1. Managing both nasal and ocular symptoms in patients with moderate to severe seasonal allergic rhinitis (SAR) “When we think about allergic rhinitis, we forget that the eyes come along.” http://kardzmed.com OBJECTIVE:

2. that about 75% of the most severe SAR patients complain of itchy eyes and about two thirds of them complain of watery eyes there's been a lot of interest in looking at combinations of nasal antihistamines and nasal corticosteroids, with previous studies showing that the combination is more effective statistically than the single entities http://kardzmed.com Basis of Research

3. Paul Ratner, MD, allergist/immunologist and founder and director of Sylvana Research, of San Antonio, Texas, a research facility for investigational medications. http://kardzmed.com Lead Reasearcher

4. the ocular effects from treatment with this combination. http://kardzmed.com Aim of study“Treat the Eyes and the Nose”

5. His investigational team enrolled 610 patients with ocular symptoms from SAR during the 2007/08 Texas Mountain Cedar season. The patients were randomized to 1 of 4 groups receiving 1 spray per nostril twice daily: azelastine alone, fluticasone alone, azelastine plus fluticasone, and placebo. http://kardzmed.com Procedure

6. The primary end point was efficacy, defined as a change from baseline in the total nasal symptom score (TNSS) for nasal congestion, sneezing, itchy nose, and runny nose. The secondary end point was the effect of azelastine plus fluticasone on the total ocular symptom score (TOSS) for itchy eyes, watery eyes, and redness http://kardzmed.com Set objectives to investigate

7. Results were presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting in a podium session http://kardzmed.com Results

8. Nasal and Ocular Symptoms Improved improvements on TNSS were statistically significant for the patients treated with the combination spray compared with single drug http://kardzmed.com 1. TNSS

9. There was also a statistically significant improvement in TOSS for those treated with the combination spray http://kardzmed.com 2. TOSS

10. The only adverse events reported by more than 2% of those treated with the combination spray were bitter taste (7.2%), epistaxis(3.9%), and headache (2.6%). http://kardzmed.com adverse effects

11. The first is that the combination therapy with nasal antihistamines and nasal steroids is definitely panning out to be more effective than treatment with the individual components Second, in addition to treating the nasal symptoms that you would expect, you're also getting the added benefit of having relief of the ocular symptoms." http://kardzmed.com Conclusion

12. allergists are now using both drugs in combination in 30% to 40% of their patients. So what this study reinforces is that polypharmacy, using an antihistamine blocker as well as a nasal steroid, may be a more effective modality in treating this ocular complaint and the nasal symptoms http://kardzmed.com

13. This study was funded by Meda pharmaceuticals November 13, 2009 (San Diego, California) Presented in ENT class (Ml410) by Dr. Karl http://kardzmed.com http://kardzmed.com THE END