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Verification Information

The Piri range includes Pirinase, Piriton, Piriteze and PiriNatural.

The substantiation for the claim: 'The UK's No.1 selling allergy care brand’/’The UK’s No.1 allergy care range’/’From the UK's No.1 selling allergy care brand/range’/’From Piri, the UK’s No.1 selling allergy care brand/range’ is summarised in the tables below.

When this claim is used in the context of advertising for the Piri range as a whole, the claim is referring to the fact that the total number of packs purchased for the Piri range (Pirinase, Piriton, Piriteze and PiriNatural) is higher than the total number of packs purchased for any other allergy care brand/range. The table below gives the number of packs sold (unit sales), in the UK, for the ten top selling allergy brands/ranges during the 12-week and one-year period to week ending 13/06/2020.

Brand MAT TY Latest 12 Weeks
PIRI RANGE (PIRITON + PIRINATURAL + PIRINASE + PIRITEZE) 8,354,726.5 3,209,327.8
BENADRYL RANGE (BENADRYL + BENACORT) 2,930,984.4 1,187,604.5
BECO RANGE (BECOALLERGY + BECODEFENCE + BECONASE) 2,450,606.0 1,047,636.4
GALPHARM 2,093,127.9 604,251.5
(CALRITYN + CLARINAZE) 1,545,182.3 724,773.7
BELLS 1,477,288.1 315,431.4
ALLACAN 1,250,572.9 395,856.9
OPTICROM 838,845.5 376,440.2
OPTREX 494,610.3 231,365.0
PHENERGAN 388,926.5 79,266.5

Source: Nielsen Scantrack Data Total Coverage GB, Unit Sales. WE 13.06.20

When the claim, 'The UK's No.1 selling allergy care brand’ is used in the context of advertising for Piriteze only, the claim is referring to the fact that more packs of Piriteze Allergy Tablets and Piriteze Allergy Syrup are purchased than any other allergy care brand. The table below gives the number of packs sold (unit sales), in the UK, for the top ten selling allergy brands during the 12-week and one-year period to week ending 13/06/2020.

Brand MAT TY Latest 12 Weeks
PIRITEZE 5,195,813.1 2,201,182.8
BENADRYL 2,909,507.4 1,183,107.0
PIRITON 2,490,973.0 704,067.9
BECONASE 2,149,542.3 924,607.3
GALPHARM 2,093,127.9 604,251.5
CLARITYN 1,509,380.3 710,586.7
BELLS 1,477,288.1 315,431.4
ALLACAN 1,250,572.9 395,856.9
OPTICROM 838,845.5 376,440.2
PIRINASE 659,393.4 295,530.1

Source: Nielsen Scantrack Data Total Coverage GB, Unit Sales. WE 13.06.20

The substantiation for the claim: 'The UK's No.1 allergy relief tablet' is summarised in the table below. The claim refers to Piriteze Allergy Relief Tablets. The table gives the number of packs sold (unit sales), in the UK, for the top ten selling allergy tablet products during the 12-week and one-year period to week ending 13/06/2020.

BRAND PRODUCT PROPERTY FORM MAT TY Latest 12 Weeks
PIRITEZE ALLERGY TABLETS 4,566,248.2 2,002,794.9
CLARITYN ALLERGY TABLETS 1,498,747.4 704,921.1
PIRITON ALLERGY TABLETS 1,433,341.4 398,596.7
ALLACAN HAY FEVER & ALLERGY RELIEF TABLETS 1,250,572.9 395,856.9
GALPHARM HAYFEVER & ALLERGY RELIEF TABLETS 1,141,196.7 269,604.1
BELLS HAYFEVER & ALLERGY TABLETS 1,006,154.3 275,287.9
BENADRYL ONE A DAY RELIEF TABLETS 667,789.7 324,820.2
GALPHARM CETIRIZINE TABLETS 550,468.6 180,733.1
BELLS ALLERGY RELIEF TABLETS 449,584.2 30,802.5
PHENERGAN TABLETS 322,183.6 66,159.9

Source: Nielsen Scantrack Data Total Coverage GB, Unit Sales. WE 13.06.20

The substantiation for the claim: 'The UK's No.1 selling allergy syrup’ is summarised in the table below. The claim refers to Piriton Syrup. The table gives the number of packs sold (unit sales), in the UK, for the top ten selling allergy syrup products during the 12-week and one-year period to week ending 13/06/20.

BRAND PRODUCT PROPERTY FORM MAT TY Latest 12 Weeks
PIRITON ALLERGY SYRUP 1,057,490.9 305,437.3
PIRITEZE ALLERGY SYRUP 629,565.2 198,388.0
ZIRTEK ALLERGY SYRUP 12,115.3 4,599.8
UNICHEM LORATADINE SYRUP 11,295.4 4,672.5
PINEWOOD SYRUP 4,217.6 1,146.4
ALLERIEF SYRUP 1,428.7 1,092.6
CLARITYN ALLERGY SYRUP 81.0 2.0
ALMUS CHLORPHENA MALEATE SYRUP 16.8 15.8
ZIRTEK ALLERGY RELIEF FOR CHILDREN SYRUP 3.0 NA
ALL OTHER SYRUP NA NA

Source: Nielsen Scantrack Data Total Coverage GB, Unit Sales. WE 13.06.20

Claim Verification Information for Pirinase Hayfever Relief for Adults 0.05% Nasal Spray and Pirinase Allergy 0.05% Nasal Spray

The UK Codes of Non-broadcast and Broadcast Advertising (the CAP and BCAP Codes) require that advertisers provide sufficient information, about comparisons with identifiable competitor products, to enable consumers to check the comparison for themselves.

GSK is currently using the following claims on various Pirinase promotional materials, which are supported by the below information.

‘No spray is stronger for hayfever relief, including itchy & watery eyes’ and ‘No spray is stronger for treating allergy symptoms’ for Pirinase Hayfever Relief for Adults 0.05% Nasal Spray and Pirinase Allergy 0.05% Nasal Spray

‘No spray is stronger for preventing or treating allergy symptoms’ for Pirinase Allergy 0.05% Nasal Spray.

Introduction

Pirinase Hayfever Relief for Adults 0.05% Nasal Spray and Pirinase Allergy 0.05% Nasal Spray contain fluticasone propionate, a once daily intranasal corticosteroid.

Pirinase Hayfever Relief for Adults 0.05% Nasal Spray is indicated for the relief of allergic rhinitis, such as hay fever symptoms.1

Pirinase Allergy 0.05% Nasal Spray is indicated for the prevention and relief of allergic rhinitis, such as hay fever symptoms,2.

Supporting data

To support the above claims, GSK reviewed all medicines with an allergy relief and/or prevention indication in a spray format available without prescription in the UK.

There are a range of Hay fever relief actives available in spray format without prescription that can be used to relieve and/or prevent the symptoms of hay fever, including nasal decongestants and other intranasal corticosteroids.

Medicines indicated for allergy relief in a spray format were identified using a number of sources including eMC3, MHRA database4 and PAGB OTC Handbook5.

To ensure that only non‐prescription products were included, the legal classification of the product was determined using eMC3.

The results of the searches can be found in table 1.
Maximum doses for the active ingredients are detailed in Table 2, using information available in the Association of the European Self‐Medication Industry (AEGSP) database6 for OTC ingredients and the MHRA’s list C7, which was archived in Dec 2014.

Table 1: OTC Medicinal Sprays available for hayfever and/or allergy symptom relief

Brand Licence Holder Active Strength
Boots Hayfever Relief For Adults 50mcg/Dose Nasal Spray The Boots Company PLC Beclometasone Dipropionate 50 Mcg /100 Microlitre (0.05% W/V)
Benacort 64 Micrograms Nasal Spray Mcneil Products Limited Budesonide 64mcg/Spray
Benacort 64 Micrograms Nasal Spray Mcneil Products Limited Budesonide 64mcg/Spray
Beconase Hayfever Relief For Adults 0.05% Nasal Spray Omega Pharma Beclometasone Dipropionate 50 Mcg /100 Microlitre (0.05% W/V)
Beconase Hayfever Omega Pharma Beclometasone Dipropionate 50 Mcg /100 Microlitre (0.05% W/V)
Clarinaze Allergy Control 0.05% Nasal Spray Bayer Consumer Healthcare Mometasone Furoate 0.05%
Pirinase Hayfever Relief Nasal Spray 0.05% Glaxosmithkline Consumer Healthcare Fluticasone Propionate 0.05%
Pirinase Hayfever Relief Nasal Spray 0.05% Glaxosmithkline Consumer Healthcare Fluticasone Propionate 0.05%
Nasobec Nasal Spray 50 Microgram Teva Uk Limited Beclomethasone Dipropionate 50 Mcg/Spray
Boots Allergy Relief 50 Microgram Nasal Spray Teva Uk Limited Fluticasone Propionate 50 Mcg /100 Microlitre (0.05% W/V)
Manx Healthcare Clear Nose Spray Manx Healthcare Limited Xylometazoline Hydrochloride 0.1%
JML Hayfever Relief For Adults 50 Micrograms/Dose Nasal Spray Ayrton Saunders Limited Fluticasone Propionate 0.05%
Ennogen Beclometasone Aqueous Nasal Spray 50mcg/Spray Ennogen Pharma Limited Beclomethasone Dipropionate 50 Mcg/Spray
Flixonase Allergy Nasal Spray 0.05%W/W Glaxosmithkline Consumer Healthcare (Uk) Trading Limited Fluticasone Propionate 0.05% W/V
Flixonase Allergy Nasal Spray 0.05%W/W Glaxosmithkline Consumer Healthcare (Uk) Trading Limited Fluticasone Propionate 0.05% W/V
GlaxoSmithKline Fluticasone Propionate Nasal Spray 50 Micrograms/Actuation Glaxosmithkline Consumer Healthcare (Uk) Trading Limited Fluticasone Propionate 0.05% W/V
GlaxoSmithKline Fluticasone Propionate Nasal Spray 50 Micrograms/Actuation Glaxosmithkline Consumer Healthcare (Uk) Trading Limited Fluticasone Propionate 0.05% W/V
Otrivine Adult Nasal Spray 0.1% W/V GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Adult Nasal Spray 0.1% W/V GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Congestion Relief Nasal Spray 0.1% GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Congestion Relief Nasal Spray 0.1% GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Adult Menthol Nasal Spray 0.1%W/V GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Adult Menthol Nasal Spray 0.1%W/V GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Adult Measured Dose Sinusitis Spray 1mg/10ml GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Otrivine Adult Measured Dose Sinusitis Spray 1mg/10ml GlaxoSmithKline Consumer Healthcare (Uk) Trading Limited Xylometazoline Hydrochloride 0.1% W/V
Astepro Nasal Spray 0.15% Mylan Products Limited Azelastine Hydrochloride 0.15%

Table 2 – Maximum OTC doses of Identified Active Ingredients

Active Ingredient Max. OTC Strength Available
Azelastine Hydrochloride 0.15%
Beclometasone dipropionate 50mcg/spray
Budesonide 64mcg/spray
Fluticasone propionate 0.05%
Mometasone furoate 0.05%
Xylometazoline hydrochloride 0.1%

There are a range of ingredients available without a prescription that can be used to relieve the symptoms of hay fever, including nasal decongestants (xylometazoline and oxymetazoline), and other intranasal corticosteroids (e.g. beclomethasone, budesonide, triamcinolone).

The quantity of the active ingredient isn’t a reflection of the strength of the product e.g. 0.1% Xylometazoline is not ‘stronger’ than 0.05% Fluticasone Propionate because they are different active ingredients.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines 2010 and the 2017 British Society of Allergy and Clinical Immunology (BSACI) guidelines recommend intranasal corticosteroids as the most effective treatment option for hay fever.

Conclusion

Based on the information presented in this document, there is no product available over the counter which is stronger than Pirinase Hay Fever Relief for Adults 0.05% Nasal Spray and Pirinase Allergy 0.05% Nasal Spray for the relief and/or prevention of allergy and hay fever symptoms.

This is supported by a significant data review capturing Pharmacy only and GSL medicines indicated for allergy relief and reviewing the quantities of the active ingredients in the products meeting the maximum dose as outlined by AEGSP and the MHRA’s list C, which was archived in Dec 2014.

From this data, GSK believe that the above claims are adequately supported.

References

  1. Pirinase Hayfever Relief for Adults 0.05% Nasal Spray SPC
    https://www.medicines.org.uk/emc/product/5116/smpc. Accessed June 2019
  2. Pirinase Allergy 0.05% Nasal Spray SPC
    https://www.medicines.org.uk/emc/product/4502/smpc. Accessed June 2019
  3. Medicines.co.uk. Accessed June 2019.
  4. MHRA RAMA XL Database. Fluticasone Propionate Products. Accessed June 2019.
    https://services.intralinks.com/
  5. PAGB OTC Handbook 2019. Accessed June 2019
  6. Association of the European Self‐Medication Industry (AEGSP) database. Accessed June 2019
  7. List C. MHRA Archive. Accessed June 2019
  8. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schünemann HJ. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision. J Allergy Clin Immunol. 2010;126:466-76
  9. Scadding GK et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47:856–889.

Claim Verification Information for Pirinase Relief for Adults 0.05% Nasal Spray and Pirinase Allergy 0.05% Nasal Spray

GSK is currently using the claim ‘Nothing is more effective for hay fever relief than Pirinase’ on various Pirinase promotional materials.

The claim is supported by the evidence summarised below.

Summary

Pirinase Allergy 0.05% Nasal Spray (P) and Pirinase Hay fever Relief for Adults 0.05% Nasal Spray (GSL) contain fluticasone propionate (FP) and are once daily intranasal corticosteroid sprays (INCS) available over the counter (OTC).

The overwhelming body of evidence demonstrate that INCS, such as FP, provide equivalent relief and in some cases superior relief to antihistamines, decongestants, eye drops and decongestant agents in the treatment of allergic rhinitis (AR) symptoms. As a result of this efficacy, INCS are considered the first line treatment for AR by a large number of important practice parameters. The efficacies of the different INCS are considered to be comparable, with differences limited to factors like patient preference, dosing regimens, and the delivery device and vehicle1-5.

Based on this evidence, we consider the following top parity claim for Pirinase Allergy 0.05% Nasal Spray (P) and Pirinase Hayfever Relief for Adults 0.05% Nasal Spray to be supportable:

‘Nothing is more effective for hay fever relief than Pirinase’

Background

Allergic rhinitis is caused by the immune system reacting to irritants or allergens by releasing histamine and other chemicals. This causes symptoms include sneezing, nasal congestion, runny nose, red/itchy/watery eyes, and nasal secretions which may be classed as persistent or intermittent.5 Common allergens that cause allergic rhinitis include pollen (this type of allergic rhinitis is known as hay fever), as well as mould spores, house dust mites, and flakes of skin or droplets of urine or saliva from certain animals.

There are a range of ingredients available without a prescription that can be used to relieve the symptoms of hay fever, including nasal decongestants (xylometazoline and oxymetazoline), antihistamine tablets (e.g. cetirizine, acrivastine) and other intranasal corticosteroids (e.g. beclomethasone, budesonide, triamcinolone).

‘Pirinase Hayfever Relief for Adults 0.05% Nasal Spray’ and ‘Pirinase Allergy 0.05% Nasal Spray’ contain the active ingredient fluticasone propionate. Pirinase Allergy 0.05% Nasal Spray is licenced for the prevention and treatment of AR including hay fever and that caused by other airborne allergens such as house dust mite and animal dander.6 'Pirinase Hayfever Relief for Adults 0.05% Nasal Spray' is used to treat the allergic symptoms of hay fever.7 When used as directed, Pirinase has an anti-inflammatory action and works in a similar way to natural body chemicals to control the body’s reactions to allergens (‘triggers’) in the environment.6,7

Active ingredients used to treat hay fever/Allergic Rhinitis

Table 1 (below) shows the active ingredients available OTC for the treatment of allergic rhinitis.

Table 1. Active ingredients available OTC for the treatment of allergic rhinitis§

Active ingredient Treatment Type Indication Dosage Instruction
*Fluticasone propionate Intranasal corticosteroid (Prophylaxis**) and treatment of allergic rhinitis 100 micrograms in each nostril once daily
Beclomethasone (beclometasone) dipropionate Intranasal corticosteroid Prophylaxis and treatment of allergic rhinitis 100 micrograms into each nostril twice daily
Budesonide Intranasal corticosteroid Prophylaxis and treatment of allergic rhinitis Two applications of 64 micrograms into each nostril each morning or one application of 64 micrograms into each nostril morning and evening
*Triamcinolone acetonide Intranasal corticosteroid Prophylaxis and treatment of allergic rhinitis 110 micrograms into each nostril once daily
Azelastine hydrochloride Intranasal antihistamine Symptomatic treatment of seasonal allergic rhinitis or perennial allergic rhinitis 140 micrograms twice daily
Sodium cromoglycate intranasal cromoglycate Prevention and treatment of perennial allergic rhinitis and hay fever One spray into each nostril four to six times daily.
Acrivastine Oral non-sedating antihistamine Symptomatic relief of allergy such as hay fever, urticaria 8 mg three times daily
*Cetirizine hydrochloride Oral non-sedating antihistamine Symptomatic relief of allergy such as hay fever, urticaria 10 mg daily
*Loratadine Oral non-sedating antihistamine Symptomatic relief of allergy such as hay fever, urticaria 10 mg daily
Chlorpheniramine (chlorphenamine) Maleate Oral sedating antihistamine Symptomatic relief of allergy such as hay fever, urticaria 4 mg every 4-6 hours
Diphenhydramine Oral sedating antihistamine Treatment of allergic conditions e.g. hay fever,vasomotor rhinitis, stings, urticaria, angioneurotic oedema, drug sensitivity,contact dermatitis and photosensitivity 1 or 2 tablets three or four times per day
Promethazine hydrochloride Oral sedating antihistamine Symptomatic relief of allergy such as hay fever, urticaria 25 mg at night or 10-25 mg twice daily
Pseudoephedrine Oral decongestant Symptomatic relief of allergic rhinitis 60 mg every 4-6 hours
[1 tablet every 12 hours]
Oxymetazoline Intranasal decongestant Symptomatic relief of congestion of the upper respiratory tract due to the common cold, hay fever and sinusitis. 1-2 sprays per nostril every 6-8 hours
Xylometazoline hydrochloride Intranasal decongestant symptomatic relief of nasal congestion, perennial and allergic rhinitis (including hay fever), sinusitis One application in each nostril 1 to 3 times daily
Clemastine hydrogen fumarate Oral antihistamine Allergic rhinitis, including hay fever and perennial rhinitis, vasomotor rhinitis 1mg clemastine base (one tablet) night and morning.
Acrivastine plus pseudoephedrine Oral antihistamine and decongestant Allergic rhinitis 8 mg acrivastine and 60 mg pseudoephedrine hydrochloride.Oral. One capsule as necessary, up to three times a day.
Triprolidine hydrochloride plus Pseudoephedrine Hydrochloride. Oral antihistamine and decongestant For the symptomatic relief of upper respiratory tract disorders which are benefited by a combination of a nasal decongestant and histamine H1-receptor antagonist, for example:
Allergic Rhinitis
Vasomotor Rhinitis
The Common Cold and Influenza
2.5 mg triprolidine hydrochloride and 60 mg pseudoephedrine Hydrochloride.
Oral. One tablet every 4-6 hours up to 4 times a day.
*Chlorphenamine plus ephedrine Oral antihistamine and decongestant Symptomatic relief of allergic conditions such as hay fever, allergic rhinitis, perennial rhinitis, urticaria etc. which are responsive to antihistamine. One or two tablets daily

* once daily products

** GSL and P products available - Indication only for Pharmacy product

§ Source: search of RAMA (a regulatory database) for the indications hay fever and allergic rhinitis, together with their dosing

Fluticasone propionate vs antihistamines

Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Antihistamines are available as oral, intranasal and eye preparations.5

A large number of randomised controlled trials investigating the effectiveness of once daily treatment with fluticasone propionate against currently available antihistamines, including loratadine and cetirizine, determined that fluticasone propionate was more effective than antihistamines in the treatment of the nasal symptoms of allergic rhinitis. 8-12

Antihistamines begin exerting their effect approximately 1-3 hours post dose,13 whilst relief of AR symptoms occur within 3-12 hours of treatment with fluticasone propionate.14 However, in an “as needed” study, fluticasone was shown to be more effective than loratadine in treating AR symptoms regardless of the time to symptom relief.11

In 2008, the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) produced guidelines based on evidence and expert opinion. The guidelines state that meta-analysis shows INCSs are superior to antihistamines and that all INCSs display similar clinical efficacy. INCSs were recommended as first-line therapy for moderate to severe persistent symptoms.5

Further, the superiority of fluticasone propionate versus antihistamines when treating allergic rhinitis symptoms has been reported in an extensive number of important review and practice guidelines.13-21

Walls RS et al. (2005)20, in a clinical update, discuss the optimized management of allergic rhinitis where INCS are considered the most effective therapy and are considered first-line treatment for persistent AR and moderate to severe intermittent AR in adults. In systemic reviews and meta-analyses INCS were shown to be superior to AH in controlling nasal symptoms of AR. Further, the author’s state there is no clear evidence that one INCS preparation is more effective than another.

Waddell AN et al. (2003)22, in a meta-analysis of randomized controlled trials comparing the efficacy of intranasal corticosteroids and oral antihistamines in the treatment of allergic rhinitis, showed a clear benefit in favour of intranasal steroids in relieving nasal symptoms and that there was no clear evidence to support the suggestion that one steroid spray was more effective than another in the treatment of seasonal or perennial allergic rhinitis.

Fluticasone propionate vs other active ingredients

The body of evidence confirms the superiority of intranasal corticosteroids (INCS) in the treatment of allergic rhinitis symptoms. Key findings and recommendations are summarised below:

Decongestants are taken by mouth or as a nasal spray or drops. They help shrink the lining of the nasal passages which helps relieves nasal stuffiness associated with allergic rhinitis. They may be useful for short-term treatment of allergic rhinitis to relieve severe nasal congestion.23

OTC saline nasal sprays/washes help counteract symptoms such as thick nasal mucus caused by AR.

Wallace DV et al. (2008)2, in a practice parameter, reported the relative efficacy of INCS against other currently available AR treatments. The author’s rated INCS as more effective than the intranasal antihistamines as well as the combination of an antihistamine and a leukotriene antagonist in the treatment of AR. The authors also state that INCS provide significant relief of seasonal AR when used not only on a regular basis but also on an as-needed basis and that this clinical response does not differ significantly between INCS preparations. This is further evidenced by a comparison of intranasal beclomethasone and fluticasone propionate in AR by Quinitilianni R (1995)24 which showed these agents to be equivalent.

In another practice parameter by Lambert M. (2009),25 INCSs are reported to be the most effective medications for controlling AR symptoms and may be used on an as-needed or regular basis. The author reports that they are more effective than intranasal chromlyn sodium, intranasal cholinergics (which are mainly effective against runny nose), as well as the combination of anti-leukotrienes and antihistamines.

A review by Gandhi RK et al. (2005)26 adds further support to the claim by detailing the relative efficacy of INCS. The authors describe cromolyns as being effective in controlling early phase symptoms however less effective at relieving nasal congestion; anticholinergic agents are useful in treatment of runny nose when INCS do not fully control this symptom; decongestant are effective only for short term use owing to their side-effect profile; and, in a meta-analysis comparing INCS with antihistamines in the treatment of AR, concluded that INCS were more effective at treating all nasal symptoms of AR including obstruction, sneezing, itching and discharge. The authors concluded that INCS are the most effective agents for treatment of AR and should be used as the first line treatment for moderate to severe AR.

In the Nielsen LP et al. (2001)16 review comparing INCSs and antihistamines (primarily antihistamines such as cetirizine and acrivastine) for the treatment of allergic rhinitis, INCSs offered superior relief. The currently available comparative data on the efficacy of INCS and AH clearly support INCS as more effective in the relief of nasal symptoms in patients with allergic rhinitis. This review supports the notion that INCS offer superior relief for the symptoms of allergic rhinitis.

Finally, in a review of fluticasone against sodium cromoglycate, Ratner PH et al. (2002)27 found intranasal corticosteroids to be more effective than sodium cromolyn (cromoglycate) for the treatment of allergic rhinitis.

Fluticasone propionate vs other intranasal corticosteroid

Intranasal corticosteroids work by suppressing multiple inflammatory mediators like histamines and leukotrienes.5 There are other intranasal corticosteroids available in the UK without a prescription in addition to fluticasone propionate. They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose. Numerous clinical guidelines and review articles recognise intranasal corticosteroids as the most effective treatment option for AR/Hay fever with equivalent or superior efficacy to other treatment types available OTC. 28-34

In their clinical guideline on the diagnosis and management of rhinitis, Wallace et al2 state:

“When comparing the available intranasal corticosteroids, the overall clinical response does not appear to vary significantly between products irrespective of the differences in topical potency, lipid solubility, and binding affinity.”

In conclusion, the overwhelming body of evidence demonstrates that intranasal corticosteroids provide equivalent relief and in some cases are superior to antihistamines, decongestants, sodium cromoglycate and anti-cholinergic agents in the treatment of AR symptoms. Further, the efficacies of the differing INCS have been demonstrated to be equivalent.

Conclusion

Based on the above information, it can be concluded that no other product available OTC is more effective than Pirinase Allergy 0.05% Nasal Spray (fluticasone propionate) or Pirinase Hayfever Relief for Adults 0.05% Nasal Spray for the relief of hay fever symptoms.

References

  1. Trangsrud AJ et al. Intranasal Corticosteroids for Allergic Rhinitis. Pharmacotherapy. 2002; 22(11): 1458–1467
  2. Wallace DV et al. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol. 2008;122:S1-84
  3. Waddell AN et al. Intranasal steroid sprays in the treatment of rhinitis: is one better than another? The Journal of Layngology & Otology. 2003; 117: 843-845
  4. Walls RS. Optimising the management of allergic rhinitis: an Australian perspective. MJA. 2005; 182: 28-33
  5. Scadding GK et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47:856–889.
  6. Pirinase Allergy 0.05% Nasal Spray Patient Information Leaflet
    https://www.medicines.org.uk/emc/files/pil.4502.pdf Accessed July 2020
  7. Pirinase Hayfever Relief for Adults 0.05% Nasal Spray Patient Information Leaflet
    https://www.medicines.org.uk/emc/files/pil.5116.pdf Accessed July 2020
  8. Charpin D and Vervloet D. “Treating seasonal rhinitis: Antihistamines or intranasal corticosteroids?” Eur Respir Rev 1994; 4(20): 256-259.
  9. Howard KB, Bowers BW, Cook CK, Westlund R, Rickard K. “Intranasal fluticasone, loratadine tablets, and their use in combination: an evaluation in of economic and humanistic outcomes”. Drug Benefit Trends 2001; Oct: 46-52.
  10. Karaman O, Gunbay A, Uzuner N, Gunbay U, Gulay Z, Serioglu S, Yuluga N. “The comparison of the efficacy of fluticasone propionate with cetirizine in perennial allergic rhinitis”. Allergol et Immunopathol 2001; 29:55-59.
  11. Kaszuba SM, Baroody FM, deTineo M, Haney L, Blair C, Naclerio M. “Superiority of an Intranasal Corticosteroid Compared With an Oral Antihistamine in the As-Needed Treatment of Seasonal Allergic Rhinitis”. Arch Intern Med. 2001;161:2581-2587.
  12. Ratner PH, Van Bavel JH, Martin BG, Hampel Jr. FC, Howland III WC., Rogenes PR, Westlund RE, Bowers BW, Cook CK. “A comparison of the efficacy of fluticasone propionate aqueous nasal spray and loratadine, alone and in combination, for the treatment of seasonal allergic rhinitis”. J Fam Prac 1998; 47:2 (118-125)
  13. Kay B. Managing summer hayfever. Practitioner 2005 249:1670 (372-378)
  14. Tiñana AM, Bloebaum RM, Grant JA. “Managing allergic rhinitis: The role of pharmacotherapy”. Drug Benefit Trends 2009 21:10 (312-318).
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