Effects of intranasal azelastine on the response to nasal allergen challenge.
OBJECTIVE
Azelastine, a second-generation H1-receptor antagonist, is available for topical administration. The aim of the study was to evaluate the effects of topical intranasal azelastine on the early-phase and the late-phase allergic responses and on nasal hyper-responsiveness to methacholine.


METHODS
Double-blind, placebo-controlled, two-way crossover study in 20 subjects with seasonal allergic rhinitis, out of their allergy season.


METHODS
Subjects were randomly assigned to receive either placebo or two puffs of azelastine twice a day (548 microg/d) for 2 weeks followed by nasal challenge with allergen. Twenty-four hours later, while still receiving treatment, subjects underwent a nasal lavage and a nasal challenge with methacholine. End points included symptom scores, levels of mediators and number of eosinophils in nasal lavages, and the weight of secretions after methacholine challenge.


RESULTS
Compared with placebo, treatment with intranasal azelastine resulted in significant reductions in allergen-induced sneezing, rhinorrhea, itching, nasal congestion, and levels of albumin during the early-phase response (P <.05). Azelastine had no effect on levels of histamine or tryptase during the early-phase response. There was a significant eosinophil influx 24 hours after challenge, which was not inhibited by azelastine. Treatment with azelastine had no effect on the levels of albumin, interleukin-4, interleukin-5, intercellular adhesion molecule-1, tumor necrosis factor-alpha, and eosinophil cationic protein during the late-phase response. However, azelastine did show a significant inhibitory effect on the methacholine response 24 hours after nasal allergen challenge (P <.05).


CONCLUSIONS
The effects of intranasal azelastine are similar to those of oral second-generation antihistamines.
Saengpanich
Supinda
S
Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 1035, Chicago, IL 60637, U.S.A.
Assanasen
Paraya
P
deTineo
Marcy
M
Haney
Lauran
L
Naclerio
Robert M
RM
Baroody
Fuad M
FM
D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D016210:Methacholine Chloride; D017817:Nasal Lavage Fluid / Q000276:immunology; D009299:Nasal Provocation Tests; D010793:Phthalazines / Q000008:administration & dosage*; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
D018836:Inflammation Mediators; D010793:Phthalazines; D016210:Methacholine Chloride; C020976:azelastine