Onset of Action of Azelastine 0.15% Versus Olopatadine/Mometasone for Allergen-Induced Rhinitis: An EEU Crossover Study
In brief
Azelastine nasal spray relieved allergen-triggered rhinitis symptoms within 15 minutes
In a controlled pollen-challenge study of 84 adults with ragweed sensitivity, azelastine nasal spray 0.15% began relieving symptoms within 15 minutes and provided greater early relief than mometasone/olopatadine or placebo. After 3.5 days, overall efficacy was comparable to the combination treatment; the findings support rapid symptom control, but come from a controlled exposure setting.
- Journal
- Clinical and translational allergy (Q1)
- Published
- 1 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jean Bousquet, Ludger Klimek, Hans-Christian Kuhl, Duc Tung Nguyen, Rajesh Kumar, William E Berger
- PMID
- 43000216
- DOI
- 10.1002/clt2.70213
Why clinicians should know about it
- Picked for Immunology and Allergy (paper of the day, 9 November 2026): Randomized crossover trial comparing treatments for allergic rhinitis
Abstract
BACKGROUND: The aim of this study was to compare the onset of action (primary), and overall efficacy (secondary) of azelastine nasal spray 0.15% (AZE 0.15%) with mometasone/olopatadine combination therapy (OloMom) in subjects with allergen-induced rhinitis under controlled allergen exposure conditions in an Environmental Exposure Unit (EEU). METHOD: This was a randomized, double-blind, placebo-controlled, three-period Williams cross-over study. Participants were randomized to receive AZE 0.15%, OloMom, or placebo. Efficacy was assessed during two pollen challenge sections in an EEC, after a single dose and after 3.5 days of treatment. Following a minimum 14-day washout period, subjects received alternate treatment and repeated study procedures until all three interventions were evaluated. The primary endpoint was time to onset of action based on change from baseline in Total Nasal Symptom Score (TNSS). Secondary assessments included total and individual nasal and ocular symptoms and overall efficacy after 3.5 days of treatment. RESULTS: Eighty-four subjects completed the study (mean age 41.5 years; balanced sex distribution), all with confirmed ragweed sensitivity. All treatments reduced TNSS post-dose, with most effective and fastest relief from AZE 0.15%, onset at 15 minutes, sensitivity analyses supported onset at 10 minutes, and greater early nasal, ocular, and total symptom relief compared to OloMom and placebo. CONCLUSION: AZE 0.15% delivered rapid and clinically significant relief of AR, demonstrating greater early symptoms improvement compared with OloMom. Overall efficacy was comparable between treatments, supporting AZE 0.15% as an effective, steroid-free alternative for rapid symptom control in patients with pollen allergies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.