Olfactory cleft inflammation is present in seasonal allergic rhinitis and is reduced with intranasal steroids.
BACKGROUND
Allergic rhinitis (AR) is commonly associated with olfactory loss, although the mechanism is not well studied. This study was designed to determine the effect of mometasone furoate (MF) on olfactory loss in seasonal AR (SAR) and study its effect on inflammation in the olfactory region.


METHODS
We performed a randomized, double-blind, placebo-controlled, parallel clinical trial in 17 patients with SAR who had symptoms of impaired olfaction. Subjects received MF or placebo for 2 weeks during their allergy season. Before and after treatment, we measured nasal peak inspiratory flow (NPIF), chemosensory quality of life, and objective olfactory function (the University of Pennsylvania Smell Identification Test). Additionally, nasal cytology samples were obtained from each visit, and a unilateral endoscopic biopsy specimen of the olfactory epithelium was obtained at the end of the study and scored for inflammation.


RESULTS
Treatment with MF was associated with improved nasal symptoms (p < 0.015), NPIF (p < 0.04), reduced nasal inflammation (p < 0.05), and chemosensory-specific quality of life (p < 0.03). Histological analysis of the olfactory region reveals fewer eosinophils in the MF group when compared with placebo (p < 0.012). We found no improvement in objective olfactory function (p > 0.05).


CONCLUSIONS
The use of MF in SAR is associated with reduced eosinophilic inflammation in the olfactory region and improved symptoms of AR. The presence of eosinophils in the olfactory area in SAR may indicate a direct, deleterious effect of inflammation on olfactory epithelium in this disease. In this study we show that inflammation in SAR can affect the olfactory cleft, implicating a direct role for allergic inflammation in smell loss. Treatment with intranasal steroids is associated with decreased inflammation in the olfactory region in humans. This treatment is also associated with improved olfactory quality of life.
Sivam
Anita
A
Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois 60637, USA.
Jeswani
Seema
S
Reder
Lindsay
L
Wang
Jianghong
J
DeTineo
Marcella
M
Taxy
Jerome
J
Baroody
Fuad M
FM
Naclerio
Robert M
RM
Pinto
Jayant M
JM
D000281:Administration, Intranasal; D000328:Adult; D000377:Agnosia; D000485:Allergens / Q000276:immunology; D031164:Ambrosia; D004804:Eosinophils / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation; D001239:Inhalation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D000068656:Mometasone Furoate; D009296:Nasal Cavity / Q000276:immunology / Q000473:pathology*; D009831:Olfactory Mucosa / Q000276:immunology / Q000473:pathology*; D006109:Poaceae; D011058:Pollen / Q000276:immunology; D011244:Pregnadienediols / Q000008:administration & dosage / Q000009:adverse effects; D011788:Quality of Life; D020127:Recovery of Function; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology
D000485:Allergens; D011244:Pregnadienediols; D000068656:Mometasone Furoate