title: Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray.
abstract: OBJECTIVE
  To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine.
  
  
  METHODS
  Prospective, randomized, multicenter, open-label, parallel-group study.
  
  
  METHODS
  Two tertiary care academic institutions.
  
  
  METHODS
  Seventy-five subjects older than 18 years with perennial allergic rhinitis.
  
  
  METHODS
  Patients received either fluticasone propionate aqueous nasal spray, 200 microg once daily, or terfenadine, 60 mg twice daily, for 1 year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy.
  
  
  METHODS
  Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment.
  
  
  RESULTS
  Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P = .03).
  
  
  CONCLUSIONS
  Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.
authors.affiliation: MD, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 S Maryland Ave, MC1035, Chicago, IL 60637, USA. fbaroody@surgery.bsd.uchicago.edu
authors.forename: F M
authors.initials: FM
authors.lastname: Baroody
authors.forename: C C
authors.initials: CC
authors.lastname: Cheng
authors.forename: B
authors.initials: B
authors.lastname: Moylan
authors.forename: M
authors.initials: M
authors.lastname: deTineo
authors.forename: L
authors.initials: L
authors.lastname: Haney
authors.forename: K D
authors.initials: KD
authors.lastname: Reed
authors.forename: C K
authors.initials: CK
authors.lastname: Cook
authors.forename: R E
authors.initials: RE
authors.lastname: Westlund
authors.forename: E
authors.initials: E
authors.lastname: Sengupta
authors.forename: J P
authors.initials: JP
authors.lastname: Corey
authors.forename: A
authors.initials: A
authors.lastname: Togias
authors.forename: R M
authors.initials: RM
authors.lastname: Naclerio
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D018926:Anti-Allergic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001284:Atrophy; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects* / Q000473:pathology; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000473:pathology; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000473:pathology; D016593:Terfenadine / Q000008:administration & dosage
chemical_list: D000730:Androstadienes; D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D016593:Terfenadine; D000068298:Fluticasone