Effect of a single dose of a topical glucocorticoid and a cyclo-oxygenase inhibitor on allergen-induced changes in nasal reactivity.
The inflammatory response of airway mucosa to allergen exposure is a complex phenomenon featuring symptoms, the influx of inflammatory cells, the release of mediators, and changes in local reactivity. These features and their pharmacological modifications can be successfully studied in nasal challenge models. We performed a nasal allergen challenge followed by a rechallenge with allergen 24 h later in order to monitor changes in specific reactivity due to the initial allergen challenge. Symptoms were monitored, as was the generation of TAME-esterase activity in nasal lavage fluids. Prior to each challenge a nasal brush specimen was taken. In a double blind, cross-over, double-dummy manner the patients were pretreated with placebo, a single dose of 200 micrograms of budesonide (topical corticosteroid) given 2 h prior to rechallenge with allergen or 600 mg ibuprofen (cyclooxygenase inhibitor) given per os t.i.d. to steady state starting 24 h prior to the initial allergen challenge. Treatment with ibuprofen induced a slightly lower composite symptom score (P less than 0.05) at the initial allergen challenge when compared with placebo. No differences were noted in the relevant TAME-esterase activities. The allergen challenge resulted in significantly increased proportions of eosinophils in the brush specimens 24 h after the initial allergen challenge (P less than 0.001) with no differences between the different treatment alternatives. At rechallenge there was a reduction in the symptoms of secretion and nasal blockage in both groups receiving active treatment compared with placebo (P less than 0.05), whereas the number of sneezes was not affected and no differences were noted in TAME-esterase activity.(ABSTRACT TRUNCATED AT 250 WORDS)
Klementsson
H
H
Department of Oto-Rhino-Laryngology, University Hospital, Lund, Sweden.
Lindqvist
N
N
Andersson
M
M
Pipkorn
U
U
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D019819:Budesonide; D004311:Double-Blind Method; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009297:Nasal Mucosa / Q000187:drug effects* / Q000201:enzymology; D010447:Peptide Hydrolases / Q000032:analysis; D011282:Pregnenediones / Q000008:administration & dosage / Q000627:therapeutic use*; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000201:enzymology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011282:Pregnenediones; D019819:Budesonide; D011451:Prostaglandin-Endoperoxide Synthases; D010447:Peptide Hydrolases; C023073:tosylarginine methyl ester hydrolase; D007052:Ibuprofen