No statistically significant difference between LORA/INFP and placebo was observed over the assessment interval (P=0.182). MP-AzeFlu onset of action assessed by TOSS, T7SS, and VAS was 10 minutes, 2 hours earlier than with LORA/INFP.

CONCLUSION: MP-AzeFlu had a more rapid onset of action (5 minutes) and was more effective than LORA/INFP.

REGISTRATION OF THE TRIAL: ClinicalTrials.gov Identifier: NCT03004131; Key words: allergic rhinitis, azelastine, environmental exposure chamber, fluticasone propionate, loratadine, onset of action.

Original languageEnglish
Pages (from-to)1726-1732
Number of pages7
JournalThe journal of allergy and clinical immunology. In practice
Issue number5
Early online date7 Feb 2018
Publication statusPublished - 30 Sep 2018


  • Journal Article
  • allergic rhinitis
  • azelastine
  • environmental exposure chamber
  • fluticasone propionate
  • loratadine
  • onset of action


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