Allergy Relief: Astelin Edges Zyrtec
Nasal Antihistamine Works Fast, Gets High Marks From Patients
Faster Action With Astelin? continued...
That's true, says Eli O. Meltzer, MD, co-director of the Allergy & Asthma Medical Group and Research Center in San Diego and clinical professor of pediatrics at the University of California in San Diego.
"If I had a gun to my head and had to say which of the two antihistamines is more likely to provide relief, I would say Astelin because it has some effects beyond histamine blocking," Meltzer tells WebMD.
Overall, Corren's study showed that the average patient got about 25% more relief from overall allergy symptoms with Astelin than with Zyrtec. But both he and Meltzer point out that no single person is an average patient. Both experts say that seasonal allergies affect different people in different ways -- and respond differently to allergy treatments.
"This is a very variable disease," Corren says. "The more arrows we have in our quiver, the better, because people vary widely in their response to treatment."
Patients With Runny Noses but Without Allergies
Corren, an allergist, says that about half of the patients who come to see him for runny noses and nasal congestion aren't really suffering from allergies. They are suffering from nonallergic rhinitis, he says. And those patients may do better on Astelin, which is the only antihistamine approved for nonallergic rhinitis.
But for people who truly have serious seasonal allergies, Corren and Meltzer agree that the best initial treatment is not an antihistamine at all. Steroid nasal sprays, they say, tend to be most effective.
"For people that have mild to moderate symptoms, particularly those without nasal congestion or who have intermittent symptoms, either an oral antihistamine or a topical antihistamine like Astelin would be proper," Corren says. "But when you move into a patient population like in this study, with moderate to severe symptoms -- particularly when congestion is present -- a nasal steroid is preferable."
"If you ask the question, 'What is the first-line treatment for people with persistent seasonal disease' -- defined as lasting at least four weeks with symptoms on most days -- my first choice is intranasal corticosteroids," Meltzer says. "For people with an intermittent problem, antihistamines work well."