THE EFFECT OF FLUTICASONE PROPIONATE AQUEOUS NASAL SPRAY ON NASAL MUCOSAL INFLAMMATION IN PERENNIAL ALLERGIC RHINITIS

Mast cell degranulation, and the subsequent recruitment of infiltratin g inflammatory cells, such as eosinophils, into the nasal mucosa has l ong been considered the most important model to explain allergic rhini tis. Several studies show a decrease in the number of eosinophils and possibly also mast cells during local corticosteroid treatment. Over t he last decade, a new model to explain allergic inflammation has evolv ed. In this model, Langerhans' cells and T-cells play an important rol e. Langerhans' cells possess a high affinity receptor for IgE. In pati ents with allergic rhinitis, allergen provocation results in stimulati on of T-cells by the IgE-positive Langerhans' cells. The T-cells produ ce a number of cytokines which stimulate IgE production as well as the inflammatory reaction. The number of T-cells is not usually influence d by corticosteroid treatment; however, the function of the T-cells, s hown by the spectrum of cytokines produced, is clearly influenced. The cells that are most dramatically affected by local corticosteroid tre atment are the Langerhans' cells, which completely disappear during tr eatment. This decrease suggests that there is a reduction in antigen p resentation. The subsequent decrease in T-cell stimulation may result in a reduction of the reactions that are dependent on T-cell-derived m ediators.