The aim of this study was to examine the effects of aqueous triamcinolone acetonide (TAA AQ) and fluticasone propionate (FP) nasal sprays on seasonal allergic rhinitis (SAR) symptoms and health-related quality of life (HRQL) in patients stratified into cohorts based on symptom severity. In a multicenter, investigator-blinded, parallel-group study, 295 patients with a > or =2-year history of SAR received once-daily TAA AQ, 220 microg, or FP, 200 microg, for 3 weeks. Median baseline total nasal symptom score (TNSS; sum of nasal congestion, rhinorrhea, sneezing, and nasal itching scores) for all patients was 8.14 (range, 0-12). Patients were stratified by baseline TNSS into a moderate (<814) or severe (> or =8.14) cohort. Changes from baseline TNSS, individual symptom scores, and HRQL were assessed. Sixty-nine TAA AQ and 76 FP patients were included in the moderate stratum (baseline mean TNSS = 6.14 and 6.22, respectively), and 79 (TAA AQ) and 71 (FP) patients were included in the severe stratum (TNSS = 10.03 and 9.47, respectively). At the study end, patients showed significant (p < 0.0001 all comparisons) and comparable improvements in TNSS in both the moderate (TAA AQ, -2.40 [95% confidence interval [CI, -2.92, -1.87], 39% improvement; FP, -2.22 [95% CI, -2.72, -1.73], 36% improvement) and the severe (TAA AQ, -3.85 [95% CI, -4.36, -3.33], 38% improvement; FP, -3.84 [95% CI, -4.43, -3.24], 41% improvement) strata. TAA AQ and FP significantly and comparably improved HRQL in both strata versus baseline. Once-daily TAA AQ and FP nasal sprays in patients with moderate or severe SAR provided significant and comparable symptom relief and improvements in HRQL.