EOSINOPHIL MARKERS IN SEASONAL ALLERGIC RHINITIS - INTRANASAL FLUTICASONE PROPIONATE INHIBITS LOCAL AND SYSTEMIC INCREASES DURING THE POLLEN SEASON

Background The purpose was to study activation markers of the eosinoph il granulocytes in seasonal allergic rhinitis, and the impact of topic al steroid therapy thereupon. Methods Sixty-three rhinitis patients wi th monoallergy to grass were examined before and at peak pollen season . Blood eosinophil count, eosinophil cationic protein (ECP), and eosin ophil peroxidase (EPO) in serum and nasal lavage fluid were measured. During the season, patients were randomized to treatment with intranas al fluticasone propionate 0.1 mg o.d. (n=26), 0.2 mg o.d. (n=25), or p lacebo (n=12). Six healthy persons served as controls. Results During the season, all parameters, except nasal lavage ECP, increased in the placebo group (P<0.001-P<0.05). Significant differences were seen betw een the steroid groups and the placebo group for all parameters (P<0.0 01-P<0.05). Higher eosinophil count (P<0.05), serum EPO (P<0.02), and nasal lavage EPO (P<0.05) were found in patients before season than in controls. The following winter, 44 patients returned for repeated mea surement. Lower levels of nasal lavage EPO were observed for patients than levels at the beginning of the season (P<0.0001). Conclusions Int ranasal fluticasone propionate reduced inflammation of the nasal mucos a, demonstrated locally by nasal lavage ECP and EPO, and systemically by blood eosinophils, serum ECP, and serum EPO. EPO seemed more sensit ive than ECP as indicator of allergic inflammation. EPO demonstrated s ome perennial eosinophil activity in hay fever patients, increasing lo cally during spring.