title: Nasal corticosteroid treatment reduces substance P levels in tear fluid in allergic rhinoconjunctivitis.
abstract: BACKGROUND
  The mechanisms underlying conjunctival symptom reduction by nasal corticosteroids in allergic rhinoconjunctivitis are unknown. A naso-ocular reflex may be present.
  
  
  OBJECTIVE
  To study the effects of nasal fluticasone furoate (FF) on conjunctival symptoms and substance P and histamine levels in tear fluid after nasal grass pollen provocation (GPP).
  
  
  METHODS
  A double-blind placebo-controlled study was performed in 26 grass pollen-allergic patients. A selective GPP was performed during the grass pollen season after 2 weeks of FF or placebo treatment. Nasal and conjunctival symptoms were scored using a visual analog scale (VAS), and tear fluid was collected for measuring substance P and histamine using an enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Compared with placebo, FF reduced conjunctival symptom scores during the pollen season (-1.75 [-2.75, 0.20] vs 0.0 [0.0, 0.0]; P = .01) and after GPP at 15 minutes (0.05 [-0.42, 1.52] vs 2.05 [0.62, 3.62]; P < .001) and 1 hour (-0.45 [-1.75, 0.1] vs 0.05 [-0.97, 1.85]; P < .01). Treatment with FF decreased substance P levels in tear fluid (44.11 [32.81, 61.02] vs 65.26 [48.62, 79.73] pg/mg protein; P = .0098). Histamine levels in tear fluid showed a GPP-induced increase in the placebo group (7.26 [3.12, 9.69] vs 5.71 [2.05, 7.00] ng/mg protein; P = .02), but not in the FF group (6.77 [3.43, 13.00] vs 5.24 [3.18, 7.06] ng/mg protein; P = .08).
  
  
  CONCLUSIONS
  FF nasal spray reduced conjunctival symptoms in grass pollen-allergic patients in parallel with lower substance P levels in tear fluid. These data help in understanding the reduction of conjunctival symptoms by intranasal anti-inflammatory therapy.
authors: Clinical Immunology, Department of Microbiology and Immunology, Catholic University Leuven, Belgium.
authors: Ina
authors: I
authors: Callebaut
authors: Evelien
authors: E
authors: Vandewalle
authors: Valérie
authors: V
authors: Hox
authors: Sonja
authors: S
authors: Bobic
authors: Mark
authors: M
authors: Jorissen
authors: Ingeborg
authors: I
authors: Stalmans
authors: Annick
authors: A
authors: De Vries
authors: Glenis
authors: G
authors: Scadding
authors: Peter W
authors: PW
authors: Hellings
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D052179:Antigens, Plant / Q000009:adverse effects / Q000276:immunology; D003228:Conjunctiva / Q000187:drug effects / Q000276:immunology; D003233:Conjunctivitis, Allergic / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006632:Histamine / Q000378:metabolism; D006801:Humans; D008297:Male; D009299:Nasal Provocation Tests; D010256:Paranasal Sinuses / Q000187:drug effects / Q000276:immunology; D006109:Poaceae; D011058:Pollen / Q000009:adverse effects / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000188:drug therapy*; D012621:Seasons; D013373:Substance P / Q000378:metabolism*; D013666:Tears / Q000378:metabolism*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D052179:Antigens, Plant; D013373:Substance P; D006632:Histamine; C523187:fluticasone furoate