Wang D, Duyck F, Smitz J, Clement P
Department of Otorhinolaryngology, University Hospital, Free University of Brussels (VUB), Belgium.
Allergy. 1998 Apr;53(4):375-82. doi: 10.1111/j.1398-9995.1998.tb03908.x.
We studied the effect and onset of action of fluticasone propionate aqueous nasal spray (FPANS) on mediator release and eosinophil accumulation in nasal secretions and on nasal symptoms of patients with seasonal allergic rhinitis after nasal allergen challenge (NAC). At the end of the pollen season, 28 patients were randomized in a double-blind and crossover design to receive 7 days' treatment with FPANS (200 microg, once daily) and matching placebo. NACs were performed before and at 6 h and 1, 2, 3, and 7 days during treatment with FPANS or placebo. Nasal secretions were collected for a quantitative determination of mediators and eosinophil count before and 5 min after each challenge. Nasal symptoms were assessed by scales grading the severity of symptoms at the same time. Results showed that for mediator concentrations there was a significant decrease of leukotriene C4 (P<0.001) at 7 days after the first administration of FPANS as compared to placebo. Two days after FPANS, both eosinophil counts and eosinophil cationic protein (ECP) concentrations were lower than those of placebo (eosinophils: P=0.032; ECP: P=0.038). The onset became even more important at day 7 (eosinophils: P=0.001; ECP: P=0.009) during the FPANS treatment period. For the subjective nasal symptoms, a significant reduction of symptom scores for nasal obstruction occurred also at day 3 (P=0.017) and for sneezing at day 7 (P=0.003). There was not yet any significant improvement of the objective nasal airway resistance after the different NACs during the study period. In conclusion, this study demonstrated that topical fluticasone propionate is effective in the treatment of mucosal inflammation induced by NAC. For optimal control of nasal symptoms induced by repeated maximal allergen challenges, a treatment period of more than 1 week is required.
我们研究了丙酸氟替卡松水鼻喷雾剂（FPANS）对季节性变应性鼻炎患者在鼻过敏原激发试验（NAC）后鼻分泌物中介质释放、嗜酸性粒细胞聚集以及鼻部症状的作用和起效时间。在花粉季节结束时，28例患者采用双盲交叉设计随机分组，分别接受FPANS（200微克，每日一次）治疗7天和匹配的安慰剂治疗。在使用FPANS或安慰剂治疗前以及治疗期间的第6小时、1天、2天、3天和7天进行NAC。每次激发试验前和激发后5分钟收集鼻分泌物，用于介质定量测定和嗜酸性粒细胞计数。同时通过症状严重程度评分量表评估鼻部症状。结果显示，与安慰剂相比，首次使用FPANS后7天，白三烯C4的介质浓度显著降低（P<0.001）。使用FPANS两天后，嗜酸性粒细胞计数和嗜酸性粒细胞阳离子蛋白（ECP）浓度均低于安慰剂（嗜酸性粒细胞：P=0.032；ECP：P=0.038）。在FPANS治疗期间的第7天，这种起效变得更加明显（嗜酸性粒细胞：P=0.001；ECP：P=0.009）。对于主观鼻部症状，鼻塞症状评分在第3天也显著降低（P=0.017），打喷嚏症状评分在第7天显著降低（P=0.003）。在研究期间，不同的NAC后客观鼻气道阻力尚未有任何显著改善。总之，本研究表明局部使用丙酸氟替卡松对NAC诱导的黏膜炎症有效。为了最佳控制反复最大过敏原激发引起的鼻部症状，需要超过1周的治疗期。
