Graf P M, Hallén H
Department of Otorhinolaryngology, Huddinge University Hospital, Stockholm, Sweden.
ORL J Otorhinolaryngol Relat Spec. 1998 Nov-Dec;60(6):334-8. doi: 10.1159/000027620.
To study the changes in nasal reactivity in patients with rhinitis medicamentosa during treatment with placebo or fluticasone propionate, in order to better understand the mechanisms of nasal congestion in such patients.
A parallel, double-blind study. Twenty patients with rhinitis medicamentosa were randomized to either placebo or fluticasone treatment during 14 days.
Nasal mucosa reactivity was studied with a histamine challenge model using three concentrations of histamine to challenge the nasal mucosa (1, 2 and 4 mg histamine/ml). Recordings of the nasal mucosa response were made 5 min after each challenge, using rhinostereometry and acoustic rhinometry, before and after the period of treatment.
The fluticasone group had a significantly increased histamine sensitivity after treatment, unlike the placebo group who had an unchanged or slightly decreased histamine sensitivity after treatment.
The results of this study support the theory that the nasal obstruction in rhinitis medicamentosa is due to interstitial oedema rather than to vasodilatation. On the first day of vasoconstrictor withdrawal, the inferior concha was congested and oedematous with a limited capacity to respond to histamine challenge. However, after 14 days of treatment with a corticosteroid nasal spray, the oedema was reduced and the increase in histamine sensitivity reflected the persistence of nasal hyperrreactivity. In the placebo group, histamine sensitivity remains unchanged with the measuring technique we used. This probably indicates that oedema was still present after treatment.
研究药物性鼻炎患者在接受安慰剂或丙酸氟替卡松治疗期间鼻腔反应性的变化，以便更好地理解此类患者鼻充血的机制。
一项平行、双盲研究。20例药物性鼻炎患者在14天内随机分为接受安慰剂或氟替卡松治疗。
采用组胺激发模型研究鼻黏膜反应性，使用三种浓度的组胺（1、2和4mg组胺/毫升）刺激鼻黏膜。在治疗前后的每次激发后5分钟，使用鼻立体测量法和鼻声反射测量法记录鼻黏膜反应。
与安慰剂组治疗后组胺敏感性不变或略有下降不同，氟替卡松组治疗后组胺敏感性显著增加。
本研究结果支持药物性鼻炎鼻阻塞是由于间质水肿而非血管扩张的理论。在停用血管收缩剂的第一天，下鼻甲充血、水肿，对组胺激发的反应能力有限。然而，在使用皮质类固醇鼻喷雾剂治疗14天后，水肿减轻，组胺敏感性增加反映了鼻高反应性的持续存在。在安慰剂组中，使用我们所采用的测量技术，组胺敏感性保持不变。这可能表明治疗后水肿仍然存在。
