No difference between over-the-counter and prescription drug in relieving seasonal allergies

February 20, 2006

A small study indicates that there was no difference between an over-the-counter decongestant (pseudoephedrine) and a prescription medication (montelukast) in relieving symptoms associated with allergic rhinitis and improving quality of life, according to a study in the February issue of Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals.

Allergic rhinitis, inflammation and congestion of the nasal passages associated with seasonal allergies, such as hay fever, affects about 40 million people in the United States. Symptoms include sneezing, runny nose, itchy nose and throat and nasal congestion, according to background information in the article. The condition also may cause more serious consequences, such as problems sleeping, daytime sleepiness and reduced productivity. Several medications, including pseudoephedrine hydrochloride (an over-the-counter preparation) and montelukast sodium (a prescription drug), are available to treat symptoms, the authors report.

Samatha M. Mucha, M.D., and colleagues at the University of Chicago compared these two treatments in a group of 58 adults with ragweed allergic rhinitis, as documented by the results of skin testing. Participants recorded their symptoms and quality of life at the beginning of the study and took one of the medications each morning for two weeks. Thirty patients received montelukast and 28 took pseudoephedrine.

Both treatments reduced all the symptoms of allergic rhinitis, including congestion, runny nose and sneezing, and improved quality of life. Pseudoephedrine was more effective than montelukast at alleviating the symptom of nasal congestion. Both medications improved nasal peak inspiratory flow, which objectively gauges nasal congestion by measuring the amount of air flowing into the nose.

Although nervousness, anxiety, insomnia, dry mouth and palpitations have been associated with pseudoephedrine in previous studies, neither medication caused any significant side effects in this investigation. "Both medications were well tolerated, and pseudoephedrine did not lead to any of its well-known stimulant adverse effects, likely owing to its once-daily administration in the morning and lower blood levels in the later hours of the day closer to bedtime," the authors write.
(Arch Otolaryngol Head Neck Surg. 2006;132:164-172. Available pre-embargo to the media at

Editor's Note: Drs. Naclerio and Baroody belong to the Speakers Bureaus of Merck & Co. Inc. and Dr. Baroody has received honoraria from Merck. This study was supported in part by a medical school grant from Merck & Co. Inc. (Dr. Baroody) and Merck contributed editorial suggestions during the preparation of this article.

The JAMA Network Journals

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