Long-Term Use of Azelastine + Fluticasone Combination Nasal Spray

Safety Profile

Nasal tissue remains healthy with prolonged use of intranasal corticosteroids, as shown by nasal biopsies in patients with perennial allergic rhinitis after 1 to 5 years of continuous therapy, according to the American Academy of Allergy, Asthma, and Immunology 1
Growth effects are minimal at recommended doses of fluticasone propionate, mometasone furoate, and budesonide, though effects may occur at twice the recommended dose or in toddlers, as stated by the American Academy of Pediatrics 1
Systemic absorption of fluticasone propionate and mometasone furoate is negligible, making them preferred for long-term safety, as recommended by the American Rhinologic Society 2

The nasal septum should be periodically examined to ensure no mucosal erosions are present, as these may precede nasal septal perforation, according to the American Academy of Otolaryngology 1
Patients must be instructed to use contralateral spray technique to aim the spray away from the septum, which reduces epistaxis risk by four-fold and reduces treatment discontinuation by three-fold, as advised by the European Rhinologic Society 3
Regular daily use of intranasal corticosteroids is required to maintain symptom control, with delayed onset of action (12 hours) and maximal efficacy reached in days to weeks, as stated by the American College of Allergy, Asthma, and Immunology 3

For patients with glaucoma, cataracts, or osteoporosis, the azelastine + fluticasone combination offers a distinct safety advantage due to azelastine's lack of systemic corticosteroid effects, as recommended by the American Academy of Ophthalmology 2
Azelastine can be safely used in children and patients with glaucoma or cataracts due to its lack of systemic corticosteroid effects, according to the American Academy of Pediatrics 2

Initiate combination therapy for moderate-to-severe symptoms, as it provides 40% greater symptom reduction than either agent alone, as recommended by the European Academy of Allergy and Clinical Immunology 4
Educate patients on proper technique using contralateral spray method and regular daily dosing, as advised by the American Rhinologic Society 3
Schedule periodic nasal examinations (every 6-12 months) to check for septal erosions or other mucosal changes, according to the American Academy of Otolaryngology 1

Oral corticosteroids should not be administered for chronic rhinitis except for rare patients with severe intractable symptoms unresponsive to all other treatments, and only as short courses (5-7 days), as stated by the American College of Allergy, Asthma, and Immunology 1
Parenteral corticosteroids are contraindicated for rhinitis due to greater potential for adrenal suppression, muscle atrophy, and fat necrosis, according to the American Academy of Allergy, Asthma, and Immunology 1