EFFECT OF INTRANASAL FLUTICASONE PROPIONATE ON THE IMMEDIATE AND LATEALLERGIC REACTION AND NASAL HYPERREACTIVITY IN PATIENTS WITH A HOUSE-DUST MITE ALLERGY

Background Patients with perennial allergic rhinitis develop nasal sym ptoms not only after allergen exposure, but generally also after non-s pecific stimuli.Objective To evaluate the effect of 2 week's treatment with fluticasone gropionate aqueous nasal spray (FPANS) on the nasal clinical response, inflammatory mediators and nasal hyperreactivity. M ethods Twenty-four rhinitis patients allergic to house dust mite (HDM) , participated in a double-blind, placebo-controlled crossover study. After 2 week's treatment with placebo or 200 mu g FPANS twice daily, p atients were challenged with HDM extract. Symptoms were recorded and n asal lavages were collected for up to 9.5 h after challenge. Nasal hyp erreactivity was determined by histamine challenge 24 h later. Results Because of a carry-over effect for the immediate symptom score, for t his variable only the data from the first treatment period were used. FPANS treatment resulted in a significant decrease of nasal symptoms w ith 70%, 69% and 63% after 100? 1000 and 10 000 Biological Units (BU)/ mL of HDM extract respectively. Active treatment resulted in a 76% dec rease of the late-phase symptoms. FPANS treatment significantly reduce d albumin influx after HDM 1000 BU/mL with 62% and tended to reduce tr yptase release after HDM 1000 BU/mL (P = 0.0629). During the late phas e FPANS treatment reduced albumin influx with 67% and eosinophil catio nic protein (ECP) release with 83%. No effect of FPANS was seen on his tamine levels. FPANS significantly decreased histamine-induced symptom score with 34%, secretion with 32% and sneezes with 41%. Conclusion F PANS significantly inhibits the immediate and late allergic response, and nasal hyperreactivity. probably by suppressing mast cells and eosi nophils in the nasal mucosa.