title: Intranasal steroid reduces exhaled bronchial cysteinyl leukotrienes in allergic patients.
abstract: BACKGROUND
  Allergic rhinitis (AR) precedes and is often associated with bronchial asthma. Indeed, local and systemic inflammations in both conditions are very similar. Cysteinyl-leukotrienes (cys-LTs) are generated during early- and late-phase allergic reactions and induce smooth-muscle contraction, microvascular leakage, and mucous hypersecretion. Cys-LTs are detected in exhaled breath condensate (EBC) of asthmatics and regardless of bronchial symptoms, they are also found in EBC of rhinitic patients.
  
  
  OBJECTIVE
  To evaluate cys-LTs in EBC of allergic patients and to assess the activity of nasal fluticasone propionate (FP) on EBC cys-LTs levels.
  
  
  METHODS
  Cys-LTs coefficient of variation (CV) was evaluated from different EBC in 5 healthy volunteers. Cys-LTs levels from EBCs in 13 healthy controls and 56 allergic rhinitic (n=31) and rhinitic/asthmatic (n=25) patients were also evaluated at baseline. Subsequently patients were randomized to receive either FP 100 microg/day per nostril or placebo for 2 weeks and then re-evaluated for EBC cys-LTs.
  
  
  RESULTS
  The CV was 14.12%. EBC cys-LTs in allergic patients were significantly higher than in healthy subjects (70.9 vs. 20.6 pg/mL (median), P<0.05), while it did not differ between asthmatic/rhinitic and purely rhinitic patients. Treatment significantly reduced cys-LTs (from 93.6 to 19.9 pg/mL, P<0.001). This effect was evident both in asthmatic/rhinitic and in rhinitic patients.
  
  
  CONCLUSIONS
  Treatment of AR with FP significantly reduces the levels of cys-LTs, major noninvasive markers of lower airway inflammation, suggesting that upper and lower airway inflammation is present and should be thus treated as a whole in subjects with AR with and without asthma.
authors.affiliation: Department of Internal and Specialistic Medicine, Section of Respiratory Medicine, University of Catania, Catania, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Failla
authors.forename: G
authors.initials: G
authors.lastname: Biondi
authors.forename: M
authors.initials: M
authors.lastname: Provvidenza Pistorio
authors.forename: E
authors.initials: E
authors.lastname: Gili
authors.forename: C
authors.initials: C
authors.lastname: Mastruzzo
authors.forename: C
authors.initials: C
authors.lastname: Vancheri
authors.forename: N
authors.initials: N
authors.lastname: Crimi
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000730:Androstadienes / Q000494:pharmacology* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests / Q000379:methods; D001980:Bronchi / Q000378:metabolism*; D003545:Cysteine / Q000378:metabolism*; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D015289:Leukotrienes / Q000378:metabolism*; D008297:Male; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D000068298:Fluticasone; D003545:Cysteine