EFFECT OF INTRANASAL AZELASTINE AND BECLOMETHASONE DIPROPIONATE ON NASAL SYMPTOMS, NASAL CYTOLOGY, AND BRONCHIAL RESPONSIVENESS TO METHACHOLINE IN ALLERGIC RHINITIS IN RESPONSE TO GRASS POLLENS

Background: We compared the effect of nasal azelastine (0.56 mg/day), nasal beclomethasone dipropionate (BDP, 200 mu g/day) and matched plac ebo on seasonal symptoms, nasal cytology, and the increase in bronchia l responsiveness occurring during pollen season in a group of subjects with history of allergic rhinitis to grass pollens only. Methods: The study was completed by nine subjects in the azelastine group, 13 subj ects in the BDP group, and 13 subjects in the placebo group. Treatment s were randomly administered for 6 weeks. Each subject recorded daily nasal, eye and chest symptoms and additional treatment requirement for the entire pollen season. Each subject performed nasal lavage 4 weeks into the pollen season. Bronchial responsiveness to methacholine was measured before and 4 weeks into the pollen season. Response was expre ssed as provocative dose causing a 20% fall in forced expiratory volum e in 1 second in micromoles. Results: Azelastine-treated subjects had significantly fewer nasal symptoms during week 4 (p < 0.05), and BDP-t reated subjects had fewer nasal symptoms during week 4 (p < 0.05) and week 5 (p < 0.05) compared with subjects given placebo. Both treatment s significantly reduced the need for additional medications. BDP, but not azelastine, treatment significantly reduced the percent of eosinop hils recovered in nasal lavage (p < 0.05). Neither azelastine nor BDP protected against the increase in bronchial responsiveness to methacho line occurring during the pollen season. Conclusion: We demonstrated t hat both azelastine and BDP are effective treatments for nasal symptom s of seasonal allergic rhinitis after 4 weeks of therapy. However, we were not able to demonstrate an antiinflammatory activity of nasally a dministered azelastine. Nasal therapy with azelastine and BDP did not block the increase in bronchial responsiveness to methacholine caused by seasonal allergen exposure.