Response to Combination Intranasal Corticosteroid and Intranasal Antihistamine in Allergic Rhinitis, A Questionnaire Based Study in ENT Outpatients

Aim: To analyse the effect of combination intranasal corticosteroid and antihistamine spray in patients suffering from proven Allergic Rhinitis who have failed primary care therapy. Background: Allergic Rhinitis is prevalent in the community and worldwide, with a rising trend, it also impacts on health related quality of life, sleep and (in appropriate age groups) school attendance. Method: The MSNOT-20 is a validated and reliable questionnaire for use in Rhinitis. It was used in two 4 month periods (2014 and 2016) in patients with Allergic Rhinitis who have failed primary care treatment. They were then commenced on a combination nasal spray of azelastine hydrochloride (antihistamine) and fluticasone propionate (corticosteroid). Results: There was improvement in overall symptom severity score (MSNOT-20 score) for each patient, with improvement in all five subgroups; nasal, paranasal, sleep, social and emotional. The MSNOT-20 score is closely correlated with sleep, social and paranasal subgroups. The top 5 most severe symptoms identified by MSNOT-20 questionnaire objectively were also identified by patients as their most troublesome symptoms and include (in descending order); blocked nose, need to blow nose, sneezing, runny nose, post nasal discharge. Conclusion: Allergic rhinitis has widespread impact on different domains of the patients’ life. This combination treatment is an effective treatment regime for patients who have failed primary care and has been proven to be of benefit in seasonal and perennial Allergic Rhinitis by improving all symptom subgroups.