Effect of intranasal fluticasone proprionate on the immediate and late allergic reaction and nasal hyperreactivity in patients with a house dust mite allergy.
BACKGROUND
Patients with perennial allergic rhinitis develop nasal symptoms not only after allergen exposure, but generally also after non-specific stimuli.


OBJECTIVE
To evaluate the effect of 2 week's treatment with fluticasone propionate aqueous nasal spray (FPANS) on the nasal clinical response, inflammatory mediators and nasal hyperreactivity.


METHODS
Twenty-four rhinitis patients allergic to house dust mite (HDM), participated in a double-blind, placebo-controlled crossover study. After 2 week's treatment with placebo or 200 micrograms FPANS twice daily, patients were challenged with HDM extract. Symptoms were recorded and nasal lavages were collected for up to 9.5 h after challenge. Nasal hyperreactivity was determined by histamine challenge 24 h later.


RESULTS
Because of a carry-over effect for the immediate symptom score, for this variable only the data from the first treatment period were used. FPANS treatment resulted in a significant decrease of nasal symptoms with 70%, 69% and 63% after 100, 1000 and 10,000 Biological Units (BU)/mL of HDM extract respectively. Active treatment resulted in a 76% decrease of the late-phase symptoms. FPANS treatment significantly reduced albumin influx after HDM 1000 BU/mL with 62% and tended to reduce tryptase release after HDM 1000 BU/mL (P = 0.0629). During the late phase FPANS treatment reduced albumin influx with 67% and eosinophil cationic protein (ECP) release with 83%. No effect of FPANS was seen on histamine levels. FPANS significantly decreased histamine-induced symptom score with 34%, secretion with 32% and sneezes with 41%.


CONCLUSIONS
FPANS significantly inhibits the immediate and late allergic response, and nasal hyperreactivity, probably by suppressing mast cells and eosinophils in the nasal mucosa.
de Graaf-in't Veld
C
C
Department of Allergology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Garrelds
I M
IM
Jansen
A P
AP
Van Toorenenbergen
A W
AW
Mulder
P G
PG
Meeuwis
J
J
Gerth van Wijk
R
R
D000281:Administration, Intranasal; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D039741:Antigens, Dermatophagoides; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006023:Glycoproteins / Q000276:immunology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000188:drug therapy* / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008925:Mites / Q000276:immunology*; D009297:Nasal Mucosa / Q000187:drug effects* / Q000276:immunology* / Q000473:pathology; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000276:immunology
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D039741:Antigens, Dermatophagoides; D006023:Glycoproteins; D000068298:Fluticasone