Fluticasone furoate nasal spray reduces the nasal-ocular reflex: a mechanism for the efficacy of topical steroids in controlling allergic eye symptoms.
BACKGROUND
Eye symptoms frequently occur in patients with allergic rhinitis and are among the most bothersome symptoms. Intranasal steroids have been shown to reduce ocular symptoms associated with allergic nasal symptoms, even though they do not reach the eye.


OBJECTIVE
To elucidate a mechanism to explain these observations.


METHODS
We performed a double-blind, placebo-controlled, crossover experiment in 20 subjects with seasonal allergic rhinitis. Nasal antigen challenge was performed consecutively for 3 days after 1 week of treatment with either placebo or fluticasone furoate nasal spray (FFNS). Subjects recorded their nasal and ocular symptoms, and nasal secretions were quantified. Nasal scrapings to quantify eosinophils were obtained before each antigen challenge.


RESULTS
Nasal challenge with antigen led to sneezing, a nasonasal, and a nasal-ocular reflex. Priming in the number of sneezes, contralateral nasal secretion weights, and total eye symptoms were observed. Treatment with FFNS reduced sneezing, the nasonasal and nasal-ocular reflexes, and the amount of eosinophils in nasal secretions.


CONCLUSIONS
We confirmed that a nasal-ocular reflex follows nasal challenge with allergen and that it can contribute to the ocular symptoms associated with allergic rhinitis. FFNS reduced eosinophil infiltration, priming, and ocular symptoms. Furthermore, our results support a mechanism by which control of eye symptoms can be achieved during nasal administration of an intranasal steroid in patients with seasonal allergic rhinitis.
Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA. fbaroody@surgery.bsd.uchicago.edu
Fuad M
FM
Baroody
Deanna
D
Shenaq
Marcy
M
DeTineo
JiangHong
J
Wang
Robert M
RM
Naclerio
D000281:Administration, Intranasal; D000328:Adult; D000485:Allergens / Q000276:immunology; D000730:Androstadienes / Q000008:administration & dosage*; D018926:Anti-Allergic Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004804:Eosinophils / Q000187:drug effects / Q000502:physiology; D005123:Eye / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009299:Nasal Provocation Tests; D009666:Nose / Q000187:drug effects* / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000187:drug effects*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology
D000485:Allergens; D000730:Androstadienes; D018926:Anti-Allergic Agents; C523187:fluticasone furoate