Onset of action of intranasal budesonide (Rhinocort aqua) in seasonal allergic rhinitis studied in a controlled exposure model.
BACKGROUND
Intranasal budesonide aqueous nasal spray (BANS) is recognized as an efficacious treatment for seasonal allergic rhinitis (SAR), but the time to onset of action is not known.


OBJECTIVE
The primary objective was to evaluate the time at which the onset of action of BANS in the symptomatic relief of seasonal allergic rhinitis becomes evident within 12 hours after a single dose in a controlled ragweed pollen exposure setting.


METHODS
The study was of a double-blind, randomized, parallel-group design, testing BANS (64 microgram and 256 microgram) and placebo on ragweed-sensitive subjects with symptoms for at least 1 year by using a controlled pollen challenge system (Environmental Exposure Unit). The efficacy variables were the combined nasal score (the sum of blocked nose, runny nose, and sneezing-itchy nose), individual nasal symptoms, overall evaluation of treatment efficacy reported by participants on diaries, and peak nasal inspiratory flow (PNIF).


RESULTS
A total of 217 participants were treated with BANS or placebo. At 7 to 12 hours, BANS was better than placebo in reducing combined nasal and blocked nose symptoms. For PNIF, the time to onset of action was shortest for 256 microgram of BANS relative to placebo (3 hours, P =.003). BANS 64 microgram was better than placebo in reducing the individual scores of blocked nose, runny nose, and sneezing-itchy nose from 3 to 5 hours after administration. Treatment efficacy was higher for those receiving BANS compared with placebo starting at 5 hours. All treatments were well tolerated, and no specific adverse events occurred.


CONCLUSIONS
The onset of action of intranasal BANS was 7 hours according to combined nasal and blocked nose symptom scores. Evidence of earlier response was observed at 3 hours for runny nose and PNIF.
Day
J H
JH
Department of Medicine, Queen's University, Kingston; the Division of Allergy and Immunology, Kingston General Hospital, Kingston.
Briscoe
M P
MP
Rafeiro
E
E
Ellis
A K
AK
Pettersson
E
E
Akerlund
A
A
D000281:Administration, Intranasal; D000328:Adult; D019819:Budesonide / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004311:Double-Blind Method; D006801:Humans; D007320:Inspiratory Capacity; D017060:Patient Satisfaction; D006255:Rhinitis, Allergic, Seasonal; D013810:Therapeutic Equivalency; D013997:Time Factors
D019819:Budesonide