BSACI regards INCS as the first-line anti-inflammatory intervention for AR, especially moderate to severe persistent AR, or where there is nasal congestion. INCS is rated more effective than oral antihistamines or LTRAs used alone, and of similar or greater efficacy compared to an oral antihistamine plus LTRA.4

It recommends that combination therapy with INCS plus INAH “is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy.”16

Systemic absorption is considered negligible for mometasone furoate, fluticasone furoate and fluticasone propionate. For budesonide, beclomethasone diproprionate, triamcinolone and flunisolide, there is generally moderate systemic absorption. Systemic absorption of intranasal betamethasone is higher so should be used for short-term only.4

The prescription-only combination nasal spray containing azelastine hydrochloride and fluticasone offers a rapid onset of action. BSACI says this combination is superior to either drug alone in SAR and better than fluticasone for PAR.