***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: The objectives of this study were to investigate the efficacy of leukotriene receptor antagonists in the treatment of perennial allergic rhinitis . The study was design ed as a r and omized , 14-day treatment to compare the efficacy of zafirlukast , loratadine , and the combination of loratadine and pseudoephedrine in the treatment of perennial allergic rhinitis . Rhinitis symptom scores , acoustic rhinometry , and rhinomanometry were used to evaluate the efficacy . The results showed that after a 14-day treatment period , patients in all treatment groups had a lower mean score for the symptoms of rhinorrhea , nasal itching , and nasal obstruction ( p < .05 ) . Patients who took zafirlukast did not report a significant decrease in sneezing score ( p = .1456 ) , but the decrease in nasal obstruction score was more pronounced than in those who took loratadine or loratadine- pseudoephedrine ( p = .014 ) . However , the results of acoustic rhinometry and rhinomanometry did not have a significant difference among the three groups ( p > .05 ) . The study concluded that zafirlukast seemed to have a better effect on relieving the symptom of nasal obstruction in patients with perennial allergic rhinitis , but the actual mechanism needs further investigation Background : In cross‐sectional clinical studies , rhinitis has been shown to be strongly associated with co‐existing chronic cough . However , to date , this association has been poorly delineated from a prospect i ve and epidemiological st and point This study compared a new intranasal anti-allergic drug , azelastine ( 0.56 mg bid ) with intranasal beclomethasone ( 0.2 mg bid ) and placebo in the treatment of symptoms associated with seasonal rhinitis . After administering placebo for 3–5 days as a “ run-in ” period , eligible patients were r and omized to treatment for 2 weeks : 83 patients received azelastine , 83 beclomethasone and 77 placebo .  Each of six symptoms was assessed daily using a four-point scale . Total symptom scores showed that azelastine-treated patients experienced a more rapid onset of overall symptom relief than beclomethasone-treated patients . This was significant on day 1 ( P < 0.003 ) and continued until day 5 . By the end of the 2-week study period , the beclomethasone-treated group showed greater improvement than both the azelastine and placebo groups ( P = 0.002 and P = 0.0001 , respectively ) . In contrast , visual analogue scales at this time showed no significant differences between the azelastine and beclomethasone treatment groups , with both groups demonstrating significant reductions in total symptom scores compared to placebo ( P = 0.0004 and P = 0.0001 , respectively ) . Differing sensitivities were found in the four-point scales reported by the patients and the investigators and the patients ' visual analogue scales in the measurement of symptom severity . However , all three techniques confirmed that both azelastine nasal spray and beclomethasone nasal spray were effective treatments for seasonal rhinitis . While a greater improvement in overall symptoms was found for the beclamethasone-treated patients compared to azelastine-treated patients , diary card data confirmed the more immediate onset of symptom relief provided by azelastine .  No serious adverse events were found in the present study and included no complaints of drowsiness Purpose To evaluate the efficacy and safety of once-daily ciclesonide in comparison to both levocetirizine alone , and a ciclesonide/levocetirizine combination in patients with seasonal allergic rhinitis ( SAR ) and perennial allergic rhinitis ( PAR ) . Methods Subjects exhibiting moderate to severe allergic rhinitis for longer than 1 year were r and omized in an open-label , 3-arm , parallel group , multicenter study . Subjects received 200 µg ciclesonide , 5 mg levocetirizine , or a combination of both . Changes from baseline until the end-of- study visit ( 2 weeks following ) were evaluated by reflective total nasal symptom scores ( rTNSSs ) , reflective total ocular symptom scores ( rTOSSs ) , physician-assessed overall nasal signs and symptoms severity ( PANS ) , and rhinoconjunctivitis quality -of-life question naires ( RQLQ ) . Results Significant improvements in rTNSS , PANS , and RQLQ in the ciclesonide monotherapy group were observed in comparison to the levocetirizine alone group . Three individual symptoms of rTNSS , including runny nose , nasal itching , and congestion , were improved in the ciclesonide-treated group . rTOSS scores  for ciclesonide monotherapy improved from baseline , but no superiority over levocetirizine was shown . The absolute score and changes in rTNSS and PANS were positively correlated . Ciclesonide spray was more effective  than levocetirizine in reducing nasal symptoms in both SAR and PAR patients . Ciclesonide and levocetrizine were well tolerated alone and in combination . Conclusions Our results provide support for an AR and its Impact on Asthma ( ARIA ) recommendation stipulating that ciclesonide is superior to levocetirizine for the treatment of AR , with tolerable safety . Addition of levocetirizine to ciclesonide did not give further clinical benefit over monotherapy WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The topical second generation anti-histamine azelastine hydrochloride ( AZE ) and the potent corticosteroid fluticasone propionate ( FP ) are well established first-line treatments in allergic rhinitis ( AR ) . • MP29 - 02 , a novel intranasal AZE and FP formulation , has been shown to control AR symptoms faster and better than st and ard intranasal AZE or FP . • The systemic bioavailabilities of marketed AZE and FP nasal spray products have been established at about 40 % and 1 % only , respectively . • For new combination medicinal products such as MP29 - 02 , the determination of possible pharmacokinetic ( PK ) drug-drug interactions between both active components and formulation-based bioavailability alterations is essential . WHAT THIS STUDY ADDS • This paper provides for the first time information on potential drug-drug interactions , AZE and FP bioavailability and disposition characteristics of each component administered by the novel nasal spray formulation MP29 - 02 . • The studies employed highly sensitive FP and AZE LC-MS/MS assays and could therefore be conducted with recommended therapeutic doses , thereby circumventing previously recognized draw-backs that required nasal bioavailability studies to be conducted using supra-therapeutic doses . • No significant PK drug-drug interaction between the active components AZE and FP was noted for MP29 - 02 . • AZE bioavailabilty was equivalent when MP29 - 02 data were compared with MP29 - 02-AZE-mono and Astelin ® . • Increased FP exposure was observed with MP29 - 02-based products compared with FP-BI . FP serum concentrations were generally very low with all investigational products suggesting no clinical ly meaningful pharmacodynamic differences in terms of systemic safety . AIM ( S ) To determine  azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) bioavailabilities of the novel nasal spray combination product MP 29 - 02 , compared with MP29 - 02-based products containing only AZE ( MP29 - 02-AZE-mono ) , FP ( MP29 - 02-FP-mono ) , marketed AZE and FP single entity products ( Astelin ® and FP Boehringer-Ingelheim ; FP-BI ) . METHODS Two r and omized , three period , six sequence , three treatment crossover studies were conducted in healthy subjects . Study 1 administered 200 µg FP as MP29 - 02 , MP29 - 02-FP-mono or FP-BI . Study 2 administered 548 µg AZE as MP29 - 02 , MP29 - 02-AZE-mono or Astelin ® . Each dose consisted of two sprays/nostril . Serum FP and plasma AZE were followed over 24 ( FP ) and 120 h ( AZE ) and quantified by LC-MS/MS  . Peak ( C(max ) ) and total exposures AUC(0,t(last ) ) were compared between the treatments by anova . RESULTS Study 1 : Average FP C(max ) was very low with all products ( ≤ 10 pg ml(-1 ) ) . FP AUC(0,t(last ) ) point estimates ( 90 % CIs ) for MP29 - 02 : MP29 - 02-FP-mono and MP29 - 02 : FP-BI ratios ( % ) were 93.6 ( 83.6 , 104.7 ) and 161.1 ( 137.1 , 189.3 ) . Corresponding ratios for C(max ) were 91.0 ( 82.5 , 100.4 ) and 157.4 ( 132.5 , 187.1 ) . Study 2 : AZE AUC(0,t(last ) ) point estimates ( 90 % CIs ) for MP29 - 02 : MP29 - 02-AZE-mono and MP29 - 02  : Astelin ® ratios ( % ) were 98.8 ( 91.0 , 107.4 ) and 105.5 ( 95.6 , 116.4 ) . Corresponding outcomes for C(max ) were 102.7 ( 92.1 , 114.4 ) and 107.3 ( 92.6 , 124.3 ) . CONCLUSIONS No interactions of AZE and FP were found with the MP29 - 02 formulation . Azelastine bioavailability was similar for MP29 - 02 and Astelin ® . Maximum and total FP exposure was higher for MP29 - 02-based products compared with FP-BI . FP concentrations were generally very low with all investigational products and did not suggest clinical ly meaningful differences concerning systemic safety BACKGROUND Guidelines are the cornerstone of health care decision making and are based on the best available evidence , ideally large r and omized controlled trials ( RCTs ) . Although guidelines target typical patients , RCTs are often based on narrow inclusion and exclusion criteria . OBJECTIVES We explored to what extent typical patients , such as those consulting general practitioners for allergic rhinitis , differ from patients enrolled in RCTs . METHODS We conducted a prospect i ve cohort study including all the consecutive patients with allergic rhinitis cared for by general practitioners in the Languedoc-Roussillon region of France within 2 weeks during the grass pollen season . We evaluated how the characteristics of these patients differed from those of patients included in the 4 largest placebo-controlled RCTs of persistent and intermittent allergic rhinitis . RESULTS Three hundred eleven patients seen by 48 general practitioners were enrolled in this study . Only 7.4 % ( 95 % CI , 4.5 % to 10.3 % ) of the patients would have been enrolled in the RCTs . The primary reasons for this difference were as follows : diagnosis of allergy based on skin test results , serum specific IgE levels , or both ( 20.4 % ) ; severity of allergic rhinitis ( 11.5 % ) ; other chronic diseases ( 11.4 % ) ; history of sinusitis ( 10.4 % ) ; and asthma comorbidity ( 10.1 % ) . A sensitivity analysis excluding contraception and the diagnosis of allergy showed that the percentage of representative patients increased to 20.2 % ( 95 % CI , 15.8 % to 24.7 % ) . CONCLUSION Only a small proportion of patients with allergic rhinitis seen in the primary care setting for allergic rhinitis would be eligible for RCTs . Thus guideline developers and health decision makers need to make careful judgments about the directness of the evidence from RCTs conducted in highly controlled setting BACKGROUND AND OBJECTIVE MP29 - 02 ( Dymista ) , a novel intranasal formulation of azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) , is significantly better than first-line therapy for the treatment of moderate-to-severe seasonal allergic rhinitis ( SAR ) , and is well tolerated following 52 weeks of continuous use in chronic rhinitis . The aim of this study was to evaluate the long-term efficacy of MP29 - 02 versus FP in patients with chronic rhinitis . PATIENTS AND METHODS In total , 612 chronic rhinitis patients ( perennial allergic rhinitis [ PAR ] , n = 424 ; nonallergic rhinitis , n=188 ) aged 12 years or older were enrolled into this open-label , parallel-group study and r and omized to MP29 - 02 ( 1 spray/nostril bid ) or FP nasal spray ( 2 sprays/nostril qd ) for 52 weeks . Efficacy was assessed by change from baseline in PM reflective total nasal symptom score ( rTNSS ) , time to first achieve 100 % PM rTNSS reduction from baseline , and percentage of symptom-free days in the total and PAR population s posthoc 
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Specifically , it addresses the relative merits of using oral H1‐antihistamines , intranasal H1‐antihistamines , intranasal corticosteroids , and leukotriene receptor antagonists either alone or in combination .
Conclusions : Appropriate treatment of AR might improve patients ' quality of life and school and work productivity .