INHIBITION OF MEDIATOR RELEASE IN ALLERGIC RHINITIS BY PRETREATMENT WITH TOPICAL GLUCOCORTICOSTEROIDS
INHIBITION OF MEDIATOR RELEASE IN ALLERGIC RHINITIS BY PRETREATMENT WITH TOPICAL GLUCOCORTICOSTEROIDS
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DOI：
10.1056/nejm198706113162403
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发表时间：
1987-06-11
影响因子：
158.5
通讯作者：
NACLERIO, RM
中科院分区：
文献类型：
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作者：
PIPKORN, U;PROUD, D;NACLERIO, RM
过敏性鼻炎患者在抗原激发后通常立即出现症状（早期反应），几小时后症状复发（晚期反应）。已知全身性糖皮质激素抑制晚期反应，但不抑制早期反应。我们在一项双盲、随机、安慰剂对照的交叉研究中，研究了局部（而不是全身）糖皮质激素预处理一周对13例过敏患者鼻抗原激发反应的影响，这些患者以前对鼻抗原激发有双重反应。这些患者接受了三次10倍增量的过敏原激发，产生早期反应，然后随访11小时，包括晚期反应，然后用最低剂量的过敏原再次激发。我们通过症状评分和测量鼻灌洗液中组胺、对甲苯磺酰-L-精氨酸甲酯（驯服）-酯酶活性和激肽水平来监测其反应。局部糖皮质激素显着降低的症状和水平的组胺，TAME酯酶活性，激肽在早期，晚期和再激发过敏反应。事实上，与全身性糖皮质激素治疗相反，长期局部糖皮质激素预处理抑制了对抗原的早期反应，这表明给药途径和持续时间影响类固醇的作用机制。我们的结论是，局部糖皮质激素抑制早期和晚期反应，可能提供了一个优势，全身糖皮质激素治疗过敏性鼻炎患者。
Patients with allergic rhinitis often have immediate symptoms after antigen challenge (the early-phase response), followed several hours later by a recurrence of symptoms (the late-phase response). Systemic glucocoticosteroids are known to inhibit the late-phase but not the early-phase response. We studied the effect of one week of pretreatment with topical (rather than systemic) glucocorticosteroids on the response to nasal challenge with antigen in a double-blind, randomized, placebo-controlled crossover study of 13 allergic patients who had previously had a dual response to nasal challenge. The patients were challenged with three 10-fold increments of allergen, producing an early response, and were then followed for 11 hours, encompassing the late response, before they were rechallenged with the lowest dose of allergen. We monitored their responses by means of symptom scores and measurements of the levels of histamine, tosyl-L-arginine methyl ester (TAME)-esterase activity, and kinins in nasal lavages. Topical glucocorticosteroids significantly reduced both the symptoms and the levels of histamine, TAME-esterase activity, and kinins in the early, late, and rechallenge allergic reactions. The fact that, in contrast to treatment with systemic glucocorticosteroids, prolonged pretreatment with topical glucocorticosteriods inhibited the early-phase response to antigen suggests that the route and duration of administration affect the mechanisms of action of the steroids. We conclude that inhibition of the early-phase as well as the late-phase response by topical glucocorticosteroids may provide an advantage over treatment with systemic glucocorticosteroids in patients with allergic rhinitis.