Increased nasal airflow with budesonide compared with desloratadine during the allergy season

Objective: To compare the effects of desloratadine, an H-1-blocking antihistamine, and budesonide, an intranasal corticosteroid, on nasal peak inspiratory flow (NPIF) in patients with seasonal allergic rhinitis. Design: We performed a randomized, double-blind, double-dummy, parallel study comparing oral desloratadine, 5 mg/d (n = 31), and budesonide, 32 mug/d per nostril (n=30), for 2 weeks during the spring allergy season. Main Outcome Measures: Subjects recorded NPIF and nasal symptoms twice daily. Baseline measurements were obtained before initiation of treatment. The Rhinoconjunctivitis Quality of Life Questionnaire was completed at baseline and after treatment. Results: Desloratadine and budesonide caused a significant increase in NPIF compared with baseline on the evening of the first dose (P<.01). Budesonide, however, led to a significantly greater increase in NPIF than did desloratadine when the change from baseline was compared for the entire treatment period (median, 475 vs 150 L/min; P=.01). Both treatments resulted in clinically significant reductions of the individual domains and overall scores on the Rhinoconjunctivitis Quality of Life Questionnaire (P<.01).. There was a significant reduction in total symptom scores (Pless than or equal to.01) compared with baseline during all treatment days in both treatment groups, with no statistically significant differences between treatments (median, -60.0 vs -59.5; P=.67). Conclusions: Both treatments led to significant improvements in NPIF, but the improvement was greater with the intranasal corticosteroid. Both treatments improved quality of life and reduced symptoms. The difference between the objective and subjective outcomes probably reflects the small sample size, the low pollen counts for the season, and the greater variability in subjective compared with objective measures.