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Patients receiving saline irrigation plus azelastine–fluticasone spray experience faster and greater reductions in persistent allergic rhinitis symptoms than those using separate nasal sprays.
According to the findings of a recent study, saline irrigation enhances the therapeutic effect of azelastine–fluticasone (Aze-Flu), leading to better clinical outcomes and patient-reported comfort in persistent allergic rhinitis (PAR).
PAR remains challenging to control, especially in those whose moderate-to-severe symptoms continue despite guideline-directed intranasal corticosteroid (INCS) therapy. As combination strategies gain momentum in allergy and airway management, clinicians increasingly evaluate whether adjunctive therapies—such as nasal saline irrigation—can enhance mucosal clearance, reduce inflammatory burden, and accelerate symptom recovery.
Against this evolving clinical landscape, the present study aimed to evaluate whether integrating nasal saline irrigation with Aze-Flu therapy delivered superior symptomatic improvement in moderate-to-severe PAR. Researchers conducted a randomized, open-label study enrolling 248 adolescents and adults across 6 tertiary hospitals, all meeting diagnostic criteria for moderate-to-severe PAR. Volunteers were randomized 1:1 to get either the combination regimen or standard dual-spray therapy.
The intervention group completed daily nasal saline irrigation followed by the Aze-Flu combination spray, whereas the control group used separate azelastine and fluticasone sprays without irrigation.
The trial’s primary endpoint measured least-square (LS) mean reductions in total nasal symptom score (TNSS) after 4 weeks, with secondary endpoints assessing earlier TNSS changes, individual symptom scores, rhinoscopic findings, visual analog scale (VAS) ratings, quality-of-life metrics, and safety outcomes.
The results confirmed prominent TNSS improvement in both groups (p < 0.001), but the experimental regimen produced greater LSmean symptom reductions at both the 2-week and 4-week evaluations, with p < 0.001 for each comparison, underscoring the clear therapeutic advantage of combination therapy. The investigation confirmed that pairing nasal saline irrigation with Aze-Flu therapy improved symptom control and mucosal health more effectively than standard treatment, without increasing adverse events. The evidence supported this combination as a reliable, practice-ready option for managing moderate-to-severe PAR.
Frontiers in Allergy
Nasal saline irrigation with azelastine-fluticasone nasal spray in moderate-to-severe persistent allergic rhinitis: a randomized controlled trial
Song Li et al.
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