EFFECT OF TERFENADINE AND BUDESONIDE ON NASAL SYMPTOMS, OLFACTION, AND NASAL AIRWAY PATENCY FOLLOWING ALLERGEN CHALLENGE

The study investigated the effect of the oral H-1-blocker terfenadine on allergen challenge in subjects with nasal allergy in comparison wit h the topical steroid, budesonide. A randomized, placebo-controlled, d ouble-blind, crossover study with 3 experimental days was performed ou tside the pollen season. Seventeen nonsmokers with hay fever (symptoms , positive skin prick test, and RAST against timothy) were treated for 14 days before each experimental day, where the response to nasal cha llenge with four different concentrations of timothy was measured ever y 15 min for 6 h. The nasal cavity dimensions were measured by acousti c rhinometry and the olfactory function as the threshold for the sense of smell of butanol. Nasal symptoms were determined by questionnaires . Both terfenadine and budesonide dry powder had an effect on the hay fever symptoms during nasal pollen challenge. Terfenadine was more eff icient than budesonide against histamine-mediated symptoms such as sne ezing and itching. Budesonide increased nasal airway dimensions better than terfenadine (P<0.01). A marked effect of budesonide was seen 1-2 h after challenge, suggesting an effect on ''early late phase'' react ion in the nose. In 7/17 subjects, a significant (P<0.05) improvement of olfactory function after budesonide treatment was seen. In conclusi on, topical steroid (budesonide) is superior to antihistamine (terfena dine) in treatment of nasal congestion in hay fever, especially for th e postchallenge reaction, and may, in some cases, relieve the decrease d sense of smell during pollen challenge.