Fluticasone propionate aqueous nasal spray reduces inflammatory cells in unchallenged allergic nasal mucosa: Effects of single allergen challenge

Background: Topical corticosteroid therapy reduces symptoms and nasal mucos al inflammatory cells in patients with allergic rhinitis. Usually patients are advised to start their medication (1 week) before the beginning of the pollen season. The effect of pretreatment with a topical corticosteroid on unchallenged nasal mucosa is not well documented. Objectives: The purpose of this study was to investigate, in a double-blind , placebo-controlled study, the effect of 6 weeks' pretreatment with 200 mu g twice daily fluticasone propionate on nasal symptoms and inflammatory cel l numbers after nasal allergen provocation in patients with seasonal allerg ic rhinitis. Methods: Nineteen patients with grass pollen-induced allergic rhinitis were treated for a 6-week period out of the grass pollen season. After completi ng the treatment period, patients were challenged with grass pollen. Nasal mucosal biopsy specimens were taken 5 times in every patient. In nasal muco sa changes in numbers of T cells, B cells, mast cells, eosinophils, macroph ages, and Langerhans' cells were investigated. Results: After 4 weeks of treatment but before allergen provocation, signif icantly fewer epithelial Langerhans' cells, macrophages, mast cells, T cell s, and eosinophils were found in the fluticasone propionate group compared with those found in the placebo group. In the lamina propria significantly fewer Langerhans' cells and eosinophils were found in the fluticasone propi onate group. Cell influx in nasal mucosa after allergen provocation was sig nificantly inhibited in the fluticasone propionate group compared with that in the placebo group for epithelial Langerhans' cells, mast cells, macroph ages, and T cells and for lamina propria eosinophils, mast cells, Langerhan s' cells, macrophages, and T cells. Conclusions: Fluticasone propionate is effective in reducing early- and lat e-phase nasal symptoms. Topical corticosteroid treatment reduces inflammato ry cells in unchallenged nasal mucosa.