Another limitation of the studies presented here was th by virtue of the study desi patient QoL was only assessed on day 4, whi howev was suf ient to demonstrate that M had clinically relevant superiority versus placebo. In follow-up research QoL assessments on day might be consider and daily visual analogue scale monitoring might help us better understand patientsviews. 5 The mechanism of action of M in conjunction with the  Proteasome Inhibitors provided evidence indicate at least an additive effect of M over FP and azelastine alone. Howev this study cannot demonstrate whether there is synergy. Challenge tests might be more appropriate. When developing newbinatio potential drug-drug interactions are important to consider.

A recent pharmacoki-netic study proved that in the given case a drug-drug interaction could be excluded. Howev at a very low lev a modest increase in systemic FP bioavailabilitypared with that of marketed FP could be detected. This may occur because the novel formulation characteristics of M could result in a greater contact area for FP absorption with the nasal mucosal surfa thereby allowing improved local bioavailability and clinical ef acy. 6 Consequent the treatment difference of M pared with amercial FP formulation can be expected to be more pronounced than shown in the studies presented here. This has J ALLERGY CLIN IMMUNOL VOLUME nn NUMBER nn been illustrated in a previously published study that showed that M provided better and faster control of AR symptoms than observed in our studies whenpared with amercial FP spray. 7 Howev that study could not distinguish formulation and pharmacologic effects and therefore was of limited scienti value when trying to dee theplementary pharmacologic ef-fects of intranasal  Varespladib antihistamines and corticosteroids in patients with AR. In summa to our knowled this is the largest body of evidenceparing the ef acy of different types of intranasal AR therapies. In nearly patien M was faster and more effective than established st-line therapies in patients with moderate and severe AR.

The results are consistent among different paramete including ocular sympto and across various allergy seasons. Taken togeth these results show that M can be considered the dukes  drug of choice for AR therapy because it offers additional bene to patients with in particular with moderate-to-severe disease. We thank Ruth B. Murr Ph for assistance in drafting and editing this manuscript. We also appreciate the critical review of William Wheel PhD . All authors fulled the criteria for authorship as described in the Internationalmittee of Medical Journal Editors Uniform Requirements. List of investigators Niran .