Pullerits Teet, Praks Lea, Ristioja Vahur, Lötvall Jan
Lung Pharmacology Group, Department of Respiratory Medicine and Allergology, Institute of Internal Medicine, Göteborg University, Gothenburg, Sweden.
J Allergy Clin Immunol. 2002 Jun;109(6):949-55. doi: 10.1067/mai.2002.124467.
Allergic rhinitis requires active intervention for symptom relief. A combination of antileukotriene and antihistamine drugs has been suggested to provide additive treatment benefits for patients with allergic rhinitis.
We evaluated how such a combination treatment would affect symptoms and local mucosal eosinophilia in comparison with a nasal glucocorticoid.
In a double-blind, randomized study 62 patients with grass pollen-induced allergic rhinitis received a nasal glucocorticoid (fluticasone propionate aqueous nasal spray [FPANS], 200 microg/d), an antileukotriene (montelukast, 10 mg/d), a combination of montelukast with an antihistamine (loratadine, 10 mg/d), or placebo throughout the season. Cromoglycate eyedrops and a limited amount of loratadine were allowed as rescue medication for severe symptoms. Patients recorded their symptoms for nasal blockage, itching, rhinorrhea, and sneezing. Before and during the season, nasal biopsy specimens were obtained from patients for evaluation of local eosinophilic inflammation.
During the peak season, both FPANS and combined montelukast-loratadine were significantly more effective than placebo and montelukast alone for daytime symptom prevention. For nighttime symptoms, FPANS was significantly more effective compared with all other treatments, whereas combined montelukast-loratadine and montelukast alone did not provide significant symptom prevention compared with placebo. The pollen-induced increase in the numbers of epithelial eosinophils was significantly lower for FPANS-treated patients compared with that seen in all other treatment groups.
In patients with seasonal allergic rhinitis, intranasal glucocorticoids are more effective than an antileukotriene drug or combined antileukotriene-antihistamine for the reduction of pollen-induced nasal eosinophilic inflammation and for control of nasal symptoms.
过敏性鼻炎需要积极干预以缓解症状。有人提出抗白三烯药与抗组胺药联合使用可为过敏性鼻炎患者提供额外的治疗益处。
我们评估了这种联合治疗与鼻用糖皮质激素相比，对症状和局部黏膜嗜酸性粒细胞增多的影响。
在一项双盲、随机研究中，62例草花粉诱发的过敏性鼻炎患者在整个花粉季接受鼻用糖皮质激素（丙酸氟替卡松水鼻喷雾剂[FPANS]，200μg/天）、抗白三烯药（孟鲁司特，10mg/天）、孟鲁司特与抗组胺药（氯雷他定，10mg/天）联合用药或安慰剂治疗。色甘酸眼药水和少量氯雷他定可作为严重症状的急救药物。患者记录鼻塞、瘙痒、流涕和打喷嚏症状。在花粉季之前和期间，获取患者的鼻活检标本以评估局部嗜酸性粒细胞炎症。
在花粉高峰期，FPANS以及孟鲁司特 - 氯雷他定联合用药在预防白天症状方面均显著优于安慰剂和单独使用孟鲁司特。对于夜间症状，FPANS比所有其他治疗方法都显著更有效，而孟鲁司特 - 氯雷他定联合用药和单独使用孟鲁司特与安慰剂相比，在预防症状方面并无显著差异。与所有其他治疗组相比，接受FPANS治疗的患者花粉诱发的上皮嗜酸性粒细胞数量增加显著更低。
在季节性过敏性鼻炎患者中，鼻内糖皮质激素在减轻花粉诱发的鼻嗜酸性粒细胞炎症和控制鼻部症状方面比抗白三烯药或抗白三烯药 - 抗组胺药联合用药更有效。
