***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Eighteen patients with perennial rhinitis were evaluated in this double‐blind cross‐over trial comparing beclomethasone dipropionate ( BDP ) aqueous nasal spray with terfenadine tablets . Both treatments were effective in reducing symptom scores but BDP was significantly better than terfenadine in relieving running nose and sneezing ( P < 0.05 ) . BDP also had a greater effect on reducing nasal inflammation than terfenadine . Although the clinicians and patients assessed both therapies to be equieffective , significantly more patients preferred the BDP treatment ( P < 0.003 ) . Overall , BDP therapy proved more beneficial than terfenadine therapy in this small group of perennial rhinitis sufferers It was the aim of the study to compare the efficacy and side effects of oral antihistamine and nasal glucocorticoid therapy in seasonal allergic rhinitis . In a double‐blind , double‐dummy , group‐comparative study , 61 adult grass pollen allergic patients were either treated with dexchlorpheniramine maleate sustained release tablets ( 6 mg b.d . ) . or with budesonide nasal spray ( 200 μg b.d . ) . After a 1‐week run‐in period , treatment was given for 3 weeks in the grass pollen season . Patients treated with budesonide showed significantly less nasal blockage than those who received dexchlorpheniramine ( P<0.05 ) , but there was no difference in the number of sneezes and nose blowings . Patients treated with budesonide  used a larger quantity of antihistamine‐vasoconstrictor eye drops ( P<0.01 ) . Drowsiness occured in the group that was treated with dexchlorpheniramine , but mainly during the first week of treatment . The side effects caused by the budesonide spray were few and insignificant . The patients ' overall assessment of the treatment favoured the glucocorticoid spray ( P=0.06 ) BACKGROUND Comparative studies with topical corticosteroids and antihistamines for treatment of allergic rhinitis have not always demonstrated clear distinctions between the two on the basis of therapeutic efficacy . OBJECTIVE This study was design ed to compare the efficacy and tolerability of fluticasone propionate aqueous nasal spray with those of terfenadine in the treatment of seasonal allergic rhinitis . METHODS Three hundred forty-eight patients with allergic rhinitis were given fluticasone propionate aqueous nasal spray ( 200 micrograms once daily ) , terfenadine tablets ( 60 mg twice daily ) , or placebo for 4 weeks in a multicenter , r and omized , double-blind , double-dummy , parallel-group study . RESULTS Clinician-rated total nasal symptom scores after 1 , 2 , 3 , and 4 weeks of therapy and patient-rated total nasal symptom scores throughout treatment were significantly ( p < 0.05 ) lower in the fluticasone propionate group compared with the terfenadine group or the placebo group . Terfenadine was not statistically different from placebo on the basis of clinician-related nasal symptom scores , except for sneezing . Total nasal airflow , measured by rhinomanometry , significantly ( p < 0.05 ) improved in the fluticasone propionate group compared with the terfenadine group or the placebo group . More fluticasone propionate-treated patients compared with placebo-treated patients had reduced nasal mucosal eosinophil counts after 4 weeks of therapy ( p < 0.05 ) . No serious or unusual drug-related adverse events were reported . Morning plasma cortisol concentrations after 4 weeks of therapy did not differ among groups . CONCLUSION Fluticasone propionate aqueous nasal spray is more effective than terfenadine tablets for treatment of seasonal allergic rhinitis Fluticasone propionate ( FP ) is a topical corticosteroid with minimal systemic activity . We examined safety and compared the efficacy of FP aqueous nasal spray , 200 micrograms every day with loratadine tablets , 10 mg by mouth every day in 240 adolescents with ragweed pollen-induced seasonal allergic rhinitis for 4 weeks in a r and omized , double-blind , parallel-group study . Nasal and eye symptoms were recorded daily on a 4-point ( 0 to 3 ) scale . A higher percentage of symptom-free days was observed for nasal blockage on waking during treatment with FP ( p < 0.0001 ) . Significant results were also obtained for all other nasal symptoms when analyzed for both symptom-free days and symptom scores . No differences were found for eye irritation symptoms ( p = 0.14 ) . Morning and evening nasal peak inspiratory flow ( PIF ) was recorded daily by 57 subjects . FP treatment was associated wit significantly higher PIF values than loratadine both morning ( p = 0.0051 ) and evening ( p = 0.0036 ) . A greater improvement over 4 weeks was observed for PIF morning values in the FP group ( p = 0.008 ) but not for evening values ( p = 0.358 ) . Statistically significant correlations were found for nasal blockage and PIF in the morning ( r = -0.54 , p = 0.0001 ) and in the evening ( r = -0.46 , p = 0.008 ) The study investigated the effect of the oral H1‐blocker terfenadine on allergen challenge in subjects with nasal allergy in comparison with the topical steroid , budesonide . A r and omized , placebo‐controlled , double‐blind , crossover study with 3 experimental days was performed outside the pollen season . Seventeen nonsmokers with hay fever ‘ symptoms , positive skin prick test , and RAST against timothy ) were treated for 14 days before each experimental day , where the response to nasal challenge with four different concentrations of timothy was measured every 15 min for 6 h. The nasal cavity dimensions were measured by acoustic rhianometry and the olfactory function as the threshold for the sense of smell of butanol . Nasal symptoms were determined by question naires . Both terfenadine and budesonide dry powder had an effect on the hay fever symptoms during nasal pollen challenge . Terfenadine was more efficient than budesonide against histamine‐mediated symptoms such as sneezing and itching . Budesonide  increased nasal airway dimensions better than terfenadine ‘ P < 0.01 ) . A marked effect of budesonide was seen 1‐2 h after challenge , suggesting an effect on ‘ early late phase ’ reaction in the nose . In 7/17 subjects , a significant ‘ P < 0.05 ) improvement of olfactory function  after budesonide treatment was seen . In conclusion , topical steroid ‘ budesonide ) is superior to antihistamine ‘ terfenadine ) in treatment of nasal congestion in hay fever , especially for the postchallenge reaction , and may , in some cases , relieve the decreased sense of smell during pollen challenge Systemic activity of the intranasal glucocorticosteroid budesonide administered once daily from a dry‐powder inhaler ( Turbuhaler ® ) was assessed by knemometry . Lower leg length was measured weekly in 38 children aged 7–15 ( mean 11.3 ) years with allergic or perennial rhinitis . The design was a r and omized , double‐blind , parallel‐group study . After 4 weeks ’ run‐in , the children were allocated to 4 weeks ’ treatment with either budesonide 200 or 400 μg or placebo . Fourteen children in the budesonide 200‐μg group , 13 in the 400‐μg group , and 10 in the placebo group completed the study . In the placebo and budesonide 200‐μg groups , growth velocities during run‐in ( 0.36 and 0.28 mm/week , respectively ) and treatment periods ( 0.34 and 0.27 mm/week , respectively ) were almost identical . In the budesonide 400‐μg group ( run‐in : 0.40 mm/week ) , a nonsignificant reduction in mean growth velocity of 0.18 mm/week was seen ( P= 0.11 ) . There were no statistically significant differences among the run‐in mean lower leg growth velocities ( F= 1.12 ; P= 0.34 ) , among growth velocities during treatment ( F= 1.10 ; P= 0.34 ) , or among the run‐in and treatment growth velocities in the three groups ( F= 1.19 ; P= 0.32 ) . These results provide good evidence that systemic activity is low in children with allergic or perennial rhinitis treated with once daily budesonide in doses of 200‐ and 400‐μg administered intranasally from a dry‐powder inhaler Sixty‐nine out patients with symptomatic perennial rhinitis were recruited to this double‐blind , parallel‐group study to compare budesonide nasal spray with oral astemizole . Following a 1‐week run‐in on placebo , 67 patients achieved a mean daily total symptom score of at least 4 ( scoring for each symptom was 0 = none , 1 = mild , 2 = moderate , 3 = severe ) , and were r and omized to study treatments ‐ 33 to budesonide , 100 ug in each nostril morning and evening , and 34 to astemizole , one 10‐mg tablet each morning , for a period of 4 weeks . No antihistamine preparations other than eye drops and no corticosteroids were permitted during the active treatment period . Patients recorded symptoms of blocked nose , runny nose , sneezing , itchy nose , sore eyes or runny eyes in diary cards each evening before retiring . Diary card data showed that there was significantly greater improvement in blocked nose , runny nose and runny eyes during the first 2 weeks of budesonide treatment than during the same period on astemizole . A similar , although non‐significant , trend was observed for sneezing and itchy nose , but there was no apparent difference in the reporting of sore eyes . After 4 weeks , blocked nose and runny nose remained significantly less troublesome in the budesonide group . Both treatments were well‐tolerated and no major adverse effects were reported . Patient ratings for treatment efficacy were significantly higher for budesonide than astemizole at both 2 weeks and 4 weeks The clinical efficacy and side effect of ( 1 ) beclomethasone dipropionate aqueous nasal spray , 400 micrograms daily , ( 2 ) astemizole , 10 mg daily , and ( 3 ) beclomethasone , 400 micrograms , plus astemizole , 10 mg daily , were compared in a double-blind , r and omized , parallel-group trial . Ninety adults were matched into groups of three according to sensitivity to ragweed pollen . One of each of the three subjects was assigned to nasal spray alone , one was assigned to astemizole alone , and one subject was assigned to both medications . Medications were started 1 week before and continued daily until 1 week after the ragweed-pollen season ( 6 weeks ) . If rhinoconjunctivitis was inadequately controlled with the trial medications , pressurized steroid nasal spray and /or antihistamine-decongestant eye drops were used in the minimum dose that would ensure relief . Nose and eye symptoms and concomitant medication use were recorded daily in a diary . Sneezing , nasal obstruction , and rhinorrhea were significantly better , and less additional nasal spray was used in subjects taking beclomethasone alone than in subjects taking astemizole alone . Beclomethasone plus astemizole provided no better control of rhinitis than beclomethasone alone . Eye symptoms and eye drop use tended to be less in subjects taking astemizole alone than in subjects taking beclomethasone alone , but the best control of eye symptoms was recorded in the subjects taking both trial medications . Side effects were mild or transient BACKGROUND We compared the effect of nasal azelastine ( 0.56 mg/day ) , nasal beclomethasone dipropionate ( BDP , 200 micrograms/day ) and matched placebo on seasonal symptoms , nasal cytology , and the increase in bronchial responsiveness occurring during pollen season in a group of subjects with history of allergic rhinitis to grass pollens only . METHODS The study was completed by nine subjects in the azelastine group , 13 subjects in the BDP group , and 13 subjects in the placebo group . Treatments were r and omly administered for 6 weeks . Each subject recorded daily nasal , eye and chest symptoms and additional treatment requirement for the entire pollen season . Each subject performed nasal lavage 4 weeks into the pollen season . Bronchial responsiveness to methacholine was measured before and 4 weeks into the pollen season . Response was expressed as provocative dose causing a 20 % fall in forced expiratory volume in 1 second in micromoles . RESULTS Azelastine-treated subjects had significantly fewer nasal symptoms during week 4 ( p < 0.05 ) , and BDP-treated subjects had fewer nasal symptoms during week 4 ( p < 0.05 ) and week 5 ( p < 0.05 ) compared with subjects given placebo . Both treatments significantly reduced the need for additional medications .  BDP , but not azelastine , treatment significantly reduced the percent of eosinophils recovered in nasal lavage ( p < 0.05 ) . Neither azelastine nor BDP protected against the increase in bronchial 
    Output:
    
There were no significant differences between treatments for nasal discomfort , nasal resistance , or eye symptoms .
The effects on sneezing , total nasal symptoms , and eye symptoms were significantly heterogeneous between studies .
The results of this systematic review , together with data on safety and cost effectiveness , support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis