CHANGES IN NASAL REACTIVITY IN PATIENTS WITH RHINITIS MEDICAMENTOSA AFTER TREATMENT WITH FLUTICASONE PROPIONATE AND PLACEBO NASAL SPRAY

Aim of the Study: To study the changes in nasal reactivity in patients with rhinitis medicamentosa during treatment with placebo or fluticas one propionate, in order to better understand the mechanisms of nasal congestion in such patients. Study Design: A parallel, double-blind st udy. Twenty patients with rhinitis medicamentosa were randomized to ei ther placebo or fluticasone treatment during 14 days. Material and Met hods: Nasal mucosa reactivity was studied with a histamine challenge m odel using three concentrations of histamine to challenge the nasal mu cosa (1, 2 and 4 mg histamine/ml). Recordings of the nasal mucosa resp onse were made 5 min after each challenge, using rhinostereometry and acoustic rhinometry, before and after the period of treatment. Results : The fluticasone group had a significantly increased histamine sensit ivity after treatment, unlike the placebo group who had an unchanged o r slightly decreased histamine sensitivity after treatment. Conclusion s: The results of this study support the theory that the nasal obstruc tion in rhinitis medicamentosa is due to interstitial oedema rather th an to vasodilatation. On the first day of vasoconstrictor withdrawal, the inferior concha was congested and oedematous with a limited capaci ty to respond to histamine challenge. However, after 14 days of treatm ent with a corticosteroid nasal spray, the oedema was reduced and the increase in histamine sensitivity reflected the persistence of nasal h yperrreactivity. In the placebo group, histamine sensitivity remains u nchanged with the measuring technique we used. This probably indicates that oedema was still present after treatment.