{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:16:33Z","timestamp":1788398193582,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allergic rhinitis (AR) represents a significant burden in Ear Nose Throat (ENT) practice and markedly affects quality\u2010of\u2010life and work productivity of AR patients. The fixed combination of intranasal azelastine and fluticasone propionate (AzeFlu) has emerged as a valuable therapeutic option for moderate\u2010to\u2010severe AR. Recent updates to international guidelines and real\u2010world evidence warrant a comprehensive review of its role in ENT practice, with particular attention to both seasonal and perennial AR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review synthesises evidence from the ARIA\u2010EAACI 2024\u20132025 guidelines, systematic reviews and network meta\u2010analyses of randomised controlled trials, pharmacovigilance data, and results from an Italian multidisciplinary inter\u2010societal Delphi Consensus. We evaluated efficacy, safety, patient acceptability and implementation considerations specific to otorhinolaryngology practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Network meta\u2010analyses demonstrate that AzeFlu provides superior symptom control compared to monotherapy for both nasal and ocular symptoms in seasonal and perennial AR, with a rapid onset of action (15\u201330\u2009min). The combination shows particular efficacy in patients with moderate\u2010to\u2010severe symptoms inadequately controlled by monotherapy. Safety profiles are comparable to those of monotherapy, with no significant effects on growth or the HPA axis in children. Real\u2010world data indicate high treatment satisfaction and adherence. The Italian Delphi Consensus achieved &gt;\u200980% agreement on key management principles, particularly emphasising control of Type 2 inflammation and the role of combination therapy in treatment algorithms. Evidence for perennial AR remains more limited, and future primary research specifically targeting perennial rhinitis populations is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Azelastine\u2010fluticasone combination therapy represents an evidence\u2010based, guideline\u2010recommended option for moderate\u2010to\u2010severe AR in ENT practice. Its dual mechanism, rapid onset, favourable safety profile and high patient acceptability support its integration into contemporary treatment algorithms, particularly for patients requiring enhanced symptom control beyond monotherapy. The combination represents a meaningful therapeutic advancement, and further research is needed to fully characterise its role in perennial AR management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.70168","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:54:06Z","timestamp":1788396846000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Azelastine\u2010Fluticasone Intranasal Combination Therapy in Otorhinolaryngology: Clinical Evidence, Current Practice Patterns and Future Perspectives"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7016-8421","authenticated-orcid":false,"given":"Giorgio","family":"Ciprandi","sequence":"first","affiliation":[{"name":"Department of Medicine and Health Sciences University of Molise  Campobasso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7155-273X","authenticated-orcid":false,"given":"Ignazio","family":"La Mantia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery University of Enna Kore  Enna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio","family":"Varricchio","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences University of Molise  Campobasso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"issue":"3","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1002\/clt2.12130","article-title":"Worldwide Prevalence of Rhinitis in Adults: A Review of Definitions and Temporal Evolution","volume":"12","author":"Savoure M.","year":"2022","journal-title":"Clinical and Translational Allergy"},{"issue":"6","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.jaip.2024.03.036","article-title":"Poor Rhinitis and Asthma Control Is Associated With Decreased Health\u2010Related Quality of Life and Utilities: A MASK\u2010Air Study","volume":"12","author":"Vieira R. 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