Influence of prolonged treatment with topical corticosteroid (fluticasone propionate) on early and late phase nasal responses and cellular infiltration in the nasal mucosa after allergen challenge

Abstract

We have examined the effect of prolonged treatment with topical corticosteroid on allergen-induced early and late nasal responses and the associated inflammatory cell infiltrate in grass pollen sensitive allergic rhinitics. Following a randomized double-blind 6 week treatment period with fluticasone propionate 200 micrograms aqueous nasal spray twice daily or matched placebo spray, nasal provocation was performed using Timothy grass pollen extract. Nasal symptoms were recorded at intervals from 0 to 24 h. Nasal biopsies were performed before treatment and at 24 h after allergen and processed for immunohistology. When corticosteroid-treated patients were compared with the placebo group there was an approximately 50% decrease in the size of the early (0-60 min) response and almost complete inhibition of late (1-24 h) nasal symptoms after allergen challenge. After allergen challenge markedly fewer T lymphocytes and CD25+ (interleukin-2 receptor bearing) cells were observed in both the epithelium and submucosa in fluticasone treated patients compared with the placebo group. Significantly less total and activated eosinophils were observed, particularly within the nasal epithelium. Submucosal mast cell counts were decreased, whereas increased numbers of submucosal neutrophils were observed. These results confirm that topical corticosteroid treatment inhibits allergen-induced early and late nasal responses. This may possibly occur following a decrease in T lymphocytes and/or mast cells and their products and a consequent reduction in tissue eosinophilia.

Allergic rhinitis-induced nasal congestion: its impact on sleep quality

“…60 Intranasal corticosteroids are considered first-line therapy for moderate-to-severe seasonal and perennial AR. 46 They suppress many of the inflammatory mediators implicated in the allergic reaction, and effectively reduce nasal symptoms including congestion, rhinorrhea, sneezing, and pruritus, 46,[61][62][63][64][65] and ocular itching, redness, and tearing. [66][67][68] Onset of effect of INS is 6-12 hours, and maximum benefit is achieved after a week or more of regular use.…”

Regulation of E-cadherin expression by dexamethasone and tumour necrosis factor-α in nasal epithelium

“…Indeed, they often coexist [2,3] and share many clinical features such as intermittent symptoms, fluctuations in severity, inflammation and obstruction. Specific allergens elicit early and late phase reactions [4][5][6] in lungs and the nose. Bronchial epithelial damage is a common feature of asthma and bronchial epithelial cells of asthmatic patients are less viable than those from control subjects [7].…”

Local IgE Production in Nasal Allergy

“…IL-4 is the signal that targets the e-gene for recombination and cross-linking of CD40 on the B cell allows recombination to proceed [1], IL-4 is nec essary for the differentiation o f T cells into the 'Th2-type' phenotype and thereafter autocrine production of IL-4 sup ports cell proliferation [2], Mast cells, as well as T lympho cytes, produce IL-4 [3] and have been shown to express CD40-ligand and may therefore provide alternative help for local IgE synthesis [4], We previously showed that allergen provocation resulted in early and late nasal symptoms ac companied by the recruitment of Th2 cells expressing IL-4 [5,6] assessed at 24 h. The principal cell source of IL-4 messenger RNA was shown to be the T lymphocyte [7]. This raised the question whether resident B cells may ex press IgE within the nasal mucosa.…”