Effect of intranasal fluticasone propionate on the immediate and late allergic reaction and nasal hyperreactivity in patients with a house dust mite allergy
Effect of intranasal fluticasone propionate on the immediate and late allergic reaction and nasal hyperreactivity in patients with a house dust mite allergy
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DOI：
10.1111/j.1365-2222.1995.tb00399.x
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发表时间：
1995-01-01
影响因子：
6.1
通讯作者：
Gerth Van Wijk, R.
中科院分区：
文献类型：
--
作者：
De Graaf-In't Veld, C.;Garrelds, I. M.;Gerth Van Wijk, R.
背景资料：常年性变应性鼻炎患者不仅在接触过敏原后出现鼻部症状，而且通常在非特异性刺激后也会出现鼻部症状。目的：评价丙酸氟替卡松鼻喷雾剂（FPANS）治疗2周对鼻腔临床反应、炎症介质和鼻高反应性的影响。方法：24例屋尘螨过敏性鼻炎患者参加了一项双盲、安慰剂对照的交叉研究。用安慰剂或200 μ g FPANS每日两次治疗2周后，用HDM提取物激发患者。记录症状，并在攻毒后收集鼻灌洗液长达9.5 h。24 h后通过组胺激发测定鼻高反应性。结果：由于即时症状评分的结转效应，该变量仅使用第一个治疗期的数据。FPANS治疗导致鼻部症状显著减少，在100、1000和10000生物单位（BU）/mL HDM提取物后分别减少70%、69%和63%。积极治疗导致晚期症状减少76%。FPANS治疗显著减少HDM 1000 BU/mL后的白蛋白内流62%，并倾向于减少HDM 1000 BU/mL后的类胰蛋白酶释放（P=0.0629）。在晚期阶段，FPANS治疗使白蛋白内流减少67%，嗜酸性粒细胞阳离子蛋白（ECP）释放减少83%。FPANS对组胺水平无影响。FPANS显著降低了组胺诱导的症状评分（34%）、分泌物（32%）和打喷嚏（41%）。结论FPANS可显著抑制鼻粘膜的即刻和迟发性变态反应及鼻高反应性，其机制可能与抑制鼻粘膜肥大细胞和嗜酸性粒细胞有关。
Background: Patients with perennial allergic rhinitis develop nasal symptoms not only after allergen exposure, but generally also after non-specific stimuli. Objective: To evaluate the effect of 2 week's treatment with fluticasone propionate aqueous nasal spray (FPANS) on the nasal clinical response, inflammatory mediators and nasal hyperreactivity. Methods: Twenty-four rhinitis patients allergic to house dust mite (HDM), participated in a double-blind, placebo-controlled crossover study. After 2 week's treatment with placebo or 200 mu-g FPANS twice daily, patients were challenged with HDM extract. Symptoms were recorded and nasal lavages were collected for up to 9.5 h after challenge. Nasal hyperreactivity was determined by histamine challenge 24 h later. Results: Because of a carry-over effect for the immediate symptom score, for this variable only the data from the first treatment period were used. FPANS treatment resulted in a significant decrease of nasal symptoms with 70%, 69% and 63% after 100, 1000 and 10000 Biological Units (BU)/mL of HDM extract respectively. Active treatment resulted in a 76% decrease of the late-phase symptoms. FPANS treatment significantly reduced albumin influx after HDM 1000 BU/mL with 62% and tended to reduce tryptase release after HDM 1000 BU/mL (P=0.0629). During the late phase FPANS treatment reduced albumin influx with 67% and eosinophil cationic protein (ECP) release with 83%. No effect of FPANS was seen on histamine levels. FPANS significantly decreased histamine-induced symptom score with 34%, secretion with 32% and sneezes with 41 %. Conclusion FPANS significantly inhibits the immediate and late allergic response, and nasal hyperreactivity, probably by suppressing mast cells and eosinophils in the nasal mucosa.