THE EFFECT OF FLUTICASONE PROPIONATE AQUEOUS NASAL SPRAY ON EOSINOPHILS AND CYTOKINES IN NASAL SECRETIONS OF PATIENTS WITH RAGWEED ALLERGICRHINITIS

Cytokines active on eosinophils are important in the pathogenesis of a llergic diseases. A study was conducted to determine if nasal eosinoph ilia in allergic rhinitis is associated with an increase in eosinophil -active cytokines in nasal secretions and to compare the effects of fl uticasone propionate aqueous nasal spray with astemizole and placebo o n the levels of these cytokines. Forty-five patients with moderately s evere ragweed allergic rhinitis were randomly assigned to receive 2 we eks of treatment with fluticasone propionate aqueous nasal spray 200 m u g once daily, astemizole 10 mg once daily, or placebo. Nasal lavage was performed in July (preseason), August (peak season), September (af ter 2 weeks of treatment), and October (postseason). The number of eos inophils, the amount of eosinophil-derived neurotoxin (EDN), and the a mount of eosinophil survival-enhancing activity were measured. Total m ean nasal symptom scores, concentrations of nasal eosinophils and EDN, and eosinophil survival-enhancing cytokine activity in nasal secretio ns were significantly lower after 2 weeks of treatment with fluticason e propionate compared with astemizole or placebo. Survival-enhancing a ctivity was detected in the nasal secretions of 25 patients. By blocki ng activity with monoclonal antibodies, specific cytokines were identi fied (granulocyte macrophage-colony stimulating factor, 3 samples; int erleukin-3, 2 samples; interleukin-5, 5 samples). In conclusion, eosin ophil-active cytokine concentrations parallel the nasal symptoms of pa tients with ragweed allergic rhinitis. Unlike astemizole, fluticasone propionate significantly lowers cytokine activity in nasal tissue, whi ch may contribute to the therapeutic efficacy of the drug.