title: Clinical efficacy of nasal steroids on nonallergic rhinitis and the associated inflammatory cell phenotypes.
abstract: BACKGROUND
  Although good response to nasal steroid therapy has been documented in allergic rhinitis (AR), the efficacy of this treatment in non-AR, and the associated inflammatory cell phenotypes has not been fully investigated.
  
  
  OBJECTIVE
  To compare the response to steroids in non-AR versus AR and to assess the impact of inflammatory cell phenotypes on non-AR treatment outcomes.
  
  
  METHODS
  A total of 149 patients with rhinitis were divided into non-AR and AR groups by using the allergy skin-prick test. Based on nasal cytology, the non-AR group was further divided into inflammatory non-AR (INAR) and noninflammatory non-AR (NINAR) groups, and the INAR groups were further subdivided into four phenotypes according to inflammatory cell type: non-AR with eosinophils (NARES), non-AR with mast cells (NARMA), non-AR with neutrophils (NARNE), and NARES and mast cells (NARESMA). All the patients were treated over 28 days with 220 μg of nasal triamcinolone acetonide once daily. Nasal symptom score, peak inspiratory flow index, and nasal mucociliary clearance time (NMCCT) were used to evaluate treatment outcomes.
  
  
  RESULTS
  The initial screening found 67 patients with non-AR and 82 patients with AR. At 28 days after nasal steroid treatment, all nasal symptom score, peak inspiratory flow indexes, and NMCCTs were significantly improved within each group; however, the non-AR group recorded significantly lower levels of improvement in blocked nose, rhinorrhea, sneezing, nasal itching, peak flows, and NMCCTs than the AR group. The NINAR group overall indicated lower levels of improvement than the INAR group. Among the INAR subgroups, the NARESMA, NARES, and NARMA phenotypes had similar outcome improvements, all better than the NARNE phenotype.
  
  
  CONCLUSIONS
  Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Virat
authors.initials: V
authors.lastname: Kirtsreesakul
authors.forename: Kodchakorn
authors.initials: K
authors.lastname: Hararuk
authors.forename: Jitanong
authors.initials: J
authors.lastname: Leelapong
authors.forename: Suwalee
authors.initials: S
authors.lastname: Ruttanaphol
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects*; D007249:Inflammation / Q000276:immunology / Q000473:pathology; D008297:Male; D008407:Mast Cells / Q000276:immunology* / Q000473:pathology; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology* / Q000473:pathology; D010641:Phenotype; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide