Intranasal Theophylline Treatment of Hyposmia and Hypogeusia

Abstract

To determine whether intranasal theophylline methylpropyl paraben can correct hyposmia and hypogeusia. Design:We performed an open-label pilot study in patients with hyposmia and hypogeusia under the following 3 conditions: (1) before treatment, (2) after oral theophylline anhydrous treatment, and (3) after intranasal theophylline treatment. Under each condition, we performed subjective evaluations of taste and smell functions, quantitative measurements of taste (gustometry) and smell (olfactometry), and measurements of serum theophylline level and body weight.Setting: The Taste and Smell Clinic in Washington, DC.Patients: Ten patients with hyposmia and hypogeusia clinically related to the effects of viral illness, allergic rhinitis, traumatic brain injury, congenital hyposmia, and other chronic disease processes were selected.Interventions: Oral theophylline anhydrous, 200 to 800 mg/d for 2 to 12 months, was administered to each patient. This treatment was discontinued for 3 weeks to 4 months when intranasal theophylline methylpropyl paraben, 20 µg/d in each naris, was administered for 4 weeks.Main Outcome Measures: At termination of each condition, taste and smell function was determined subjectively, by means of gustometry and olfactometry, with measurement of serum theophylline levels and body weight.Results: Oral theophylline treatment improved taste and smell acuity in 6 patients after 2 to 12 months of treatment. Intranasal theophylline treatment improved taste and smell acuity in 8 patients after 4 weeks, with improvement greater than after oral administration. No adverse effects accompanied intranasal drug use. Body weight increased with each treatment but was greater after intranasal than after oral administration.Conclusions: Intranasal theophylline treatment is safer and more effective in improving hyposmia and hypogeusia than oral theophylline anhydrous treatment.

Olfaction in allergic rhinitis: A systematic review

“…[17][18][19][20] Six articles included patients with AR and non-AR and did not provide a separate analysis for the subgroup of patients with AR. [21][22][23][24][25][26] Two articles were excluded because they only assessed the immediate effects of an allergic challenge, therefore providing little clinical information. 27,28 One article consisted of a meeting abstract of work in progress without sufficient data.…”

Initiation of smell function in patients with congenital hyposmia

“…While oral theophylline was the method of drug delivery in these patients intranasal theophylline administration has been shown to be more effective and act in a more rapid manner in other, noncongenital smell loss patients [20]. Whether or not this delivery method would be more successful in initiating smell function in these patients is unknown.…”

Erythrocyte membrane antigen frequencies in patients with Type II congenital smell loss

“…Many patients suffering from smell loss (including Type II congenital smell loss) exhibited abnormalities in the balance of these cytokines [38] and in the concentration of adenylyl cyclase [39,40,41,42,43]. Treatment of these patients (including those with Type II congenital smell loss) with phosphodiesterase (PDE) inhibitors demonstrated improvement in smell function in about 50% of patients [44,45]. These drugs increase the concentration of cAMP and cGMP (downstream messengers of adenylyl cyclase) in nasal mucus and help promote growth of olfactory receptors [46].…”