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We aimed to compare the efficacy and potential mechanisms of budesonide nasal spray (BD), oral montelukast (MNT), and combination therapy comprising a half\u2010dose of budesonide plus montelukast (hBD+MNT) in SAR patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a single\u2010center, randomized, open\u2010label study in SAR subjects (n = 100). Participants were randomized to receive BD (256 \u03bcg), MNT (10 mg), or hBD (128 \u03bcg)+MNT for 14 days. Symptom severity scores, nasal cavity volume (NCV), fraction of exhaled nitric oxide (FeNO), eosinophil cationic protein (ECP), histamine and cysteinyl\u2010leukotrienes (CysLTs), and T\u2010cell subsets were assessed before and after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All treatments significantly improved symptoms from baseline; however, hBD+MNT produced significantly greater improvements in nasal congestion compared with BD or MNT alone. The BD and hBD+MNT groups had fewer patients with uncontrolled symptoms and improved NCV to a greater level than the MNT group. FeNO was decreased to a significantly greater extent from baseline after hBD+MNT treatment than after BD and MNT treatments. ECP, histamine, and CysLTs showed significantly greater decreases after BD and hBD+MNT treatments than after MNT treatment. BD decreased T\u2010helper 1 (Th1) and Th2 cells and increased T\u2010regulatory (Treg) cells in nasal mucosa and MNT decreased Th1 cells and increased Treg cells in peripheral blood, and this trend was reflected with hBD+MNT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The hBD+MNT combination may have an overall better efficacy profile than BD and MNT monotherapy for treatment of SAR.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22197","type":"journal-article","created":{"date-parts":[[2018,8,24]],"date-time":"2018-08-24T14:31:54Z","timestamp":1535121114000},"page":"1242-1252","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Comparison of the efficacy and mechanisms of intranasal budesonide, montelukast, and their combination in treatment of patients with seasonal allergic rhinitis"],"prefix":"10.1002","volume":"8","author":[{"given":"Hui","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Beijing TongRen Hospital, Capital Medical University  Beijing China"},{"name":"Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology  Beijing China"},{"name":"Department of Allergy, Beijing TongRen Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongfei","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Beijing TongRen Hospital, Capital Medical University  Beijing China"},{"name":"Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifei","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Allergy, Beijing TongRen Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0910-9884","authenticated-orcid":false,"given":"Luo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Beijing TongRen Hospital, Capital Medical University  Beijing China"},{"name":"Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology  Beijing China"},{"name":"Department of Allergy, Beijing TongRen Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengshuo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Beijing TongRen Hospital, Capital Medical University  Beijing China"},{"name":"Beijing Key Laboratory of Nasal Diseases Beijing Institute of Otolaryngology  Beijing China"},{"name":"Department of Allergy, Beijing TongRen Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01620.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.05.013"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2010.06.047"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-6749(96)80216-8"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2016.06.009"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-016-0620-y"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.13527"},{"issue":"19","key":"e_1_2_6_9_1","first-page":"1","article-title":"International consensus report on the diagnosis and management of rhinitis. 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