Changes in nasal leukocytes and epithelial cells associated with topical beclomethasone treatment

Background: We had previously observed that changes in nasal cytology were associated with specific clinical patterns in cross-sectional studies of al lergy clinic patients. In the present study, we sought to determine whether specific cytologic changes occurred with antiinflammatory therapy in a con trolled setting in a prospective manner. Objective: To examine changes in nasal leukocytes and epithelial cells asso ciated with topical beclomethasone treatment in allergic rhinitis patients. Specifically we tested the hypothesis that number of nasal leukocytes rela tive to epithelial cell numbers are altered by topical beclomethasone treat ment. Methods: Adult volunteers (n = 26) with symptoms consistent with allergic r hinitis and positive aeroallergen skin tests were enrolled for treatment wi th either beclomethasone or placebo nasal spray. Sprays were allocated in a double-blind manner and were prescribed to be administered over a 2-week p eriod. Baseline quality of life, nasal cytograms, and mucosal physical appe arance scores were obtained at baseline and at the end of the treatment per iod. Changes in various nasal leukocytes and epithelial cell types were ana lyzed for association with active treatment using bivariate and multivariat e analysis. Results: Total leukocytes showed greater decreases with beclomethasone trea tment than with placebo. Total epithelial cells on the other hand showed an increase with active treatment compared with placebo treatment. In multiva riate analysis, the changes in both total leukocytes and total epithelial c ells showed independent associations with beclomethasone treatment. Combini ng these two variables into a single leukocyte per epithelial ratio resulte d in variable with values showing a significant decreases associated with b eclomethasone treatment compared with placebo treatment (P = .03). Conclusions: The administration of topical corticosteroids results in decre ases in total leukocytes and this decrease is of enhanced significance when adjusted for the quantities of associated epithelial cells. Further invest igation relating to the quantities of total nasal leukocytes in inflammator y nasal diseases may be helpful in gauging disease activity and monitoring treatment modalities.